Physiotherapy intervention on monosymptomatic nocturnal enuresis: a systematic review.

Bedwetting that happens without other urinary symptoms, known as monosymptomatic nocturnal enuresis, is common in children and can affect wellbeing and quality of life. When first-line treatments do not work, physiotherapy approaches such as electrostimulation, magnetotherapy, biofeedback, behavioral therapy and pelvic floor muscle training are sometimes used instead, but how well they work has not been clearly established. This review pulled together ten randomised-controlled trials testing these approaches in children and adolescents up to age 16. Electrostimulation stood out as the most researched and the most promising option, linked to improvements in bladder volume and fewer wet nights, especially when paired with other therapies like behavioral training or biofeedback.

Magnetotherapy had less evidence behind it. The main limitation is that this is a small evidence base of just ten trials, so while the results are encouraging for electrostimulation specifically, confidence in combined treatment benefits and in magnetotherapy remains limited.

If you're a parent of a child who wets the bed at night and first treatments haven't helped, you may have heard about physiotherapy-based options like electrical stimulation, magnet therapy, biofeedback, behavioral training, or pelvic floor exercises. This review looked at the existing research, pulling together ten randomised-controlled trials in children and teenagers up to 16, to see which of these approaches actually show promise. Electrostimulation came out as the best-studied and most promising option, associated with larger bladder capacity and fewer wet nights, particularly when combined with behavioral therapy, biofeedback, or pelvic floor exercises.

Magnet therapy had much less research behind it, so less can be said about whether it helps. It's important to know this is based on only ten trials, a relatively small amount of evidence overall. The physiotherapy approaches were described as well tolerated in the studies, but this review cannot tell us with strong certainty how reliably these treatments work compared to other options.

This is a summary of research, not medical advice. Talk to your own healthcare provider about anything affecting your care.

For clinicians considering second-line options for children with monosymptomatic nocturnal enuresis refractory to first-line treatment, this systematic review of ten randomised-controlled trials offers a synthesis of which physiotherapy modalities have been tested and with what results. Electrostimulation emerged as the most studied intervention, with significant improvements reported in bladder volume and frequency of wet nights, and these effects appeared to be enhanced when electrostimulation was combined with behavioral therapy, biofeedback, or pelvic floor muscle training.

The abstract does not report a direct statistical comparison isolating the added benefit of each combination, so these combined-therapy findings should be treated as suggestive rather than confirmed added benefit. Magnetotherapy had comparatively less supporting evidence, meaning confidence in its effectiveness is lower than for electrostimulation. The review states the treatments were well tolerated, though it does not provide detailed adverse event data beyond this characterization. The main limitation for practice is the small size of the evidence base, only ten trials total, which constrains how much weight can be placed on any single comparison, including the electrostimulation-combination findings.

The review does not establish long-term outcomes, optimal treatment protocols, or head-to-head comparisons between all modalities, so it should inform rather than dictate clinical reasoning around physiotherapy as a second-line option.