Clinical Resource for Healthcare Professionals
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For Pediatricians & Healthcare Providers

Rethinking How We Address Nocturnal Enuresis in Primary Care

A behavioral treatment program built on a clinic model in which 91.8% of patients who completed treatment stopped wetting, giving you a documented answer for the next parent who asks about their child's bedwetting.

91.8% Of Completers, Clinic Report
150,000+ Families Online Since 2013
40+ Years of Clinical Data
3–5 Months Avg. Treatment

When Parents Ask About Bedwetting, What Do We Tell Them?

Nocturnal enuresis affects about 1 in 6 children at age 5 and 1 in 10 at age 7 (NIDDK). Yet in most primary care settings, the condition is undertreated. Parents look to their pediatrician for guidance, yet the response they receive often falls short of what's possible.

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They'll Grow Out of It

The most common response, yet many children don't outgrow enuresis for years. At age 15, 1 to 2 in 100 still wet the bed. Meanwhile, years of unnecessary distress accumulate: low self-esteem, social withdrawal, missed sleepovers, and family stress. Waiting is not a treatment strategy.

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Diagnostic Testing

Urine tests, blood work, ultrasound, and sometimes even invasive urological procedures. These tests are costly for families and, in the vast majority of cases, return normal results. Why? Because nocturnal enuresis is typically not a medical condition. If the bladder functions normally during the day, the urinary system is not the problem.

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Medication (DDAVP)

Desmopressin addresses the symptom but not the underlying cause. It reduces urine production at night but does not train the child's reflex response. The result: most children relapse once medication is discontinued (American Family Physician puts relapse at 80 to 100 percent). It works quickly while taken and has a place in some situations, but it is not a long-term solution.

If the Bladder Works During the Day, the Problem Isn't Urological

This is the key clinical insight that changes everything. Children with nocturnal enuresis typically have completely normal daytime bladder function. They don't leak, they control urination appropriately, and their urinary system operates as expected.

The same bladder that copes perfectly during waking hours fails at night. This tells us the issue is not structural or urological. Rather, the issue lies in a conditioned reflex that hasn't developed properly. The child's body does not respond to the signal of a full bladder during sleep. The arousal mechanism that should wake the child (or trigger sphincter contraction) is not functioning as it should.

Research finding: In a study of 257 patients covering about 4,800 enuretic episodes, Dr. Jacob Sagie demonstrated that enuresis alarm treatment works through behavioral conditioning of the reflex response to bladder filling, not by altering sleep patterns. The reflex improves progressively, with measured reductions in urine volume per episode even before the child learns to wake independently.

Sagie, J. "The Relationship between Nocturnal Enuresis, Time of Night and Waking Response in the Process of Treatment with Enuresis Alarm." Children's Hospital Quarterly, 8(1), 1996, pp. 7-9.

This is why diagnostic tests come back normal. They're examining the anatomy and physiology of a system that is, in fact, functioning correctly. The deficit is in the conditioned reflex, and that is precisely what behavioral treatment addresses.

Results from 40+ Years of Clinical Practice

The Sagie treatment model has been applied in institutional clinical settings and documented. The following data comes from the Enuresis Clinic at Schneider Children's Medical Center (SCMCI), November 1994 to October 2002. Read the full clinic report.

91.8%

Ceased Wetting Completely

Of 2,308 patients who completed treatment at SCMCI (1994 to 2002), 2,119 ceased wetting. An additional 1.9% showed improvement.

3,004

Patients in the Study

3,004 started treatment, ages 4 to 35; some were still in treatment when the report closed. 82% primary enuretics. 77% had neither an anatomic nor a psychological cause (idiopathic). 97.5% described by parents as very heavy sleepers.

3–5 mo.

Average Treatment Duration

A structured, time-limited intervention with a clear endpoint. Unlike "waiting it out," there is a defined timeline and measurable progress at every stage.

180,000+

Patients and Families Since 1984

About 30,000 patients in the clinics (1984 to 2013) and over 150,000 families through the TheraPee online program since 2013.

SCMCI Enuresis Clinic Founded and directed by Dr. Jacob Sagie, Ph.D.
Shanghai Children's Medical Center Project Hope Partnership

TheraPee: The Complete Behavioral Treatment System

TheraPee is not simply an alarm. It is a comprehensive, clinically-backed behavioral treatment program. Developed by Dr. Jacob Sagie, Ph.D. and Dr. Tal Sagie, Ph.D., the program is built on the same multimodality approach that produced the documented clinical results, now delivered through an interactive online platform accessible from the patient's home.

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StoPee Alarm Device

Proprietary sensor pad that detects the first sign of moisture, activating the conditioning response cycle.

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Adaptive Treatment Algorithm

Sophisticated online system that tailors the treatment protocol to each patient's specific condition and progress.

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Progress Tracking

Detailed monitoring of reflex response, wetting frequency, and urine volume, providing measurable outcomes throughout treatment.

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Behavioral Exercises

Daily bladder capacity training, sphincter strengthening, positive reinforcement protocols, and guided exercises for child and parent.

From clinic to home: the same clinical standard. For 30 years (1984 to 2013), this treatment was delivered exclusively through face-to-face clinical programs. In 2013, Dr. Jacob Sagie and Dr. Tal Sagie developed TheraPee to bring the same level of care to any patient, anywhere. The online program mirrors every step of the proven clinical protocol: the same treatment model and the same therapeutic techniques, now accessible from the comfort of the child's home.

Send an Information Handout to a Patient's Family

Provide your patient's parent with a clear, professionally prepared overview of nocturnal enuresis and the TheraPee treatment program. Simply enter their email address below. They will receive the handout directly from our clinical team.

The handout explains bedwetting in parent-friendly language and outlines next steps. No spam, just the resource you're recommending.
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The Clinical Team

Dr. Jacob Sagie, Ph.D.

Founder & Clinical Director

Bedwetting specialist and certified family psychotherapist specializing in the psychophysiology of enuresis, treating patients since 1984. Founded and directed the Enuresis Clinic at Schneider Children's Medical Center (SCMCI). Established the first enuresis clinic in China, at Shanghai Children's Medical Center with Project Hope. His research on enuresis, time of night and waking response (257 patients, about 4,800 episodes) was presented at the European Sleep Society conference. Author of “Hooray I'm Dry”, the comprehensive guide to bedwetting and toilet training.

Dr. Tal Sagie, Ph.D.

Enuresis Specialist & TheraPee Developer

Bedwetting specialist with expertise in children's behavioral problems, treating patients since 1999. Co-established the first enuresis clinic in China with Dr. Jacob Sagie. Developed the TheraPee interactive software and led R&D for the StoPee device. Together, the two specialists have treated about 30,000 patients in the clinics (1984 to 2013), and over 150,000 families have used the TheraPee online program since 2013.

Publications

  • Sagie, J. "The Relationship between Nocturnal Enuresis, Time of Night and Waking Response in the Process of Treatment with Enuresis Alarm." Children's Hospital Quarterly, 8(1), 1996, pp. 7-9.
  • Sagie, T. "The Gap between Social Functioning to Emotional Functioning among Young Adolescents with Nocturnal Enuresis." Studia Edukacyjne, 32/2014, pp. 357-373 (published 2015).
  • Sagie, T. "THERAPEE: Behavioral Cyber Therapy for Enuresis (Bedwetting)." In H. Krauze-Sikorska, M. Klichowski (eds.), The Educational and Social World of a Child, Wydawnictwo Naukowe UAM, Poznań, 2015, pp. 478-489.
  • Sagie, T. Conference talk, II International Conference "The Educational and Social World of a Child", Poznań, 26 March 2014.
  • Sagie, T. Conference talk on enuresis as a risk factor among young people in the school system, International Conference "Challenges of Today's Education", Poznań, 6 July 2015.

Clinic report and publications