folic acid as a potential adjunct in the management of primary nocturnal enuresis: a clinical trial study

Background :primary nocturnal enuresis (pne) is a common pediatric condition with a multifactorial etiology, involving both neurodevelopmental and nutritional factors. recent evidence suggests that folic acid may contribute to neural maturation and bladder control. objectives :the present study aimed to evaluate the therapeutic effect of folic acid supplementation on the frequency and severity of pne in children. methods :in a double-blind, randomized controlled trial, 68 children aged 5 - 18 years diagnosed with pne were assigned to receive either folic acid supplementation or placebo over a sixty-day period. baseline and post-treatment assessments included enuresis frequency and urinary control parameters. the number of dry nights was recorded at baseline, month 1, and month 2. group-level means and standard deviations were compared using independent t-tests. effect sizes (cohen's d) and percentage changes from baseline were calculated to assess the magnitude and clinical relevance of the intervention's impact. results :at baseline, there was no significant difference in the number of dry nights between groups (intervention: 19.2 ± 3.7; control: 18.9 ± 4.3; p = 0.63). by month 1, the intervention group showed greater improvement (24.5 ± 4.8 vs. 22.4 ± 5.1 dry nights; adjusted mean difference = 2.1, 95% ci: 0.9 - 3.3; p = 0.0004; cohen's d = 0.42). at month 2, this difference further increased (26.0 ± 4.6 vs. 23.2 ± 4.6; adjusted mean difference = 2.8, 95% ci: 1.7 - 3.9; p < 0.0001; cohen's d = 0.61). the intervention group achieved a 35.4% increase in dry nights from baseline, compared with 22.8% in the control group, indicating a moderate to large and clinically meaningful treatment effect. conclusions :folic acid supplementation may offer a safe and effective adjunctive treatment for pne, potentially through its role in neurodevelopmental regulation. further studies are warranted to confirm these findings and to explore the underlying mechanisms.