Enuresis, or bedwetting, is defined as unwanted urination at night by a child  past the age of 6 years. The bedwetting may be ongoing or episodic, but dry periods are unpredictable and never prolonged. Five to seven million children are affected by the condition (boys more commonly than girls). Enuresis can negatively affect the relationship between child and parents, child and siblings, and child and peers. These relationship problems will only magnify the child’s already low self-esteem. Seeking remedies and dispelling myths about enuresis are necessary to keep psychological trauma to a minimum.

Causes of Bedwetting

While the causes of enuresis are not fully understood or agreed upon, this condition does tend to run in families.

·        If both parents were bedwetters, the child has a 70% chance of being a bedwetter.

·        If one parent was a bedwetter, the child has a 44% chance of being a bedwetter.

Most children will eventually “outgrow) bedwetting. Each year about 15% of the bedwetters will stop spontaneously. By the age of 18, only 1% are still wetting the bed.

Treatment

If the family and physician decide treatment is appropriate, a full description of the plan must be given to the entire family. Without proper motivation and understanding of the plan, it will probably fail.

Counseling the child:  The child must be assured that enuresis is common- he or she is not the only child who wets the bed. The child must understand the treatment plan.

Counseling the parents:  Parents need to know that treatment can take awhile to work-possibly as long as 6 months. The parents must be encouraged to follow the treatment and to be patient, understanding and devoted. The child may wet the bed after a period of dryness, and parents should be discouraged from scolding or punishing the child.

Treatment Options

There are various treatment options available for enuresis. The physicians at Central Arizona Urologists will give options and help the family select one that is appropriate for the particular child, and his family situation.

Alarms-  Wet-bed alarms are moisture sensitive and ring when the child wets. This wakes the child so that he or she can seek the bathroom. Initially the child awakens after or during voiding; the child then learns to associate bladder fullness with a conditional response (i.e. awakening and avoiding bedwetting).

Pharmacologic Therapy-  Two pharmacologic treatments are indicated for use in primary nocturnal enuresis: imipramine HCl and DDAVP Nasal Spray (desmopressin acetate) (an oral form of DDAVP has also recently been marketed)

·        DDAVP Nasal Spray and tablets(desmopressin acetate) acts by decreasing the production of urine during the night. DDAVP is actually a hormone called anti-diuretic hormone or ADH. It is delivered in the form of a nasal spray and more recently as a pill. DDAVP has an almost immediate effect on reducing urine output and therefore reduces enuresis. Success rates are as high as 70%, but most children experience a return to bedwetting as soon as the drug is discontinued. DDAVP is effectively used for special occasions, like camp or sleepovers when a dry night is particularly important. The cost of the medication can be prohibitive at times to long term use.

 ·        Impramine was initially used as an antiderpressant medication and is classified as a tricyclic antidepressant. Imipramine is thought to relax the bladder muscle allowing for greater filling and with less bladder sensitivity to filling. Imipramine may take a week or longer to start working and has the potential side effects of decreased appetite, irritability, headaches and constipation. All of these side effects are infrequent and disappear when the medication is stopped.

What Doesn’t Work

Restricting fluids, except for a mild fluid restriction as bedtime approaches, does not develop better nighttime control. 

Rejection, shame, and punishment because of bedwetting does not help resolve the condition. It does increase the child’s anxiety and lowers the child’s self esteem. Parents must realize that bedwetting is not deliberate or controlled by the child.

Evaluation by concerned medical professionals, like the physicians at Central Arizona Urologists, will allow the condition of enuresis to be given appropriate understanding and treatment.

Informative Enuresis links:

Urinary Incontinence in Children

Pediatric Urology Access (Johns Hopkins Pediatric Urology Dept.)