Bed-wetting Treatments

Bed-wetting at night, or nocturnal enuresis, is a common occurrence in children under the age of six mainly because they have yet to fully establish bladder control. While genetics can play a role—children whose parents wet the bed when they were young have an 80 percent chance of doing it themselves—there are often underlying causes (including a small bladder, diabetes, chronic constipation, hormone imbalance, urinary tract infection, or sleep apnea), and bed-wetting treatments are available.

How to Stop Bed-wetting

When the cause of nocturnal enuresis is behavioral and not a symptom of a more serious condition, there are a few approaches that can make a difference.

Bladder training

The goal of bladder training is to stretch the bladder and increase time between urination—starting at five minutes and progressing to 45 minutes over time. By teaching the child to hold his urine for longer periods of time, he also learns to better recognize the cues the bladder sends to the brain. This option is particularly helpful for children with small bladders.

Fluid Management

Before bedtime, keep drinking to a minimum. Some physicians suggest children consume 40 percent of their daily fluids in the morning, 40 percent in the afternoon, and only 20 percent after 5 p.m. Avoid caffeinated drinks like soda, which act as a diuretic and increases urine production.

Bed-wetting Alarms

A bed-wetting alarm can be placed either in the underwear or on a child's bed pad and will ring and vibrate when the child first begins to urinate. Over time, the child's brain calearn to recognize the signal the bladder is sending before an accident occurs.

This method takes an average of three to four months to be effective. But it has staying power: According to one study of more than 500 children, 79 percent of those who used moisture alarms were dry by 10 weeks, and most maintained nighttime bladder control six months later.

Bed-wetting Medications

Medications for bed-wetting may be used used when behavioral measures fail, or when the cause of bed-wetting is due to a urinary tract infection, sleep disorder, hormone imbalance, or overactive bladder. They aim to reduce nighttime urine production, soothe the bladder, or modify the child's sleeping habits. (Drugs alone, however, may not be enough to alleviate the problem.)

Hormone therapy

Desmopressin acetate is a synthetic form of the body's own anti-diuretic hormone (ADH). When this hormone is boosted, the body makes less urine at night. This medication—in the form of a nasal spray or pill—is given before bed and the dosage can be altered until the child consistently has dry nights. Side effects include runny nose, nose bleeds, headache, nasal stuffiness, and more seriously seizures.

Anticholinergic Drugs

Oxybutynin (Ditropan) or hyoscyamine (Levsin) are used to treat overactive bladder by minimizing bladder contractions and improving bladder capacity. Side effects include facial flushing and dry mouth.

Antibiotics and Anti-inflammatories

If bedwetting is due to a urinary tract infection, antibiotics (such as amoxicillin or ampicillin) may kill the bacteria and non-steroidal inflammatories (NSAIDS) may reduce swelling of the ureters.

Laxatives

Constipation can place undue pressure on the bladder. In these cases, over-the-counter fiber supplements, stimulants, lubricants, stool softeners, and saline laxatives can ease chronic constipation which, in turn, eases pressure on the bladder.

Antidepressant

Imipramine (Tofranil) is a tricyclic antidepressant that has been prescribed to treat bed-wetting for nearly 30 years. It is unclear how it exactly works, but the medication can relax the bladder, allowing it to store more urine. It may also reduce urine production and alter a child's sleeping and waking pattern. While side effects—nervousness, constipation, mood changes, and anxiety—are rare with the proper dosage, imipramine should only be administered if other treatments have failed.

Bed-wetting Prognosis

Most children eventually establish bladder control without any treatment, while those who have inherited the condition tend to outgrow bed-wetting at the same age their parent stopped. A comprehensive look at 40 clinical studies on the efficacy of bed-wetting medications found inconclusive proof that drugs alone were enough to stop bed-wetting; rather, they worked best in combination with behavioral therapies such as bladder training, moisture alarms, and fluid management.

References:

Fleming E. (2012). Supporting children with nocturnal enuresis. Nurs Times.

Deshpande AV, Caldwell PH, Sureshkumar P. (2012). Drugs for nocturnal enuresis in children (other than desmopressin and tricyclics). Cochrane Database Syst Rev.

Sakellaropoulou A., Hatzistilianou M., et al. (2012). Association between primary nocturnal enuresis and habitual snoring in children with obstructive sleep apnoea-hypopnoea syndrome. Arch Med Sci.

Cendron M. (1999). Primary nocturnal enuresis: current concepts. Am Fam Physician.

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