How to Treat Bedwetting – Know the Facts

Your doctor may recommend a medication such as the DDAVP tablet. The DDAVP tablet can help achieve dryness in some children with PNE. However, it also has the potential for serious side effects and should be used with caution and only under close supervision by a physician. The FDA has recently placed a ban on treating PNE with DDAVP in the nasal spray form. Behavioral treatments are most effective and with the right approach for the right child, most school-age children can be dry within 12 weeks.

Slow nighttime urine production. The drug desmopressin acetate (DDAVP) boosts levels of a natural hormone (anti-diuretic hormone, or ADH) that forces the body to make less urine at night. The medication is available as a pill or nasal spray. As of December 2007, however, only the pill form is approved to treat bed-wetting. DDAVP has few side effects. The most serious is a seizure if the medication is accompanied by too many fluids.

Since bedwetters rarely hold their urine all night, the inside of the bladder is not elasticizing or stretching as it should. This causes the capacity of the bladder to remain small. The bladder itself is normal and growing with the body, but, like a balloon that never gets blown up, the potential to expand is there but it just has not been realized.

Imipramine (Tofranil) is a relatively inexpensive inexpensive trycyclic antidepressant that has been used for bedwetting for about 30 years. It is not known exactly how it works, but it may relax the bladder, decrease the depth of sleep in the last third of the night, and increase bladder capacity (taken one hour before bedtime). Mild reactions can include nervousness, insomnia, gastrointestinal disturbances, fatigue and sensitivity to sunlight. Parents must be very careful to keep imipramine out of the reach of children, as it can be toxic in large doses and an overdose can be fatal.

Because a majority of children 5 years and older spontaneously stop bedwetting without any treatment, many medical professionals choose to observe the child until age 7. The age at which to treat, then, depends on the attitudes of the child, the parents/caregivers, and the health-care provider.
All aspects of the treatment are spelled out in a manual given to parents, and the parents and child complete an explicit behavioral contract that specifies what each is to do to implement the treatment at home. For example, all procedures including the necessity to wake the child are specified in the contract section for using a body worn urine alarm. The protocol also incorporates Retention Control Training where the child practices holding back from the urge to urinate for longer and longer intervals until the child can successfully withhold for 45 minutes.

Children who have an increase in accidental wettings after treatment are considered to have relapsed. A relapse is defined as more than 2 wet nights in 2 weeks. The most likely time for a child to relapse is within the first 6 months after treatment. If a child relapses after stopping a successful therapy, that same therapy usually is repeated.

Rewards should be given for the child's staying dry by waking in the night and going to the toilet. Staying dry by holding the urine till morning is a less satisfactory achievement, because these children have not overcome the primary problem.