What's the treatment for bedwetting?
Parents and the child need to know that bed-wetting is quite common, that it can be corrected, and that nobody should feel guilty about it. An older child who has bed-wetting can take responsibility by limiting fluids after dinner (especially caffeinated beverages), urinating before going to bed, recording wet and dry nights, and changing clothing and bedding
when wet. Parents may choose to give the child age-appropriate rewards (positive reinforcement) for dry nights.
Because there are several theories regarding the cause nighttime wetting, there are a variety of therapies available based on the premise of each of these theories. However, no one theory has proven correct nor has one treatment proven 100% successful. Often a combination of therapies is used in the hopes of gaining nighttime control.
Motivational therapy - Motivational therapy for the treatment of nocturnal enuresis involves reassuring the parents and the child, removing the guilt associated with bed-wetting and providing emotional support to the child. In motivational therapy, parents attempt to encourage the child to combat bed-wetting, but the child must want to achieve success. Positive reinforcement, such as praise or rewards for staying dry, can help improve self-image and resolve the condition. Punishment for "wet" nights will hamper the child's self-esteem and compound the problem.
Behavior modification - Behavioral conditioning in the treatment of primary nocturnal enuresis is based on the use of a signal alarm device. When the child voids in bed, a moisture-sensing device that has been placed near the genitals is activated and triggers an alarm. This evokes a conditioned response of waking and inhibiting urination. In some cases, behavioral therapy is combined with motivational therapy to reinforce successful behavior by rewarding the child for dry nights.
Bladder training exercises - Bladder training exercises are based on the theory that those who wet the bed have small functional bladder capacity. Children are told to drink a large quantity of water and to try to prolong the periods between urinations. These exercises are designed to increase bladder capacity but are only successful in resolving bed-wetting in a small number of patients.
Alarms - A child who wets the bed needs to develop a better response to a full bladder, and an enuresis alarm can be an effective way to do this. When the child starts to wet the bed, a moisture sensor sends a signal to a control panel, which sounds an alarm. Some alarms also vibrate, which is useful for children with hearing impairments or those who sleep in a room with others.
Pharmacologic therapy - Pharmacologic therapy for the treatment of primary nocturnal enuresis is usually reserved for use in children older than seven years of age. Two approaches to drug therapy can be used. One approach is to increase bladder capacity. The other is to reduce the amount of urine produced by the kidneys. A desmopressin nasal spray is usually effective in the short term. It works by making the child produce less urine. It works quickly and produces few side-effects. One puff is given to each nostril before bed. Desmopressin tablets are also available. Anticholinergic medications, such as hyoscyamine (Levsin) and oxybutynin (Ditropan), have a direct effect on smooth muscle relaxation and therefore reduce or decrease the bladder's ability to contract. Desmopressin acetate (DDAVP), a synthetic analog of arginine vasopressin (antidiuretic hormone), has a highly specific antidiuretic effect, a relatively long half-life and an extended duration of action. A drug called imipramine, which is used as an antidepressant in adults, may help by improving the child's sleep patterns or affecting the way the bladder muscles of the bladder work. However, it should not be used for more than three months. There may be side-effects such as changes in behaviour. It can be fatal in overdose and must be stored out of children's reach.
Combination therapy - Combination drug therapy may be tried in older patients with refractory primary nocturnal enuresis when neither the alarm nor pharmacologic therapy has been effective. In some children, a combination of medications and behavioral therapy will stop bedwetting when other treatments have failed.