Persistent Children Bed Wetting

In most cases, children bed wetting in the night (i.e. nocturnal enuresis) is a self-limited condition due to delay in maturation which differs in each child. However, persistent bed wetting carries psychosocial side-effects on both the child and the family. A significant number of parents use punitive measures to deal with bed wetting. This will only lead to poor self-esteem in the child.

Generally, the treatment strategies aim at teaching the child to recognize the sensation of a full bladder and to visit- feel that it is important to wake up to void. Below are 3 major options for treatment of persistent children bed wetting :

1.  Conditioning with Urine Detector and Alarm

The highest success rate has been reported with the use of enuresis alarm. This consists of a urine detector, worn as a pad in the underpants and is triggered by a change in resistance to an electric current when urine comes into contact with the detector. This sets off the alarm in the form of a bell, beeper, buzzer or vibrator. The parents have to help the child to monitor his progress with a ‘star’ chart. Once he has been dry for at least 3 weeks, a useful strategy is to encourage him to drink water before bedtime and if he can remain dry with this challenge, there is a higher likelihood for cure. The curing rate with this strategy is around 60-70%, with a recurrence rate of 5-10%.

2.  Reduce Urine Volume with Desmopressin

Study has shown that some bed wetting children suffer from a lack of rise in Antidiuretic Hormone (ADH) in the night. ADH is important in increasing the concentration of the urine and thus reducing the volume. The lack in ADH leads to a high overnight diluted urine production exceeding the child’s bladder capacity. “Desmopressin” is useful in this context and it can be given as a nasal spray or orally before the child goes to bed. Precaution parents need to take when using this drug treatment is to reduce the water intake before bedtime and after administration of the drug to avoid problems of water retention. Most side effects are minor, such as headache, loss of appetite and abdominal cramps. Overall, its use in treating persistent bed wetting in children has been safe. The standard treatment period is 3 months. The success rate is about 70% but after discontinuation, a recurrence may occur in about 50-70% of children treated. A second course of Desmopressin can be used in those with recurrence after discontinuation. Desmopressin can also be used as a short-term measure for children going to school camps or travelling overseas.

3.  Changing Sleep Pattern with Central Stimulants

“Imipramine” is an antidepressant medication which could be used at night to alter the sleep pattern of the bedwetting child. The child will be able to perceive the urge to void and is hence able to wake up to pass urine. This drug is only recommended for children older than 7 years. This treatment will be more effective when used with the ‘star’ chart. The treatment typically lasts for 3 months with gradual reduction in dose towards the end of treatment period as abrupt cessation of Imipramine will result in a high relapse rate. Since it is an antidepressant, precaution should be taken by parents to keep the drug out of reach of young children. In children who are wearing the urine detector but have a problem waking up at the sound of the alarm, Imipramine is a useful adjunct.

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