From the Guidelines
Bedwetting in an eleven-year-old should be addressed with a combination of behavioral strategies and possibly medication if needed, prioritizing the child's physical and emotional well-being. The treatment approach should be guided by the latest evidence from the International Children's Continence Society, as outlined in their standardization document from 2010 1.
Initial Assessment
The initial consultation with a healthcare provider is crucial in identifying the underlying causes of bedwetting and developing an effective treatment plan. A good case history is essential, focusing on voiding habits, symptoms such as urgency, holding maneuvers, and interrupted micturition, as well as current or previous daytime incontinence 1. The healthcare provider should also inquire about bowel habits, as constipation is a common comorbidity that can affect treatment outcomes.
Behavioral Strategies
Behavioral strategies should be the first line of treatment, including:
- Limiting fluid intake 1-2 hours before bedtime
- Ensuring the child uses the bathroom right before sleep
- Establishing a bedwetting alarm system to train the brain to respond to bladder fullness during sleep
- Keeping a calendar to track dry nights and using positive reinforcement for progress
Medication Options
If behavioral strategies are unsuccessful after 2-3 months, medication options such as desmopressin (DDAVP) may be considered, typically prescribed as a 0.2-0.6 mg tablet taken before bedtime 1. However, medication should be used temporarily and under medical supervision.
Ruling Out Medical Causes
It is essential to rule out potential medical causes of bedwetting, such as urinary tract infections, diabetes, or sleep apnea, by discussing the issue with the child's doctor. The presence or absence of heavy snoring and/or nocturnal sleep apnea can be relevant information, as some children may become dry after upper airway obstruction is relieved.
Prioritizing the Child's Well-being
Avoid punishing or shaming the child, as bedwetting is involuntary and not their fault. The treatment approach should prioritize the child's physical and emotional well-being, taking into account their motivation and compliance with treatment. By working together with the child and their family, healthcare providers can develop an effective treatment plan that addresses the underlying causes of bedwetting and improves the child's quality of life.
From the Research
Bed Wetting in Eleven Year Old
- Bed wetting, also known as nocturnal enuresis, is a common issue in children, and several studies have investigated its treatment using desmopressin 2, 3, 4, 5, 6.
- Desmopressin is a synthetic analogue of arginine vasopressin, which has been proven effective in treating primary nocturnal enuresis and polyuria 2, 6.
- A study published in 2005 found that desmopressin is a safe drug for the treatment of enuresis, with a low incidence of side-effects 2.
- Another study published in 2018 reviewed the clinical outcomes and safety profile of desmopressin in the management of adult nocturnal voiding dysfunction, and found that desmopressin is the only anti-diuretic hormone approved for nocturia 3.
- A 2023 study found that combination therapy of desmopressin plus oxybutynin improves the response rate compared to desmopressin alone in patients with monosymptomatic nocturnal enuresis, and that nocturnal polyuria and absence of constipation predict the response to this treatment 4.
- Desmopressin has also been found to be effective in reducing nighttime urine production, episodes of nocturia, and urgency episodes in female patients with overactive bladder and nocturia 5.
Treatment Options
- Desmopressin is available in various forms, including spray and tablets, and can be administered in different dosages 2, 3.
- Combination therapy of desmopressin plus oxybutynin or anticholinergic drugs has been found to be effective in treating monosymptomatic nocturnal enuresis and overactive bladder with nocturia 4, 5.
- The safety profile of desmopressin is generally good, with a low incidence of side-effects, although hyponatremia remains a concern, especially in patients over 65 years of age 3.