From the Guidelines
Treatment for enuresis should always begin with behavioral interventions, including limiting fluid intake before bedtime, scheduled bathroom trips, and bedwetting alarms, as these approaches have been shown to be highly effective in achieving dry nights. Behavioral interventions should be tried first, as they are non-invasive and have a high success rate, with studies showing that up to 66% of children can achieve long-term success with conditioning treatment 1. Medications can be considered when behavioral methods are insufficient. Desmopressin (DDAVP) is the most common medication, typically prescribed at 0.2-0.6 mg orally at bedtime, which reduces urine production by mimicking antidiuretic hormone, and has been shown to be effective in approximately 30% of children with enuresis 1. For children with small bladder capacity or overactive bladder, anticholinergics like oxybutynin (5 mg before bedtime) may help, but should only be considered after standard treatment has failed and non-pharmacological methods have been tried first 1. Imipramine, a tricyclic antidepressant, can be used at 25-50 mg at bedtime for children over 6 years, but has more side effects and is generally considered a second-line option due to safety concerns and side effects 1.
Some key points to consider when treating enuresis include:
- Ensuring the child has a healthy bowel regimen and treating constipation if present, as this can help eliminate enuresis 1
- Encouraging physical activity and a normal lifestyle despite the condition 1
- Providing psychological support throughout treatment, as enuresis can affect a child's self-esteem
- Gradually withdrawing treatment once the child achieves 14-30 consecutive dry nights
- Considering combination therapy for resistant cases, but only after standard treatment has failed and under close supervision due to potential side effects and interactions.
It's also important to note that most children outgrow enuresis naturally, as it results from delayed maturation of bladder control mechanisms or insufficient nighttime antidiuretic hormone production, and that treatment should be tailored to the individual child's needs and circumstances.
From the FDA Drug Label
May be useful as temporary adjunctive therapy in reducing enuresis in children aged 6 years and older, after possible organic causes have been excluded by appropriate tests. The treatment option for enuresis is imipramine (PO), which may be useful as a temporary adjunctive therapy in reducing enuresis in children aged 6 years and older, after possible organic causes have been excluded by appropriate tests 2.
- Key considerations:
- The patient should be aged 6 years and older
- Possible organic causes should be excluded by appropriate tests
- The effectiveness of treatment may decrease with continued drug administration
From the Research
Treatment Options for Enuresis
The treatment options for enuresis include:
- Behavioral modifications, such as counseling the child and parents 3
- Bed alarm therapy, which is a first-line treatment for enuresis 3, 4, 5
- Desmopressin, a medication that can be used to treat enuresis, especially for children who have not responded to behavioral modifications or bed alarm therapy 3, 4, 6, 5
- Combination therapy, such as desmopressin plus oxybutynin, which can be effective for children who have not responded to standard treatments 6
- Referral to a pediatric urologist for children with primary enuresis refractory to standard and combination therapies, or for children with secondary causes of enuresis, such as urinary tract malformations or neurologic disorders 3
Evaluation and Diagnosis
Before starting treatment, it is essential to evaluate the child for any underlying conditions that may be contributing to the enuresis, such as:
- Constipation 3
- Obstructive sleep apnea 3
- Diabetes mellitus 3
- Diabetes insipidus 3
- Chronic kidney disease 3
- Psychiatric disorders 3 A thorough evaluation, including a history, physical examination, and urinalysis, can help identify any underlying conditions that need to be addressed 3, 4
Effectiveness of Treatment Options
The effectiveness of treatment options for enuresis can vary, with:
- Bed alarm therapy having a higher success rate than desmopressin for monosymptomatic enuresis 4, 5
- Combination therapy, such as desmopressin plus oxybutynin, having a high success rate for children who have not responded to standard treatments 6
- Behavioral modifications, such as counseling and positive psychological support, being an essential part of treatment for enuresis 3, 4, 7