From the Guidelines
Nocturnal enuresis (bedwetting) in a 12-year-old boy is most commonly caused by delayed maturation of bladder control, genetic factors, sleep arousal difficulties, or reduced nocturnal antidiuretic hormone production. The most common causes of bedwetting in a 12-year-old boy can be attributed to several factors, including:
- Delayed maturation of bladder control
- Genetic factors
- Sleep arousal difficulties
- Reduced nocturnal antidiuretic hormone production
- Nocturnal polyuria, which is the production of an excessive amount of urine at night
- Detrusor overactivity, which is an overactive bladder muscle
- Increased arousal threshold, which makes it difficult for the child to wake up when their bladder is full
Treatment Options
Treatment for nocturnal enuresis should begin with behavioral approaches, including:
- Limiting fluid intake 1-2 hours before bedtime
- Ensuring regular bathroom visits before sleep
- Using a bedwetting alarm that awakens the child when moisture is detected
- A reward system for dry nights can also be motivating If these measures don't work after 2-3 months, medication options include desmopressin (DDAVP), starting at 0.2 mg taken 30-60 minutes before bedtime, which reduces urine production overnight 1. The dose may be increased to 0.4 mg if needed, with treatment typically lasting 3-6 months before attempting withdrawal. Anticholinergics like oxybutynin (5 mg before bedtime) may help if there are daytime urgency symptoms. Constipation should be addressed if present, as it can contribute to enuresis. Psychological support is important as bedwetting can affect self-esteem, especially in older children. Parents should maintain a supportive, non-punitive approach, as bedwetting is involuntary and not the child's fault. Most children eventually outgrow bedwetting, with a spontaneous resolution rate of about 15% per year 1.
It is essential to note that the treatment approach may vary depending on the underlying cause of the enuresis and the presence of any comorbid conditions. A thorough evaluation, including a detailed medical history and physical examination, is necessary to determine the best course of treatment for each individual child. In some cases, a combination of behavioral and pharmacological interventions may be necessary to achieve optimal results. Regular follow-up appointments with a healthcare provider are crucial to monitor the child's progress and adjust the treatment plan as needed. By working together with a healthcare provider, parents and children can develop an effective treatment plan to manage nocturnal enuresis and improve the child's quality of life.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Causes of Nocturnal Enuresis
- Nocturnal enuresis, or bedwetting, is a common condition that affects many children, with around 15-20% of five year olds and up to 2% of young adults experiencing the condition 2
- The exact cause of nocturnal enuresis is not fully understood, but it is thought to be related to a combination of factors, including genetics, bladder control, and hormone regulation 3
- Contributory factors to the cause of bedwetting include underlying pathology, such as urinary tract infections or neurological disorders, as well as lifestyle factors, such as fluid intake and bowel habits 4
Treatment Options
- Desmopressin is a commonly used treatment for nocturnal enuresis, which works by reducing the amount of urine produced at night 2
- Enuresis alarms are also effective in treating nocturnal enuresis, and may be used as a first-line treatment or in combination with desmopressin 5
- The choice of treatment will depend on the individual child and their specific needs, and may involve a combination of behavioral modifications, such as limiting fluid intake before bedtime, and medical treatments, such as desmopressin or enuresis alarms 4
- Research has shown that desmopressin can be effective in reducing the number of wet nights, but may not be sustained after treatment is stopped, and that enuresis alarms may produce more sustained benefits 2, 5
Efficacy of Treatment Options
- Studies have shown that desmopressin can reduce the number of wet nights by at least one night per week during treatment, and that children on desmopressin are more likely to become dry 2
- Enuresis alarms have also been shown to be effective in reducing the number of wet nights, and may be more effective than desmopressin in producing long-term results 5
- The efficacy of desmopressin may depend on the individual child's response to the medication, and research has shown that some children may not respond as well to desmopressin as others 6