From the Guidelines
Enuresis, commonly known as bedwetting, should be treated with a combination of behavioral interventions and medication, with desmopressin (DDAVP) at 0.2-0.6 mg orally at bedtime as the first-line medication, as it reduces urine production overnight and has a low risk of side effects 1.
Treatment Approach
The treatment approach for enuresis should prioritize behavioral interventions, including:
- Limiting fluid intake before bedtime
- Scheduled bathroom trips
- Using bedwetting alarms that wake the child when moisture is detected
- Encouraging physical activity and a healthy bowel regimen to prevent constipation If these approaches fail, medication may be considered, with desmopressin (DDAVP) being the first-line medication.
Medication
Desmopressin (DDAVP) is a synthetic analogue of the antidiuretic hormone (ADH) vasopressin, which decreases urine production at night when taken at bedtime. The recommended dose is 0.2-0.6 mg orally at bedtime, with a low risk of side effects, including water intoxication and hyponatremia 1.
Behavioral Interventions
Behavioral interventions, such as conditioning night awakening to the sensation of a full bladder, have been shown to be effective in treating enuresis, with a success rate of approximately 66% 1. A written contract, thorough instructions, and frequent monitoring appointments can enhance success.
Quality of Life
Reassuring parents and children that enuresis is a common condition that typically resolves with time is essential for reducing anxiety and shame associated with bedwetting. Encouraging children to lead a normal life despite the condition and promising to work together to achieve dryness can improve their quality of life 1.
From the FDA Drug Label
Safety and effectiveness in the pediatric population other than pediatric patients with nocturnal enuresis have not been established The safety and effectiveness of the drug as temporary adjunctive therapy for nocturnal enuresis in pediatric patients less than 6 years of age has not been established The safety of the drug for long-term, chronic use as adjunctive therapy for nocturnal enuresis in pediatric patients 6 years of age or older has not been established; consideration should be given to instituting a drug-free period following an adequate therapeutic trial with a favorable response.
Imipramine can be used as adjunctive therapy for nocturnal enuresis in pediatric patients, but its safety and effectiveness have not been established for long-term use in patients 6 years or older, and it has not been established for use in patients less than 6 years old 2.
From the Research
Definition and Prevalence of Enuresis
- Enuresis is a common condition that affects 5-10% of school-aged children, characterized by the involuntary urination during sleep, also known as bedwetting 3.
- The condition can be primary, where the child has never achieved nighttime dryness, or secondary, where the child has previously achieved nighttime dryness but has since begun to experience bedwetting again 3.
Pathophysiology of Enuresis
- The pathophysiology of enuresis is complex and multifactorial, involving an altered antidiuretic hormone profile, arousal failure, and delayed bladder maturation 3.
- Coexisting conditions such as constipation, obstructive airway disease, attention deficit hyperactivity disorder, obesity, and genetic preconditions can influence the prevalence of enuresis 3.
Diagnosis of Enuresis
- Diagnosis of enuresis relies on history-taking and simple non-invasive examinations to differentiate monosymptomatic enuresis and patients with daytime symptoms 3, 4.
- It is essential to exclude daytime voiding symptoms, overactive bladder, dysfunctional voiding, and urinary tract infections 3, 4.
Treatment of Enuresis
- The treatment of enuresis depends on the type and severity of the condition, as well as the presence of any underlying medical conditions 3, 4.
- Desmopressin and alarm systems are commonly used to treat monosymptomatic enuresis, while anticholinergics and urotherapy may be used to treat non-monosymptomatic enuresis 3, 4.
- Combination therapy with desmopressin and imipramine has been shown to be effective in reducing wet nights in patients with refractory nocturnal enuresis 5.
- Alarm therapy is considered the first-line treatment for enuresis, with a success rate of 50-70% 4.
- Pharmacotherapy, such as desmopressin, can be a helpful adjunctive treatment for enuresis 4.
Comparison of Treatment Options
- A study comparing the use of alarms, desmopressin, and imipramine in the treatment of monosymptomatic nocturnal enuresis found that alarm therapy was the most effective treatment, with a success rate of 100% 6.
- Another study found that combination therapy with desmopressin and imipramine was more effective than desmopressin and oxybutynin in reducing wet nights in patients with refractory nocturnal enuresis 5.
- A study comparing alarm monotherapy with combination therapy using desmopressin and imipramine found that alarm monotherapy was no more effective than combination therapy, but had a lower relapse rate 7.