Medication for Bedwetting
Another treatment direction to consider is medication. The upside of medication is the ease, convenience and speed with which it works (sometimes on the first day). The downside of medication is of course the risk of side effects and the fact that once the medication stops, the enuresis is likely to start up again.
There are a number of pharmacological therapies that are used to treat bedwetting and I’ll briefly explain the 3 that are most commonly used.
1. OXYBUTYNIN – This is the one that is used least frequently nowadays. It’s brand name is DITROPAN and it is a muscle relaxant that reduces the sense of urgency and reduces the intensity of bladder contraction. It is more commonly prescribed to adults with incontinence but occasionally it is used for enuresis in children. It has a long list of possible side effects including: constipation, interference with body heat regulation, diarrhea, drowsiness, blurred vision, nose bleeds, insomnia, and about 20 more. All potentially serious problems. It is not uncommon that when a medication is used to resolve one problem, other problems crop up as a result of the first medication. So the question then with most medications is “Do the benefits outweigh the risks?” It is the parents’ job then, in consultation with their doctor to decide whether to use a particular medication and it always comes down to balancing the risks against the benefits.
2. IMIPRAMINE – It is an antidepressant commonly called TOFRANIL and is reported to have a success rate of approximately 50% for bedwetting. Unfortunately it also has an even longer list of side effects and consequently is not prescribed for bedwetting as often as it used to be. It is unclear how imipramine acts within the brain to reduce bedwetting but some experts think it has something to do with altering the levels of sleep. Altering someone’s sleep pattern with drugs is in my mind something you would not do without careful consideration. The side effects associated with this drug are serious and it seems to me that using imipramine for a problem as benign as bedwetting is more risky than is necessary. Your doctor will give you a more complete picture of the risks and benefits than I am able.
3. DESMOPRESSIN ACETATE – Commonly called DDAVP and it is much safer than either of the other 2 drugs. It is a synthetic hormone that acts like the natural hormone vasopressin. Vasopressin is produced naturally in your brain and it is released into your blood stream at night. Its purpose is to regulate urine production by decreasing the volume of water in it. You have probably had to produce a urine sample for analysis sometime in your life that requires the first morning voiding. One of the reasons for this is the first morning urine contains less water and is more concentrated with the waste byproducts of your body and it is the hormone vasopressin that regulated you naturally to produce this water reduced urine. Naturally when you produce less urine, your need for voiding during the night time is reduced and for a bed wetter it could mean night time control. Studies have shown that a significant number of bed wetters do not produce amounts of vasopressin that non bed wetters produce, however if a bed wetter is supplemented with DDAVP, they too may go the night without wetting. Studies indicate that DDAVP is fast, safe, effective and well tolerated. Success rates are being reported in the 70%-80% range and often times it kicks in the first night of use and the child is dry. Now understand that discontinuing the DDAVP will probably result in bedwetting again so it would be incorrect to say it cures bed wetting. This drug is available in 3 forms – a nasal spray, a tablet and injection form. The injection form is typically not used for enuresis but rather other applications such as surgery. It is so quick acting that doctors are prescribing it so kids can go away to camp and sleepovers etc. without having to worry about a wet bed and it usually is effective on night # 1. The list of side effects is considerably shorter and less scary that the other 2 drugs but your doctor can help you decide if it could be considered. DDAVP is usually the drug of choice by most physician once a decision is made to move towards a pharmacological treatment for enuresis.
To date, no effective and side effect free medication has been developed that cures bed wetting. The chances of the child once again becoming a bed wetter after ceasing the medication is great. It does appear to have some short term benefits that may be worth considering and again, your doctor is the one to talk to.