Doctors from around the world agree that nighttime bedwetting (medical term: nocturnal enuresis) can have negative effects on the child. In an article published in a Korean Medical Association Journal (1) Korean authors reviewed the scientific literature of enuretic (bedwetting) children from several regions of the world including Turkey, Great Britain, and Korea. They affirm that “Children with enuresis may have lower self-esteem and lower quality of life,” and that bedwetting “may affect negatively the psychosocial development of children.”
However, the main purpose of the article was to promote prescription drugs as a primary treatment. Interestingly, most U.S. doctors don’t like to prescribe for bedwetting as we discussed in a previous post because the drug options have potentially serious side effects. The medications the authors write about are Desmopressin, (also known as DDAVP), anticholinergics, and Imipramine. These are briefly reviewed below.
Desmopressin acts to prevent the child’s body from making urine. This medication has worked to prevent bedwetting. Often it works while it being used and many children return to bedwetting once the medication is stopped. The logic behind this treatment is, if the body is making too much urine, just stop urine production. However, because we need to produce urine to eliminate waste Desmopressin would only be prescribed at night, effectively delaying the natural waste elimination process. Many parents don’t like the idea of preventing waste elimination.
Anticholinergics are a broad category of medications used to treat a wide variety of conditions including Parkinson’s Disease (e.g. Cogentin) and psychiatric disorders (e.g. Thorazine). Anticholinergics work by blocking the neurotransmitter called acetlycholine which is necessary for muscle contraction. The logic behind this treatment for bedwetting is to prevent the bladder (a muscle) from contracting, acting as an antispasmodic medicine. If a child is wetting due to bladder spasms, he or she will likely also have daytime wetting.
Imiprimine is an antidepressent used to treat depression. Even the Korean authors admit that it “has serious and lethal cardiotoxic effect,” and do not recommend it for childhood bedwetting. The logic behind this medication is probably closest to the actual cause of most cases of bedwetting, deep sleep. Imiprimine reduces the amount of time a person spends in deep sleep. However, the potential danger outweighs the potential benefits of this medication.
It’s always a good idea to check with your child’s pediatrician to rule out a medical cause of bedwetting but in otherwise healthy children, the cause is usually deep sleep. For these cases there is an alternative way end bedwetting. Most doctors now agree that education with an individualized training program is the best way for a child to learn how to wake up dry. For years, instead of resorting to potentially dangerous prescription medications, doctors would encourage parents to wait until the child outgrows bedwetting. This wasn’t entirely bad advice because most kids do outgrow it. In fact, only 1% continue wetting into adulthood. But the question is, when will they outgrow it? Will your child be in the 1%? How how long is too long to wait?
Most children learn to be dry at night by around age 3 but wets nights occurring to age 4 are not uncommon. Boys tend to take longer than girls to get dry at night and boys are more likely to continue wetting beyond 5 years old. Your child should be dry at night by the time he or she starts kindergarten. This is also likely the time when they’ll realize that bedwetting is not normal. The sooner it is corrected after your child has this awareness, the better. Thus, the time to intervene is when your child is aware that it’s not usual, is wetting on a regular basis (several nights), and is at least 5 years old.
Dry Kid Academy was founded in 2008. It is an in-home education and training program. No office visit. No clinic settings. Each family receives unlimited support and guidance until dryness is achieved and beyond if necessary.
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Article Reference: (1) https://doi.org/10.5124/jkma.2017.60.10.796