What is nocturnal enuresis and who is affected?
Nocturnal enuresis is characterized by involuntary and unconscious micturition (passage of urine) when sleeping at night. It affects girls over 5 years of age and boys over 6 years of age (before this age, occasional bedwetting is said to be "normal"). There are two types of enuresis: primary enuresis and secondary enuresis.
Primary enuresis occurs in boys more frequently and affects about 20% of all children by age 5. Although an affective (emotional) problem may partly be the cause, some children may simply have a smaller bladder while others may not produce enough antidiuretic hormone (which reduces the amount of urine) during the night. In still other cases, the child's sleep is so deep that his need to urinate does not wake him up. Sometimes all these factors are involved.
Unlike those who suffer from primary enuresis, children who have secondary enuresis used to have bedtime control, but have now lost it. The main cause of secondary enuresis is affective, meaning that these children have reverted to get more attention. This occurs frequently when a sibling is born or when a familial conflict disrupts the child (divorce, arguing, etc.). Urinary infections and diabetes, however, can also cause secondary enuresis.
Is enuresis hereditary?
Nocturnal enuresis has a major hereditary component. Children have a 77% chance of also suffering nocturnal enuresis, if both parents suffered from it. When 1 or neither of their parents suffered from it during childhood, their chance of having it falls to 44% and 15% respectively.
How is nocturnal enuresis treated?
Fortunately this problem usually resolves by itself, with or without treatment, as the child grows. The cure rate is about 15% in children 6 years and older. By age 15, 99% of children who once wet their bed no longer do. In an effort to speed the process along, however, many parents resort to various treatments, especially when the child has to sleep away from home. Punishing the child is not a solution and tends only to aggravate the problem.
It is possible to use an electronic alarm that awakens the child as soon as some urine wets the child's underwear. Using this device has a 75% cure rate and is superior to any medications. To increase the chance of success, the child should actively participate in using it and receive plenty of loving support during the process. In addition, bladder exercises are useful, since they improve the situation in 66% of cases when used alone.
Bladder exercise program
Increasing urine volume:Have the child drink a lot during the day and then wait as long as possible before going to the toilet.
Strengthening muscles:Ask the child to suddenly stop urinating, to help strengthen the external sphincter (the muscle that keeps urine inside the bladder).
Which drugs are used to control enuresis?
Tofranil™ (imipramine) and DDAVP™ (antidiuretic hormone) are the two most commonly used drugs to control or cure enuresis. Their success rate varies between 25% and 70%. They have two very different mechanisms of action, so a child who does not respond to one might respond to the other. When these drugs are used to cure enuresis, both drugs are used for a 3-month trial period. Then they are very gradually withdrawn to prevent relapse. On the other hand, because of their short onset of action, they can also be useful in controlling enuresis for a short period, for example when the child is visiting friends or family and has to sleep away from home.
These two drugs differ in their pharmacological formulation, their side effects, and their cost. Imipramine is available in tablets and is not expensive but causes many side effects. DDAVP, on the other hand, is available as a nasal spray or tablets, causes very few side effects, but is a lot more expensive.
If your child takes imipramine, have him suck hard candies or chew sugar-free gum to prevent dryness of the mouth that it may cause. Always keep this medication OUT OF REACH OF CHILDREN, in a childproof bottle, since ACCIDENTAL INTOXICATION can have very serious consequences.