Children's Health: Beating the Bed-wetting Blues (cont.)

PARKER:
There are really two medications that are used and probably DDAVP is the one most commonly used now, especially since you can take a pill instead of the spray into the nose that we had to do previously. DDAVP is a naturally occurring hormone that makes us make less urine. Some people think one of the causes of nighttime bed-wetting may be that children make more urine at night and don't have more of this hormone being naturally created during the nighttime so the DDAVP slows down urine production and the child can get through the night.

Side effects with DDAVP are very rare and have really only been seen in children who have way too much to drink before they go to sleep. That can cause "water intoxication" because they are not making very much urine and the water stays in the body and can cause problems with the mineral concentration in the body. But that's pretty rare and with sensible precautions, it's very unlikely. As far as I know, no other problems with DDAVP have been found.

The other medication, which I used to use much more before DDAVP came around, is called imipramine. It is kind of an antidepressant but works very well in keeping children dry. Again, it's relatively safe because you're only giving one dose at night and a low dose at that. The concern about imipramine however, is that an overdose of imipramine is horrific. If there's a chance of a toddler getting into it or anyone taking many of the pills for some reason, it's not a good idea to even have around. But it is fairly safe and a good alternative to DDAVP if you want to get through a night without wetting.

MEMBER QUESTION:
My 13-year-old nephew still wets the bed at night and his urine has a really strong smell to it. What can I do to help?

PARKER:
Well, as I said before, the first order of business will be to make sure that strong- smelling urine is normal. That means to be sure that he has been seen by his pediatric provider and the urine has been tested to make sure there's no evidence of infection or other problems that might continue the nighttime bed-wetting.

Let's assume that's not the case and he is perfectly healthy. Then it's likely he is still one of the few percent of children who continue to have bed-wetting into their teens. This is again probably due to genetics and often runs in families.

If he is motivated at this point, the urine alarm is probably, again, the best way to go, to help him to achieve nighttime continence. If he is not motivated to do that, you're not going to get very far. Certainly a 13-year-old needs to participate in his own treatment. It helps to do that by explaining what's going on, about how the brain is too asleep and how the alarm will help to wake him up. If he has not tried an alarm, I would certainly go that route first, and then if that didn't work, add DDAVP onto the alarm and see if you can achieve some success.

If that doesn't work, send me a message on my message board in a few months and we'll go to plan C. Good luck.

MODERATOR:
Dr. Parker has a message board right here on WebMD and you can always post questions to him on his message board.

MEMBER QUESTION:
Is there a brand of alarm system that is better than another?

PARKER:
I don't think so, they're all pretty good at this point and I never like to recommend one brand vs. another. You can talk to your pediatric provider and you can look online. They all work by pretty much the same principle and are, as far as I can tell, pretty equivalent in terms of their ability to help the child.

MEMBER QUESTION:
Is it just that the children sleep so soundly?

PARKER:
That's a really good question and still hotly debated. It probably has, in some children, a little bit to do with the lack of their waking up to the stimulation of the urge to pee, but this observation of some parents is suspect. Parents have always told us that when they try to wake their child up at night to go to the bathroom, he or she remains really sleepy and hard to wake up. Of course, they don't wake up any of their other children at night, who might be equally hard to wake up, who aren't wetting the bed.

We also used to think that bed-wetting occurred just at one certain stage of sleep but now it seems to occur at all stages of sleep. So the returns aren't in. Maybe the children are a little bit of a deeper sleep and sleep a little deeper but it's not clear if this is a cause or just a contributor to children who don't wet the bed or who do wet the bed.

"I do want to mention one cause of daytime wetness in girls many of you should be aware of because I have seen it quite commonly. It's called vaginal reflux. This occurs often in chubby girls who have wet panties throughout the day."

MEMBER QUESTION:
What's the best route to take if they have a problem in the day and the night?

PARKER:
I'm glad you asked because just as I said there are two kinds of nighttime bed-wetting -- primary when the child has been wetting his or whole life and secondary, which occurs after a period of dryness -- there's also what's called diurnal enuresis, when children are wetting during the day and/or at night. As you might imagine, this is a very different story. The child is awake when he or she wets, and so the issues and the cause are likely quite different than that in primary nighttime bed-wetting.



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