Bedwetting (cont.)

Parents sometimes believe that their child's primary bedwetting is emotional. No medical or scientific literature exists to support this impression.

The "cure" for primary bedwetting is "tincture (or passage) of time." However, since many parents and children are frustrated with bedwetting as it starts to interfere with self-esteem or social events (for example, sleepovers), a patient step-by-step approach is best. Fortunately, it can be anticipated to have a successful outcome in over 75% of such patients. You should always discuss treatment options with your child's physician, since it is important to differentiate between primary and secondary enuresis prior to starting specific treatments.

It is also important to remember that different children develop differently and that primary enuresis can be a normal developmental stage. Toilet training a child requires special patience. While most children are fully toilet trained by 3-4 years of age, many will not stay dry overnight, even though they can during the day. Reassurance and encouragement often will work in time, but for some children, there are steps that can be taken to address the issues.

Some common recommended management and treatment options include the following:

1. Encourage voiding prior to bedtime, and restrict fluid intake before bed.

2. Cover the mattress with plastic.

3. Bedwetting alarms: There are generally reserved for older school-age children. There are commercial alarms that are available at most pharmacies. When the device senses urine, it alarms and wakes up the child so he/she can use the toilet. The cure rate is variable.

4. Bladder-stretching exercises are aimed at increasing the bladder volume and increasing the periods between daytime urinations.

5. Medications, such as DDAVP (desmopressin acetate or antidiuretic hormone) and Tofrinil (imipramine), have been shown to be very effective and are used to temporarily treat the nighttime urination, but they do not "cure" the enuresis. Many pediatricians will prescribe one of these medications, especially if the child is engaged in behavioral conditioning as well. Medications are very helpful when a child is not sleeping at home (camp or sleepovers), since the trauma of bedwetting in those settings is predictable. In addition, a recent study presented at the 2009 Pediatric Academic Society's annual meeting suggested that ibuprofen (Motrin, Advil, etc.) may also decrease the incidence of bedwetting by possibly stabilizing the bladder muscle that contracts during urination (detrusor muscle).

Source: MedicineNet.com
http://www.medicinenet.com/bedwetting/article.htm