Wetting at night without any daytime issues is properly termed mono-symptomatic nocturnal enuresis. I find this term cumbersome and prefer bedwetting for use with parents and colleagues alike. I confess that I am not conversant with the voluminous literature relating to bedwetting. Remotely I was involved in the industry-sponsored trial of DDAVP that paved the way for FDA approval of this drug for the treatment of bedwetting in the US. From that trial I became biased against the use of this medication as 30% of the patients that I enrolled experienced significant weight gain on the medication (presumably from fluid retention) and 10% develop hypertension. The company would not provide me with data from other sites and which soured my outlook for both DDAVP and industry sponsored research. In the absence of daytime wetting or UTI bedwetting is considered a benign voiding dysfunction (more common in boys) that generally doesn’t warrant further medical evaluation. Secondary bedwetting occurs commonly (25% of all bedwetters used to be dry at night) but is not a medical concern unless accompanied by other symptoms such as daytime wetting or UTI. While bedwetting is not a medical problem, parents weary of the odors and the soiled sheets often demand treatment. Time is clearly the most effective therapy for this problem; 15% of 5 year olds, 7% of 10 year olds and perhaps 1-2% of 15 year olds will wet the bed.1 My view, supported by the literature, is that bedwetting is most likely a sleep disorder and the most effective therapy is the night time alarm system coupled with behavioral modification. 2,3 If the alarm is unsuccessful, I suggest shelving it for 6 months with subsequent re-initiation. Our mid-level providers have great success in the bed wetters by treating unrecognized bowel problems. They are able to gain dry beds with bowel management as the sole intervention for about 25% of all bedwetters similar to published results. 4
It should be noted that there is some association with obstructive sleep apnea, large tonsils and bedwetting. About 25% of all children requiring T&A will wet the bed and perhaps 1/2 of these will stop wetting the bed after surgical removal of the tonsils. 11 I am nihilist regarding pharmacologic management of bedwetting. When I started in Pediatric Urology imipramine was the drug of choice for bed wetters, but the risk profile for this drug seemed to great and I stopped using it. Anti- cholinergics are generally ineffective and , as mentioned above, DDAVP is not as effective as behavioral interventions and it too has complications. From my view isolated bedwetting is a benign voiding dysfunction that warrants no further medical evaluation. To answer the parent’s inevitable question, everything is likely OK from a medical standpoint. Lastly I’ll relate a clinical observation that I can spend 1/2 an hour talking to parents about wetting only to become aware that the parents are talking about night time wetting and while I was trying to focus on the larger Urologic issue of wetting pants in the daytime.
- Caldwell P, Deshpande A, Von Gontard A; Management of nocturnal enuresis. British Medical Journal, 347: f6259, 2013
- Glazener C, Evans J, Peto R: Alarm Interventions for Nocturnal Enuresis in Children. Chochrane Database Syst Rev 2005:2:CD002911.
- Van Dommelen P, Kamphus M, Van Leepdam J, DeWede J Regstra A, Campagne A, and Verkerk P, the Short and Long-ter Effects of Simple Behavioral Interventions for Nocturnal Enuresis in Young Children: A randomized Controlled Trial. J Pediatr, 154: 662, 2009
- McGrath KH, Caldwell P, Jones M,: The Frequency of Constipation in Children with Nocturnal Enuresis: A Comparision with Parental Reporting. J Ped Child Health, 44: 19, 2008.
