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Treatment Options for Bed-Wetting

31 Mar 2006 10:37 PM -

A reader passed on an interesting home remedy for her 8 year old boy, whose bed-wetting resolved with a teaspoon of honey given in the evening. Bed-wetting, also known as ‘Nocturnal Enuresis' is a common problem and is considered normal up to the age of 5 years. Ten per cent of 5 year olds wet the bed and it is more common in boys than girls. There is often a strong family history of bed-wetting. Nocturnal enuresis is thought to be caused by a combination of factors, namely underdeveloped arousal response to a full bladder, excess urine production during sleep and reduced functional bladder capacity. Because it happens during sleep, the child has no conscious control over it. Bedwetting can also be associated with constipation and functional bladder problems, especially if daytime incontinence occurs simultaneously.

Some research on the internet reveals a couple of interesting references to honey as a remedy for bed-wetting. It seems that it is originally an African natural remedy and it is claimed to work by its sedative actions on the nervous system and fluid retention effects on the kidneys. Unfortunately, I could not find any placebo controlled trials to support this treatment, which is my preference before recommending a treatment.

There are a number of good trials available that have looked at effectiveness of various treatments available for nocturnal enuresis. The following treatments are suggested by the literature:

  1. No treatment. Avoidance of punishment for bed-wetting. Most cases resolve over time, but 1% of 17 year olds may still wet the bed.
     
  2. Bed alarm or underpant probe alarms. These sense loss of urine and an alarm wakes the child (and usually the rest of the family)There is good evidence supporting the use of bed alarms and studies showed short term and long term benefits. The downside is that it is hard work and the family must be motivated. Poor family motivation and adverse family circumstances reduce effectiveness.
     
  3. Desmopressin is a drug that acts on the brain to reduce the amount of urine produced during the night.
    It is usually given as a nasal spray during the evening and can be used in children over the age of six years. Caution must be used to restrict evening fluid intake to prevent water overload and brain swelling. It can also cause nasal irritation. Used by itself, it is effective in the short-term, but relapses are common once the treatment is stopped.
     
  4. Combining Bed alarms and Desmopressin. This is more effective than either treatment by itself, and long term results are better.
     
  5. Imipramine - This is an old anti-depressant medication that causes urinary retention as a side effect. It has a moderate benefit while being taken, but relapses are common when the drug is ceased. There are concerns about the high incidence of side effects and it can be lethal in overdose.
     
  6. Oxybutinin - This drug relaxes the bladder and causes urinary retention. There are conflicting reports in the literature regarding its effectiveness, but there is concern about the high rate of side effects with this drug.
     
  7. Hypnotherapy - Hypnotherapy has been put forward as another possible drug-free way to address nighttime wetting, especially in children older than seven years old. Hypnotherapy in this context focuses on empowering the children to take control of their own bodily functions. It's claimed advantages are that it is completely non-invasive and free of side effects. It is also apparently useful in daytime urinary symptoms and can also be used to enhance other more established treatments such as enuresis alarm systems. Unfortunately there a few well documented comparative studies on the benefits of hypnotherapy versus other more established treatment options, but there are a number of anecdotal studies to support its use. Hypnotherapy is becoming more accepted as a valuable and legitimate tool that can be used to enhance traditional approaches, particularly when employed by well-trained professionals.

Useful Websites:

www.cyh.com/healthtopics (Child & youth Health Services, SA)

http://www.continence.org.au/ (National Continence foundation of Australia)

http://www.bedwetting.com.au/ ('Boss of the Bladder' Program by Dr Janet Hall)

Sources:

1. Evidence based management of nocturnal enuresis. BMJ. Volume 323, 17 Nov 2001, 1167-1170.

2. Children's Hospital at Westmead. http://www.chw.edu.au/parents/factsheets/ .

3. Bedwetting and toileting problems in children. Wicks,G. MJA Jun 2005, Vol 182 No.11, 596.