Bedwetting medical therapy: Difference between revisions
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'''Editor(s)-in-Chief:''' [[C. Michael Gibson]], M.S.,M.D. [mailto:charlesmichaelgibson@gmail.com] Phone:617-632-7753; '''Steven C. Campbell''', M.D., Ph.D., [mailto:campbes3@ccf.org] Phone:216-444-5595 Professor of Surgery, Residency Program Director, Section of Urologic Oncology, Glickman Urological and Kidney Institute, Cleveland Clinic. | '''Editor(s)-in-Chief:''' [[C. Michael Gibson]], M.S.,M.D. [mailto:charlesmichaelgibson@gmail.com] Phone:617-632-7753; '''Steven C. Campbell''', M.D., Ph.D., [mailto:campbes3@ccf.org] Phone:216-444-5595 Professor of Surgery, Residency Program Director, Section of Urologic Oncology, Glickman Urological and Kidney Institute, Cleveland Clinic. | ||
==Overview== | |||
Treatments range from [[Behaviour therapy|behavioral-based]] options such as [[bedwetting alarm]]s, to medication such as hormone replacement, and even surgery such as urethral enlargement. Since most bedwetting is simply a developmental delay, most treatment plans aim to protect or improve [[self-esteem]].<ref name="johnson" /> Bedwetting children and adults can suffer emotional stress or psychological injury if they feel shamed by the condition. Treatment guidelines recommend that the physician counsel the parents, warning about psychological damage caused by pressure, shaming, or punishment for a condition children cannot control.<ref name="johnson" /> | |||
==Medical Therapy== | ==Medical Therapy== | ||
[[ | There are a number of treatment and condition management options for bedwetting. The following options apply when the bedwetting is not caused by a specifically identifiable medical condition such as a bladder abnormality or diabetes. | ||
===When Treatment is Recommended=== | |||
Doctors consider treatment when there is a specific medical condition such as [[bladder]] abnormalities, [[infection]], or [[diabetes]]. Physicians also treat bedwetting when it may harm the child's [[self-esteem]] or relationships with family/friends. Only a small percentage of bedwetting is caused by a specific medical condition, so most treatment is prompted by concern for the child's ''emotional'' welfare. Behavioral treatment of bedwetting overall tends to show increased self-esteem for children <ref>Patrick C. Friman and Kevin M. Jones (2005): Behavioral Treatment for Nocturnal Enuresis. ''Journal of Early and Intensive Behavioral Intervention 2 (4),'' Pg. 259- 267 [http://www.baojournal.com BAO]</ref> | |||
Parents become concerned much earlier than doctors. A study in 1980 asked parents and physicians the age that children should stay dry at night. The average parent response was 2.75 years old, while the average physician response was 5.13 years old.<ref>{{cite journal |author=Shelov SP, Gundy J, Weiss JC, ''et al.'' |title=Enuresis: a contrast of attitudes of parents and physicians |journal=Pediatrics |volume=67 |issue=5 |pages=707–10 |year=1981 |month=May |pmid=7255000 |doi= |url=}}</ref> | |||
Punishment is not effective and can interfere with treatment. | |||
===Treatment Options with High Success Rates=== | |||
====Waiting==== | |||
Almost all children will outgrow bedwetting. For this reason, urologists and pediatricians frequently recommend delaying treatment until the child is at least six or seven years old. Physicians may begin treatment earlier if they perceive the condition is damaging the child's self-esteem and/or relationships with family/friends.<!-- Deleted image removed: [[File:Wearable alarm.gif|thumb|250px|Wearable Bedwetting Alarm]] --> | |||
====Bedwetting Alarms==== | |||
Physicians also frequently suggest [[bedwetting alarm]]s which sound a loud tone when they sense moisture. This can help [[Classical conditioning|condition]] the child to wake at the sensation of a full [[Urinary bladder|bladder]]. These alarms are considered effective, with study participants being 13 times more likely to become dry at night. There is a 29% to 69% relapse rate, however, so the treatment may need to be repeated.<ref name="bmj">{{cite web|url=http://www.bmj.com/cgi/content/full/323/7322/1167?view=full&pmid=11711411#SEC5|title=Evidence based paediatrics: Evidence based management of nocturnal enuresis|publisher=BMJ|accessdate=2008-02-03|last=Evans|first=Jonathan}}</ref> | |||
====DDAVP (Desmopressin)==== | |||
[[Desmopressin]] tablets are a synthetic replacement for [[Vasopressin|antidiuretic hormone]], the hormone that reduces urine production during sleep. Desmopressin is usually used in the form of desmopressin acetate, DDAVP. Patients taking DDAVP are 4.5 times more likely to stay dry than those taking a placebo.<ref name="bmj" /> The drug replaces the hormone for that night with no cumulative effect. <br /> US drug regulators have banned using desmopressin nasal sprays for treating bedwetting since the oral format are considered safer. | |||
====Tricyclic Antidepressants==== | |||
[[Tricyclic antidepressant]] [[prescription drug]]s with [[anti-muscarinic]] properties have been proven successful in treating bedwetting, but also have an increased risk of side effects, including death from overdose.<ref>Evaluation and management of enuresis, W. Lane M. Robinson, N Engl J Med, 360:1429</ref> These drugs include [[amitriptyline]], [[imipramine]] and [[nortriptyline]]. Studies find that patients using these drugs are 4.2 times as likely to stay dry as those taking a [[placebo]].<ref name="bmj" /> The relapse rates after stopping the medicines are close to 50%. | |||
===Condition Management Options=== | |||
====Absorbent Underwear==== | |||
Absorbent underwear or diapers can reduce embarrassment for bedwetters and make cleanup easier for caregivers. These products are known as training pants or diapers when used for younger children, and as absorbent underwear or incontinence briefs when marketed for older children and adults. Some brands of diaper are marketed especially for sufferers of bedwetting. A major benefit is the reduced stress on both the bedwetter and caregivers. Absorbent underwear can be especially beneficial for bedwetting children wishing to attend sleepovers or campouts, reducing emotional problems caused by social isolation and/or embarrassment in front of peers. Extended diaper usage may interfere with learning to stay dry at night, at least in adults with severe disabilities.<ref>{{cite web|url=http://seab.envmed.rochester.edu/jaba/articles/2004/jaba-37-01-0097.pdf|format=PDF|title=EXTENDED DIAPER WEARING: EFFECTS ON CONTINENCE IN AND OUT OF THE DIAPER|publisher=JOURNAL OF APPLIED BEHAVIOR ANALYSIS|accessdate=2008-02-03|last=|first=}}</ref> | |||
*Waterproof mattress pads are used in some cases to ease clean-up of bedwetting incidents, however they only protect the mattress, and the sheets, bedding or sleeping partner may be soiled. | |||
===Unproven/Ineffective Treatment Options=== | |||
====Acupuncture==== | |||
While acupuncture is safe in most adolescents,<ref>{{cite journal|last=Jindal|first=Vanita|coauthors=Ge, A., Manksy, P. J.|title=Safety and efficacy of acupuncture in children: A review of the evidence|journal=Journal of Pediatric Hemotol Oncology|volume=30|issue=6|pages=431–442|doi=10.1097/MPH.0b013e318165b2cc|url=http://www.ncbi.nlm.nih.gov/pmc/articles/pmc2518962/|accessdate=2012-02-18}}</ref> studies done to assess its effectiveness for nocturnal enuresis are of low quality.<ref>{{Citation| title = Acupuncture for nocturnal enuresis in children: A systematic review and exploration of rationale | |||
| year = 2005| journal = Neurourol. Urodyn| pages = 272| volume = 24| issue = 267| doi = 10.1002/nau.20108| last1 = Tang | first1 = J.| last2 = Yeung | first2 = C. }}</ref> | |||
====Dry Bed Training==== | |||
Dry bed training consists of a strict schedule of waking the child at night, attempting to condition the child into waking by himself/herself.<ref name="yahoohealth">{{cite web|url=http://health.yahoo.com/fitness-resources/dry-bed-training-for-bed-wetting/healthwise--hw211600.html | |||
|title=Dry-bed training for bed-wetting|publisher=Yahoo! Health|accessdate=2008-02-03|last=Fackler|first=Amy}}</ref> Studies show this training is ineffective by itself<ref name="bmjconcise">{{cite web|url=http://www.aafp.org/afp/20060501/bmj.html|title=Clinical Evidence Concise: Nocturnal Enuresis|publisher=American Family Physician|accessdate=2008-02-03|last=|first=}}</ref> and does not increase the success rate when used in conjunction with a bedwetting alarm.<ref name="bmj" /> | |||
====Star Chart==== | |||
A star chart allows a child and parents to track dry nights, as a record and/or as part of a reward program. This can be done either alone or with other treatments. There is no research to show effectiveness, either in reducing bedwetting or in helping self-esteem.<ref name="bmj" /> Some psychologists, however, recommend star charts as a way to celebrate successes and help a child's self-esteem.<ref name="yahoohealth" /> | |||
== References == | == References == | ||
{{reflist|2}} | {{reflist|2}} | ||
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{{WikiDoc Sources}} | |||
[[Category:Sleep disorders]] | [[Category:Sleep disorders]] | ||
[[Category:Urology]] | [[Category:Urology]] | ||
[[Category:Pediatrics]] | [[Category:Pediatrics]] | ||
[[Category:Psychiatry]] | [[Category:Psychiatry]] | ||
[[Category:Needs overview]] | [[Category:Needs overview]] | ||
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Editor(s)-in-Chief: C. Michael Gibson, M.S.,M.D. [1] Phone:617-632-7753; Steven C. Campbell, M.D., Ph.D., [2] Phone:216-444-5595 Professor of Surgery, Residency Program Director, Section of Urologic Oncology, Glickman Urological and Kidney Institute, Cleveland Clinic.
Overview
Treatments range from behavioral-based options such as bedwetting alarms, to medication such as hormone replacement, and even surgery such as urethral enlargement. Since most bedwetting is simply a developmental delay, most treatment plans aim to protect or improve self-esteem.[1] Bedwetting children and adults can suffer emotional stress or psychological injury if they feel shamed by the condition. Treatment guidelines recommend that the physician counsel the parents, warning about psychological damage caused by pressure, shaming, or punishment for a condition children cannot control.[1]
Medical Therapy
There are a number of treatment and condition management options for bedwetting. The following options apply when the bedwetting is not caused by a specifically identifiable medical condition such as a bladder abnormality or diabetes.
When Treatment is Recommended
Doctors consider treatment when there is a specific medical condition such as bladder abnormalities, infection, or diabetes. Physicians also treat bedwetting when it may harm the child's self-esteem or relationships with family/friends. Only a small percentage of bedwetting is caused by a specific medical condition, so most treatment is prompted by concern for the child's emotional welfare. Behavioral treatment of bedwetting overall tends to show increased self-esteem for children [2] Parents become concerned much earlier than doctors. A study in 1980 asked parents and physicians the age that children should stay dry at night. The average parent response was 2.75 years old, while the average physician response was 5.13 years old.[3] Punishment is not effective and can interfere with treatment.
Treatment Options with High Success Rates
Waiting
Almost all children will outgrow bedwetting. For this reason, urologists and pediatricians frequently recommend delaying treatment until the child is at least six or seven years old. Physicians may begin treatment earlier if they perceive the condition is damaging the child's self-esteem and/or relationships with family/friends.
Bedwetting Alarms
Physicians also frequently suggest bedwetting alarms which sound a loud tone when they sense moisture. This can help condition the child to wake at the sensation of a full bladder. These alarms are considered effective, with study participants being 13 times more likely to become dry at night. There is a 29% to 69% relapse rate, however, so the treatment may need to be repeated.[4]
DDAVP (Desmopressin)
Desmopressin tablets are a synthetic replacement for antidiuretic hormone, the hormone that reduces urine production during sleep. Desmopressin is usually used in the form of desmopressin acetate, DDAVP. Patients taking DDAVP are 4.5 times more likely to stay dry than those taking a placebo.[4] The drug replaces the hormone for that night with no cumulative effect.
US drug regulators have banned using desmopressin nasal sprays for treating bedwetting since the oral format are considered safer.
Tricyclic Antidepressants
Tricyclic antidepressant prescription drugs with anti-muscarinic properties have been proven successful in treating bedwetting, but also have an increased risk of side effects, including death from overdose.[5] These drugs include amitriptyline, imipramine and nortriptyline. Studies find that patients using these drugs are 4.2 times as likely to stay dry as those taking a placebo.[4] The relapse rates after stopping the medicines are close to 50%.
Condition Management Options
Absorbent Underwear
Absorbent underwear or diapers can reduce embarrassment for bedwetters and make cleanup easier for caregivers. These products are known as training pants or diapers when used for younger children, and as absorbent underwear or incontinence briefs when marketed for older children and adults. Some brands of diaper are marketed especially for sufferers of bedwetting. A major benefit is the reduced stress on both the bedwetter and caregivers. Absorbent underwear can be especially beneficial for bedwetting children wishing to attend sleepovers or campouts, reducing emotional problems caused by social isolation and/or embarrassment in front of peers. Extended diaper usage may interfere with learning to stay dry at night, at least in adults with severe disabilities.[6]
- Waterproof mattress pads are used in some cases to ease clean-up of bedwetting incidents, however they only protect the mattress, and the sheets, bedding or sleeping partner may be soiled.
Unproven/Ineffective Treatment Options
Acupuncture
While acupuncture is safe in most adolescents,[7] studies done to assess its effectiveness for nocturnal enuresis are of low quality.[8]
Dry Bed Training
Dry bed training consists of a strict schedule of waking the child at night, attempting to condition the child into waking by himself/herself.[9] Studies show this training is ineffective by itself[10] and does not increase the success rate when used in conjunction with a bedwetting alarm.[4]
Star Chart
A star chart allows a child and parents to track dry nights, as a record and/or as part of a reward program. This can be done either alone or with other treatments. There is no research to show effectiveness, either in reducing bedwetting or in helping self-esteem.[4] Some psychologists, however, recommend star charts as a way to celebrate successes and help a child's self-esteem.[9]
References
- ↑ 1.0 1.1
- ↑ Patrick C. Friman and Kevin M. Jones (2005): Behavioral Treatment for Nocturnal Enuresis. Journal of Early and Intensive Behavioral Intervention 2 (4), Pg. 259- 267 BAO
- ↑ Shelov SP, Gundy J, Weiss JC; et al. (1981). "Enuresis: a contrast of attitudes of parents and physicians". Pediatrics. 67 (5): 707–10. PMID 7255000. Unknown parameter
|month=ignored (help) - ↑ 4.0 4.1 4.2 4.3 4.4 Evans, Jonathan. "Evidence based paediatrics: Evidence based management of nocturnal enuresis". BMJ. Retrieved 2008-02-03.
- ↑ Evaluation and management of enuresis, W. Lane M. Robinson, N Engl J Med, 360:1429
- ↑ "EXTENDED DIAPER WEARING: EFFECTS ON CONTINENCE IN AND OUT OF THE DIAPER" (PDF). JOURNAL OF APPLIED BEHAVIOR ANALYSIS. Retrieved 2008-02-03.
- ↑ Jindal, Vanita. "Safety and efficacy of acupuncture in children: A review of the evidence". Journal of Pediatric Hemotol Oncology. 30 (6): 431–442. doi:10.1097/MPH.0b013e318165b2cc. Retrieved 2012-02-18. Unknown parameter
|coauthors=ignored (help) - ↑ Tang, J.; Yeung, C. (2005), "Acupuncture for nocturnal enuresis in children: A systematic review and exploration of rationale", Neurourol. Urodyn, 24 (267): 272, doi:10.1002/nau.20108
- ↑ 9.0 9.1 Fackler, Amy. "Dry-bed training for bed-wetting". Yahoo! Health. Retrieved 2008-02-03.
- ↑ "Clinical Evidence Concise: Nocturnal Enuresis". American Family Physician. Retrieved 2008-02-03.