By adolescence, only 4 percent of boys and 2 percent of girls wet the bed; the figures fall to 1.5 percent and 0.5 percent by age eighteen. So you can appreciate how distressing it is to be one of those teenagers who is still experiencing urinary incontinence at night. In most cases the lack of bladder control has been a problem since birth, as opposed to having resurfaced after six months or more of dryness. The former condition is called primary nocturnal enuresis; the latter, secondary nocturnal enuresis.
How Nighttime Incontinence is Evaluated
The cause for nocturnal enuresis is multifactoral. Contributing factors may include poor dietary control with excessive caffeine intake, a deep sleep pattern that can be part of normal adolescent development, inconsistent sleep schedule and limited hours sleeping. Other influencing factors include:
Primary nocturnal enuresis often follows a similar pattern. It is helpful to identify the age of nocturnal continence for both parents. If one parent was incontinent through a particular age, their children will have a similar problem approximately 40 percent of the time. If both parents have primary nocturnal enuresis through a particular age, their children have a 70 percent chance of following a similar pattern. Secondary enuresis in older children or adolescence should prompt a review for urinary-tract infections, major medical illnesses, social stress factors and the potential for sexual abuse.
How Nighttime Incontinence is Treated
Treatment of nocturnal enuresis is based on differentiating primary from secondary nocturnal enuresis. Any factor that resulted in secondary nocturnal enuresis would need to be managed prior to concentrating on the enuretic event. A child who actively participates in their treatment has a better chance to improve their outcome.
It is first important to educate the child and family on appropriate dietary intake. While totally restricting fluids is not practical, eliminating products with caffeine is essential and recommending moderate intake is appropriate. The child needs to routinely use the bathroom prior to going to bed and immediately upon waking in the morning. You can wake your teenager once during the night so he can urinate if necessary, but waking him more than once a night may disrupt his sleep pattern, which could lead to diminished school performance the following day.
Behavior modification through the use of an enuretic alarm is effective in approximately 70 percent of motivated children. The device contains moisturesensitive sensors that result in buzzing or vibrating. Typically the expense for these alarms is sixty to a hundred dollars. This form of therapy requires active participation by an adult and long-term commitment. Strong office support should be provided in follow-up.
There are only two medications that have been approved for nocturnal enuresis—imipramine and desmopressin. The exact action of imipramine is not completely understood, but it has been shown to be effective in approximately 50 percent of enuretic children. The dosing of imipramine is somewhat arbitrary and the family should be advised regarding the potential toxicity for overdose of the medication. A baseline EKG prior to initiating therapy is recommended although cardiac side effects have not been reported with doses used to treat bed-wetting. The family should also maintain strict control over dispensing the medication because of the potential for overdosing.
Desmopressin (DDAVP) is a synthetic antidiuretic hormone (ADH). Its mechanism of action is similar to ADH and is effective in improving nocturnal enuresis in approximately 40 to 60 percent of children. DDAVP is available in both nasal spray and pill forms. When continued long term, expense can become an issue with medication costing $80 to $120 for a month’s supply.