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| |    Treatments for Bed-Wetting by Robert Needlman, M.D., F.A.A.P. reviewed by Laura Jana, M.D., F.A.A.P. Many different medications can help with bed-wetting. Some reduce urine production, others decrease the tendency of the bladder to contract, and others work in ways we don't really understand. Bed-wetting alarms By far the safest, most effective, and least expensive approach is to use a bed-wetting alarm. These little electrical devices wake the child up as soon as he begins to pass urine. One kind uses an audible buzzer; another kind vibrates like a pager, which has the advantage of not waking up the whole family. On the other hand, if your child is a deep sleeper, he may not wake with the vibrating alarm. In this case, you'll need to get up when you hear the buzzer and get him out of bed. The actual mechanism is very simple. There are two small metal strips that touch the child's underpants or pajamas. When the cloth gets wet, a tiny electric current--far too small for the child to feel--flows between the strips and sets off the device. Bed-wetting alarms work because they make the child take notice of something that he was ignoring: being wet. Bed-wetting alarms are also a mild form of punishment: No one likes being awakened from sleep by a buzzer. By delivering this mild form of punishment (technically, "negative reinforcement") every time urine escapes, the buzzer trains the child to hold the urine in. The research on bed-wetting alarms is encouraging: About 70 percent of children will become dry after a month or two of using one. And most of those (again, about 7 out of 10) who become dry will stay dry even after alarm use is stopped. Bed-wetting alarms work best if they are part of a total program that your child's doctor sets up. Usually this includes encouragement and incentives (for example, a sticker chart). The alarms are available by mail order for about $50. Unfortunately, most insurance plans won't pay for them, although it can't hurt to ask. A word of warning: Several commercial ventures promise that they can solve your child's bed-wetting problems. These businesses use bed-wetting alarms that are no more effective than the kinds you can buy yourself, and they include blank sticker charts and information and an attractive guarantee. The problem? They tend to charge hundreds of dollars. Between you and your child's doctor, you should be able to take care of the problem for much, much less. Medications Two commonly used medications to treat bed-wetting are imipramine (trade name, Tofranil) and desmopressin (also called DDAVP). Imipramine is one of a class of drugs called tricyclic antidepressants. These medications are usually used to treat depression, as their name implies, but they also do help with bed-wetting. The exact way they do this is unknown. The dose used to treat bed-wetting is usually quite low, and the risk of serious side effects is low as well. But severe side effects can happen. And if a child or adult takes an overdose of this medication, it can be fatal. So, it's important to think long and hard before deciding to use this sort of medication. Desmopressin (DDAVP) comes in the form of a nasal spray. One spray up each nostril before bed is usually very effective. Although this medication is safe, it has been known to cause severe problems with blood chemistry when taken in large overdose. More is not better. Main advantages: easy, effective. Main disadvantages: extremely expensive, and once you stop using it, you're back where you started. Both of these medications work pretty well as long as your child is taking them. But once you stop the medications, the wetting is likely to come right back. The medications are a treatment, not a cure. The alarms, on the other hand, can actually cure the problem, and they have the added benefit of being something the child did for himself--a nice boost to self-esteem. Medications are worth considering, though, if the alarm hasn't worked or if your child can't use it for some reason. Sometimes using medication along with an alarm helps do the trick. Other treatments One of the more effective treatments, and one that is 100 percent safe, is relaxation and mental imagery, also sometimes called self-hypnosis. This approach is about as effective as the bed-wetting alarms. Unfortunately, not every pediatrician is trained to do it. There is nothing mysterious about self-hypnosis. Like biofeedback, it is simply a technique for helping a child gain conscious control over muscles that are usually controlled unconsciously.
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