Enuresis Medication

  • Author: Wm Lane M Robson, MA, MD, FRCP, FRCP(Glasg), FRSPH; Chief Editor: Marc Cendron, MD   more...
 
Updated: Apr 30, 2012
 

Medication Summary

Pharmacologic management plays an important role in the treatment of bedwetting. Three pharmacologic approaches are currently considered: desmopressin, anticholinergic medications, and imipramine.

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Vasopressin Analog

Class Summary

Secretion of vasopressin at night reduces urine output. Water is conserved and concentrated by increasing the flow in the kidney through the collecting tubules to the medullary interstitium.

Desmopressin is a synthetic analog of ADH. The first reported use of desmopressin to treat a child with bedwetting was in the 1960s. The mechanism of action was presumed to be a reduction in the overnight production of urine. Later studies demonstrated that some children with bedwetting had lower nocturnal levels of ADH than children who were dry at night. This provided a scientific rational for desmopressin use; however, not all children with bedwetting have lower levels of ADH at night, overproduce urine at night, or respond to desmopressin. In addition, not all children who respond to desmopressin have lower levels of ADH or overproduce urine at night prior to treatment with the medication.

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Desmopressin, oral (DDAVP)

 

Increases cellular permeability of collecting ducts, resulting in reabsorption of water by kidneys. Formulated as a tab and a nasal spray. Because of the risk for severe hyponatremia, the intranasal formulation is no longer indicated for PNE.

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Anticholinergic agents

Class Summary

Some children with bedwetting have a small functional bladder capacity at night. Other children with bedwetting also have daytime symptoms of frequency and urgency. These children may benefit from treatment with an anticholinergic medication that allows the bladder to hold more urine. In the absence of these situations, treatment with an anticholinergic medication is not likely to decrease the incidence of bedwetting.

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Oxybutynin (Ditropan)

 

Should be considered in children who are likely to have small functional bladder capacity either only at night or throughout the day. Daytime symptoms that may indicate potential for therapeutic benefit include frequency, urgency, and incontinence. Nighttime symptoms include wetting more frequently than once per night. Formulated as a liquid and tab and ER form (not approved for children < 12 y).

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Tolterodine (Detrol)

 

Used in patients likely to have small functional bladder capacity either only at night or throughout the day. Daytime symptoms that may indicate potential for therapeutic benefit include frequency, urgency, and incontinence. Nighttime symptoms include wetting more frequently than once per night. Competitive muscarinic receptor antagonist for overactive bladder. Differs from other anticholinergic drugs in that it has selectivity for urinary bladder over salivary glands.

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Flavoxate (Urispas)

 

For symptomatic relief of incontinence. Has anticholinergic effects and exerts direct effect on muscle. Counteracts smooth muscle spasm of urinary tract.

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Tricyclic antidepressants

Class Summary

Imipramine was first prescribed for bedwetting in an era when psychological causes were considered common. The modern understanding is that psychological causes are not a common cause of PNE. The mechanism whereby imipramine improves bedwetting is not clear. Current theories include CNS- or local bladder-related effects.

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Imipramine (Tofranil)

 

Facilitates urine storage by decreasing bladder contractility and increasing outlet resistance. Inhibits reuptake of norepinephrine or serotonin (5-hydroxytryptamine, 5-HT) at presynaptic neuron.

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Contributor Information and Disclosures
Author

Wm Lane M Robson, MA, MD, FRCP, FRCP(Glasg), FRSPH  Medical Director, The Children's Clinic

Wm Lane M Robson, MA, MD, FRCP, FRCP(Glasg), FRSPH is a member of the following medical societies: International Children's Continence Society, Royal College of Physicians and Surgeons of Canada, Royal College of Physicians and Surgeons of Glasgow, and Royal Society for Public Health

Disclosure: Nothing to disclose.

Specialty Editor Board

Howard M Snyder III, MD  Professor, Department of Surgery, Division of Pediatric Urology, University of Pennsylvania School of Medicine and Children's Hospital of Philadelphia

Howard M Snyder III, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Surgeons, American Medical Association, American Urological Association, and National Kidney Foundation

Disclosure: Nothing to disclose.

Mary L Windle, PharmD  Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Harry P Koo, MD  Chairman of Urology Division and Director of Pediatric Urology, Professor of Surgery, Virginia Commonwealth University School of Medicine, Medical College of Virginia; Director of Urology, Children's Hospital of Richmond

Harry P Koo, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Surgeons, and American Urological Association

Disclosure: Nothing to disclose.

Daniel Rauch, MD, FAAP  Director, Pediatric Hospitalist Program, Associate Professor, Department of Pediatrics, New York University School of Medicine

Daniel Rauch, MD, FAAP is a member of the following medical societies: Ambulatory Pediatric Association, American Academy of Pediatrics, and Society of Hospital Medicine

Disclosure: Baxter Honoraria Consulting

Chief Editor

Marc Cendron, MD  Associate Professor of Surgery, Harvard School of Medicine; Consulting Staff, Department of Urological Surgery, Children's Hospital Boston

Marc Cendron, MD is a member of the following medical societies: American Academy of Pediatrics, American Urological Association, European Society for Paediatric Urology, Johns Hopkins Medical and Surgical Association, New Hampshire Medical Society, Society for Fetal Urology, and Society for Pediatric Urology

Disclosure: Nothing to disclose.

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Table 1. Percent of Children Dry by Day and Night at Various Preschool Ages
Age, yDry by Day, %Dry by Night, %
22510
2.58548
39878
Table 2. Causes of Primary and Secondary Enuresis
Causes of Primary EnuresisCauses of Secondary Enuresis
Idiopathic



Disorder of sleep arousal



Nocturnal polyuria



Small nocturnal bladder capacity



Idiopathic



Disorder of sleep arousal



Nocturnal polyuria



Small nocturnal bladder capacity



Overactive bladder and dysfunctional voidingOveractive bladder and dysfunctional voiding
CystitisCystitis
ConstipationConstipation
Neurogenic bladderPsychological
Urethral obstructionAcquired neurogenic bladder
PsychologicalSeizure disorder
Ectopic ureterOSA
Diabetes insipidusDiabetes mellitus
Acquired diabetes insipidus
Acquired urethral obstruction
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