ENURESIS (BED WETTING)
Enuresis refers to bed-wetting occurring at least several times
per month in children at least 5 to 6 years old. There is a wide
variation in the age at which nighttime urinary continence is
achieved, thus, normal preschool-age children who wet the bed are not
viewed as having enuresis but rather considered to have
developmentally appropriate night wetting. Bed-wetting is considered
normal up to age 5. When the problem persists, however, a visit to
the doctor is in order. Bed-wetting rarely signals a health problem,
but daytime wetting, which often occurs with bed-wetting yet may be
overlooked if it's only a dribble, can represent serious illness.
The first thing that needs to be established is the type of enuresis
your child is suffering from; PRIMARY or SECONDARY. A history of the
child's pattern of wetting will determine this. If he has wet
consistently with few, or, short-lived periods of dryness then a
diagnosis of primary enuresis will be given. Children with primary
enuresis have never gone for a significant period--at least six
months--without wetting the bed. Secondary (or acquired) enuresis is
bed-wetting that occurs in a child who has previously demonstrated
nighttime bladder control for six months or longer. The distinction is
important because children with secondary enuresis will more often
have underlying medical or psychological problems: structural
abnormalities or infection of the urinary tractor significant
emotional trauma. Over 90% of bed wetters, however, have primary
enuresis. Is there a family history of enuresis? Genetic
predisposition is extremely prominent. A positive family history of
enuresis can help allay the child's shame, the parents' fears, and
your suspicion of an organic etiology.
If, on the other hand, the child begins wetting after a long
period of dryness or begins wetting after no prior history of enuresis
then it's secondary enuresis.
Bedwetting may be a symptom of another problem. This is why a
thorough history is the next step including a history of toilet-
training methods, and sleep habits is needed. Even complications at
the time of delivery, birth weight and milestones can be important.
There is not one cause that encompasses all enuretics.
1. Genetic Predisposition. The one factor that does seem to play a
role in enuresis is heredity. For example, while it is estimated
that only 15% of all children are enuretic, this figure increases
to 45% when one parent was enuretic and 75% if both parents were
bed-wetters. One possible explanation may be a genetic
predisposition for insufficient productions of Antidiuretic Hormone
(ADH). Results of a study announced by a Danish investigator, Dr.
Jens Norgaard, demonstrated that 80-85 percent of his bedwetting
cases in the past nine years were due to insufficient production of
antidiuretic hormones (ADH). ADH production, which ordinarily
increases during sleep, apparently remains unchanged during both
day and night in bed wetters.
2. Smaller functional bladder capacity; that is, the enuretics can
hold less volume in their bladders before feeling the urgent need
to urinate. Over 75% of enuretic children have small functional
bladder capacity. Enuretic children often talk of a real urgency
whenever they need to urinate. These children may also experience
stronger and more frequent contractions of their bladder.
3. Obstruction. Does the child ever experience daytime incontinence?
A positive response would increase your suspicion of obstructive
uropathy or of structural anomalies such as an ectopic ureter. A
child with either of these problems will be almost constantly wet:
He or she will have damp underwear during the day and a wet bed
each night. (Diurnal incontinence may also be associated with
emotional disturbances.) Stool impaction is a rare cause of
enuresis that is always accompanied by fecal soiling. Severe
impaction can impinge on the bladder by reducing its storage
capacity or distorting the neck of the bladder and reducing control
4. Urinary Tract Infection. (UTI). Does the child have symptoms of
urinary tract infection (UTI) such as urgency, frequency, burning
pain on urination, or fever? Does the urine have a foul odor? 5% to
10% have UTI.
5. Tonsillar obstruction. (Breathing difficulties at night can cause
enuresis. These children tend to be groggy in the morning and
easily irritated. They will often be mouth breathers and snorers).
6. Neurogenic Bladder. Does the child also have fecal soiling?
Enuresis accompanied by encopresis may indicate a neurogenic
bladder. ( It may also be present in children with severe emotional
7. Urethral Meatal Stenosis. An uncommon cause of enuresis, urethral
meatal stenosis seems to be physiologically significant only if it
results in an abnormally thin and turbulent urinary stream, when it
can produce retrograde pressure, urethral inflammation, bladder
distention, and incomplete bladder emptying.
8. Diabetes mellitus or insipidus. A thorough exam is particularly
important in children with secondary enuresis, because of the
greater likelihood that their problem has organic causes.
Because psychogenic factors may weigh more heavily in children with
secondary enuresis, such children may need a more thorough
psychosocial evaluation than children with primary enuresis. Possible
1. Psychological Stress. Have there been recent significant stresses
or crises in the family--births, deaths, marital discord, a move to
a new home? Has the child changed schools? Has there been a change
in his or her school performance or in relationships with friends?
Has the child been ill or in the hospital recently? Is this a sign
of regression in response to some recent trauma. This could be the
cause, particularly in an older child, who at one time was
enuretic, has had a long period of being dry, and begins to wet
the bed after some life crises.
2. Inhibition of impulses. How does the child handle his anger? You
might ask this question of the parent(s) and then rephrase it and
direct it at the child later in the interview: "What do you do when
you get angry?" or "How would Mom and Dad feel if you got angry and
said something to them?" Inhibition of expression of affects such
as anger is sometimes a factor in enuresis, though it's more often
implicated with encopresis of daytime incontinence. If the history
suggests that an enuretic child is suppressing a significant amount
of anger or rage, whether because of guilt or fear, you may wish to
discuss this issue with the parents and the child, focusing on the
verbal expression of anger, expression through permissible motor
actions, and the constructive use of anger to resolve conflicts
rather than create them.
3. Secondary Gain. Occasionally, the child will unconsciously wet as
a means of getting back at a family member (usually the mother).
Another of these secondary gains may be the intense involvement of
the family in the enuresis problem. Effective management of bed-
wetting sometimes hinges on deft manipulation of the impact the
condition is having on the rest of the family. Who gets up when
the child wets the bed and how is the situation handled? Who's
responsible for stripping the bed and washing the soiled items?
Is the child ever left to sleep in a wet bed, or is any other form
of punishment administered? How do siblings react to the situation?
How do the parents behave toward the child on "wet mornings" and on
"dry mornings"? Does the child wish to solve his problem? Is he
embarrassed or ashamed? A child who seems to be unconcerned about
wetting the bed may be deriving secondary gains from it and may
consequently be quite difficult to treat unless you succeed in
arousing some concern or in helping parents minimize the secondary
gratifications of wetting the bed.
3. Toilet Training. When toilet training was initiated, how it
proceeded, and how well it worked can also be a factor. Although
a harsh toilet training regimen more often results in daytime
urinary or bowel incontinence, a child sometimes develops enuresis
in the context or unrealistic parental expectations in this
area. At the opposite extreme are parents who have been overly
lax about their child's impulse control (weaning and toilet
training late, for example) and who at first may not even have
spoken with the child about the bed-wetting. This exaggerated
permissiveness sometimes results in an impulse-ridden child who may
not only wet the bed but also have difficulty dealing with other
societal norms that frustrate the immediate gratification of
Bedwetting itself is a rather benign disorder. In fact, it is not the
wetting itself that causes parents to seek out treatment, but rather
the hassle and embarrassment of wet sheets and the frustration and
emotional scarring that are associated with the wetting. If your
child got up in the middle of the night to use the toilet he would
hardly be brought in for treatment. When considering whether to seek
treatment, consider these factors: Does your child request treatment?
Is your child's urination more frustrating to you or him? Is your
relationship with your child suffering from this disorder? Is your
child suffering emotional repercussions be cause he is wetting the bed
(ie teasing, low self esteem, social restrictions)?
Spontaneous resolution is generally the conservative rule if the child
and parent are willing to wait. The spontaneous cure rate for
enuresis is 15% per year after age 6 and that very few individuals are
still enuretic after puberty. If not, taking your child to his doctor
for a through medical examination to rule out the possibility of
Enuresis is a common, often misunderstood condition that affects
millions of children. Preventing psychological repercussions is an
important consideration when deciding whether to seek treatment. Look
at the stress on your child and yourself before deciding to pursue a
treatment plan. Often just knowing that the condition is not unusual
and that treatment is available is enough to alleviate a child and a
Psychological Treatments for children with enuresis without an evident
cause are varied. Most doctors agree that a combination of these work
best. An excellent behavior modification described by Nathan Azrin,
PhD, of Nova University, includes 4 basic principles:
1. Alarm system
2. Cleanliness training (putting dirty sheets into hamper and remaking
3. Nightly waking schedule to urinate
4. Positive practice (at bedtime lying down on the bed counting to 50
then getting up to urinate, repeat 20 times).
A "new generation" of enuresis alarms has rendered obsolete the older
"bell and pad" alarm, which required the child to sleep on a
cumbersome system of bed sheets and conducting mats that were attached
to a rather large alarm. At least 10 mL of urine was required to
complete the circuit and set off the alarm. The new enuresis alarms,
typified by the Wet-Stop, are lightweight, portable, transistorized,
and inexpensive ($35-$40). They're activated by even a few drops of
urine, so the child has a much better chance of being awakened in time
to finish urinating in the toilet. Moreover, they eliminate the need
for conducting mats. The Wet-Stop, for example, features a small
cotton flannel strip that is sewn to the outside of the child's
underwear. A plastic insert with two metal strips fits into a pocket
in the strip and is attached by wire to a tiny buzzer held in place by
a patch of hook-and-loop tape (Velcro) sewn near the collar or
shoulder area of the child's pajama top.
When the alarm is activated by a few drops of urine, the child stops
the buzzer by pulling the plastic insert out of the cotton pocket and
shaking or wiping it dry. There is no possibility of electric shock
because the unit is operated by tiny hearing aid batteries. The
pockets and patches can be washed and dried by machine along with the
pajamas and underwear to which they've been sewn. Four of each are
provided with each alarm.
The enuresis alarm gradually conditions an enuretic child to recognize
subliminal bladder contractors during sleep. Children with small
bladders often learn to awaken and void in the toilet instead of
urinating in bed. Children with normal-sized bladders also may
develop an increased awareness of bladder contractions during sleep
but often learn how to inhibit the micturition reflex without the
necessity of awakening to go to the bathroom. With both types of
enuretic children, the ultimate goal is to have them gain control over
the enuresis without the help of the alarm.
Enuresis alarms are slow in effecting cures, often requiring three or
more months of conscientious use. The child typically needs 4-6 weeks
to master waking up promptly at the sound the buzzer and contracting
his or her bladder sphincter so as to prevent a complete emptying of
the bladder in bed. Another 4-6 weeks are usually required for the
child to begin anticipating the alarm and awakening spontaneously upon
bladder distention or to begin successfully inhibiting the micturition
reflex. When the child has gone three weeks without wetting the bed,
he can discontinue use of the alarm.
Despite the lengthy time enuresis alarms take to cure bed-wetting,
they have the highest cure rate of any therapeutic modality currently
used for childhood enuresis, averaging about 70%. The relapse rate is
approximately 10%-15%, but a short second course of treatment with
alarms is usually successful. Relapse rates have sometimes been
dramatically reduced by the use of over learning techniques, such as
urging the child to drink as much fluid as possible in the hour before
What about the 30% of enuretic children for whom enuresis alarms fail?
Roughly half of these children use the alarm improperly,
inconsistently, or not at all, and the other half fail to awaken at
the sound of the buzzer. Some of these hard-to-wake children may be
helped by keeping a night-light on in the bedroom. It's not true,
however, that enuretic children generally spend a greater amount of
time in deep sleep than other children. Successful use of an enuresis
alarm depends on your thorough and careful explanation of its purpose
and functioning to the patient and his parents. After your
instructions, the child should be able to set up the alarm system
every night, use it correctly, and take care of its components on his
own--though he may need some parental help with responding to the
alarm quickly during the first week of therapy.
Tell the child that the purpose of the enuresis alarm is to remind him
to wake up when he has to urinate during the night. As such, he can
consider it a backup system for his self-awakening program if he has a
small bladder. Once the child understands how to operate the device,
suggest that he give himself a nightly "pep talk" before going to
sleep. This self-exhortation might run as follows: "I'm going to try
to beat my alarm tonight. I'm going to wake myself up when In feel
that I have to urinate. If the alarm goes off, I'm going to stop the
flow and finish urinating in the toilet."
Have the child continue to keep a record of his "dry nights," while
using the enuresis alarm, and urge the parents to continue providing
praise, encouragement, and rewards for his success. Schedule follow-
up visits or phone calls monthly for the duration of treatment. The
best approach to using medications for childhood enuresis is a
cautious one. The efficacy of drugs in permanently curing enuresis is
not impressive, and there is currently no safe, effective drug for
treating enuresis in children.
An enuresis alarm for nighttime use may be indicated in a child who:
1. Is age 8 or older
2. Has a small bladder capacity that has responded neither to bladder
stretching exercises nor to the various self-awakening techniques
3. Has intense motivation to try the alarm and to use it correctly,
consistently, and independently of parental aid (at least after the
4. Children with normal sized bladders who have failed in their
regimen of positive reinforcement and stream interruption exercises
may also be candidates for an enuresis alarm, again provided
they're older than age 8 and strongly motivated to try this
With counseling It's crucial to establish an optimistic setting for
therapy and a positive outlook in the patient and the parents.
Remember that the problem will eventually resolve itself, even in the
absence of treatment: The spontaneous remission rate for enuresis is
15% per year after age 6. Also make sure the parents understand that
a punitive approach to bed-wetting will only exacerbate the problem
and delay its resolution.
Once everyone is confident that the child can master the problem, try
to enlist the child's help--if he is old enough--in selecting a
treatment program. The more a child feels that a certain modality
will work for him, the greater are its chances of success. He will
also be more motivated to work on his problem if he feels like a
partner in therapy instead of its passive object. From the child's
perspective, the parents have been trying to solve his problem for
him--and have failed to do so. Now you are explaining certain things
that can be tried but leaving it up to him--the patient--to select the
right combination of choices. This shift in the "ownership" of the
problem, making it incumbent on the child to do something for himself,
may prove to be an entirely novel motivating factor for him.
In general, use the same criteria for referral to a mental health
professional as you would for a non-enuretic child. Refer if:
1. The child--or the family situation--is obviously and severely
2. The child's emotional and behavioral problems are chronic and
pervasive, adversely affecting peer relationships as well as
interactions with parents and school officials.
3. The child displays an unusually low level of self-esteem or a high
level of depression.
4. The older child whose enuresis is causing him significant shame,
embarrassment, or secondary social problems--or whose parents are
over pressuring him because of the bed-wetting
6. The child who exhibits daytime incontinence exclusively, in the
absence of a medical explanation
Bear in mind that the incidence of severe emotional problems is
probably no higher in bed wetters than in the age-matched
population at large. It's estimated that 5%-10% of all children
need professional counseling, so there's going to be some
overlap between disturbed children and enuretics.
Parental expectations can exert a significant influence on the
treatment program of an enuretic child. Some parents may simply
require reassurance that their child's enuresis is a benign
condition. This is often true of parents who were enuretic
themselves or who have had prior experience with another enuretic
Initial treatment options for enuresis in which an underlying medical
or psychological disorder is not suspected include: counseling of the
child and parents, positive reinforcement/behavior modifications,
fluid restrictions, bladder exercises, self-awakening, and
Positive reinforcement/behavior modification A popular way of
motivating enuretic children involves the use of a calendar or chart
posted in a conspicuous site in the home. On dry mornings the child
puts a star over the date, draws a smiling face, or writes the word
"dry." Make sure the parents and older siblings understand that they
should respond positively to a dry morning, whether by verbal praise
or by a hug--something that will show the child how proud and pleased
they are with his progress. Material rewards--a dime or a small gift-
-can also be profiled, though most children are sufficiently motivated
simply by knowing they have the entire family's support. Most
children also respond eagerly to a "points system," whereby a certain
number of dry mornings earns them a trip to the movies or some other
privilege. An older child can keep a record of his progress in a
diary instead of on a chart. Parents can provide a small reward when
the child demonstrates increased bladder capacity and offer praise and
encouragement when he at least matches his current record. Children
younger than age 6, however, sometimes have difficulty complying with
this exercise regimen. Keep in mind, however, that this or any other
form of behavior modification is more likely to cure enuresis over the
short term than over the long term.
In using motivational counseling and behavior modification, it's
a common mistake to assume that success in stopping enuresis without
completely resolving an underlying emotional problem that may be
contributing to it will cause the problem to surface in another area
of the child's life. On the contrary, if a child with low self-esteem
can be led to resolve his enuresis by whatever means, his ego is
enhanced, and his heightened sense of self-worth in this area may well
extend to other aspects of his psychological functioning.
Other Adjunct Measures:
1. Fluid restriction:
Have parents limit the fluid intake of their enuretic child after
dinner, and warn them not to give beverages containing caffeine,
because they increase diuresis. Make sure, however, that this
common sense recommendation abut evening fluid intake doesn't result
in conflicts between over vigilant parents and a thirsty child.
Remind the child to urinate immediately before going to bed, even
if he feels no sense of bladder fullness.
2. Cleaning bedclothes:
Involving the child in cleaning the bedclothes is another way to
help motivate him--one that also reduces parental frustration or
anger. A young child may be made to feel that he's helping to
clean up even if the parent is actually doing all the work. After
about age 6, the child can be responsible for doing all the
cleaning himself. This task can be simplified if he sleeps in his
underwear on a large towel, so that neither bed linen nor pajamas
have to be washed. In fact, if the towel and underwear are rinsed
out in the morning, they don't have to be thoroughly washed more
than once a week.
3. Bladder exercises:
Although a enuretic child should restrict his evening fluid intake,
he may benefits from increasing his daytime fluid consumptions and
attempting to prolong the interval between urinations. By drinking
approximately 1 cup/h during the day--especially in the morning--
and voiding only when the feeling of urgency has reached a high
level, the child can increase his bladder capacity by as much as 1
4. Stream interruption exercises can help children with normal bladder
capacity learn to withstand bladder spasms and achieve greater
control over the urinary sphincter. Every time the child urinates,
he should interrupt the steam when his bladder feel half empty,
count to 10, and then complete the voiding.
5. Self-awakening Before going to bed, the child rehearses actions to
perform in the middle of the night when his or her bladder is full.
You can introduce the program to the child in the following way:
"The most urine your bladder can hold is oz, but your kidneys make
at least oz during the night. The only way you can be dry at night
is by waking yourself up. There are a number of ways to do that,
but here's one way that might work. Every night at bedtime, before
you've urinated, lie down on your bed and close your eyes. Pretend
it's the middle of the night and you feel your bladder is full.
Then get out bed, go to the bathroom, and start to urinate--but
just before the stream starts, hold back and don't let the urine
out. Go back to bed and start all over again. Do this five times.
On the fifth practice run, empty your bladder. And say to yourself
every time you practice, 'This is what I'm going to do in the
middle of the night.'" An alternative to this active rehearsal
involves the use of visual sequencing, whereby the child lies on
the bed, closes his eyes, and pictures himself waking up during the
night, getting out of bed, going to the bathroom, and urinating.
Discourage the parents from waking the child before they retire for
the night. This practice prevents the child from assuming
responsibility for his problem and may delay the age at which he is
able to wake himself.
You may want to consider using it as part of the self-awakening
program for children age 5 or older. One researcher claims to
achieve a 77% cure rate by using relaxation techniques with
enuretic children and having them practice self-hypnosis every
night before they go to bed. The posthypnotic suggestion can take
the following form: "When I feel that I have to urinate, I will
wake up, go to the bathroom, urinate in the toilet, and go back to
bed." As with all other forms of therapy for enuresis, the child
being considered for hypnotherapy must be motivated not only to
solve his bed-wetting problem but also to do so by means of the
treatment modality chosen.
Cure rates are not always encouraging (for example, 35% with bladder
exercises). The greatest failure rates occur in children with very
small bladders, in those who have never been dry at night, and in
those with a parent or sibling who wet the bed into adolescence. In
the case of relapse after treatment, try the successful treatment
program again in conjunction with continuing bladder exercises.
Drug therapy is probably the most widely used medical treatment
for enuresis with imipramine being the drug most prescribed. When
taken on a regular basis imipramine is successful in controlling
enuresis at a rate up to 70%. However, children rarely stay dry once
the drug is withdrawn. Considering this, the compound is often
recommended for nights when the child really needs to stay dry such as
going to camp or sleeping at a friends. Often just knowing that they
can have a dry night when necessary helps to ease the feeling of
helplessness bedwetting can create.
The drug most frequently used for enuresis is imipramine HCL
(Janimine, SK-Pramine, Tofranil, etc.). Its initial success
rate in controlling enuresis may reach as high as 50%-60%,
but the permanent cure rate is only 25% because relapses occur at
a rate of over 50% when the drug is discontinued. This
figure may be compared with the 15%/yr spontaneous cure rate in
children over 6 years of age and with the estimated success rates
for other treatment modalities: motivational counseling, 25%; bladder
exercises, 35%; enuresis alarms, 70%. Medications for enuresis work
best in children with normal-sized bladders; the failure rate is
high in children with small bladders--the great majority of bed
wetters. Drugs are also generally ineffective in the treatment
of enuretic adolescents.
For children 8-12 years old, start imipramine HCl (Janimine, SK-
Pramine, Tofranil, etc.) at 50 mg, 1-2 hours before bedtime. In the
absence of a positive response, consider increasing the dosage to 75
mg after one week. Start children over age 12 on 75 mg.
For families with unrealistic expectations, make it clear that
imipramine does not work for some children and that, for others, it
may merely decrease the frequency of bed-wetting. Alert parents to
the possible side effects associated with the use of imipramine (see
"Drawbacks of drug therapy," page 83).
You can keep a child who shows a positve response to imipramine on the drug
for 2-3 months. Gradually taper the drug over a period of 2-4 weeks so that
discontinuance takes place after one month of continuous dryness. In case
of relapse, consider another course of 2-3 months for the child.
An antispasmodic agent sometimes used to treat childhood enuresis is
oxybutynin chloride (Ditropan). The dosage for children age 8-12 is 5 mg at
bedtime. This agent's anticholinergic side effects are similar to those of
imipramine, though the drug is not associated with cardiac arrthythmia.
Oxybutynin is the drug of choice for enuretic children with associated
day-time wetting and bladder spasms. As with imipramine, a positive
response, if it is to occur, will be seen during the first week of therapy.
Promising New Drug Treatment
Therapy using a synthetic form of ADH (Desmopressin) eliminated
bedwetting in 80 percent of children who received the drug. Of 29
children who participated in a four-week study, 20 had total
elimination of bedwetting with administration of intra-nasal
Desmopressin. Four others had a significant increase in dry nights.
The average number of dry nights for a group of 21 children followed
for six months increased from 2.2 to six nights per week.
An Illinois pediatrician, Dr. Kenneth Miller, reports similar results
following a seven-year study. His work included gradually reducing
the amount, and frequency of administration of Desmopressin. Using a
protocol he had developed, 15 of 28 bedwetting children who had
achieved dryness using the drug were weaned totally from the drug over
time and remain dry.
Desmopressin acetate (DDAVP, Rorer Pharmaceuticals),
Physiological: Desmopressin was pressed into service after
investigators discovered that primary nocturnal enuresis seems to have
a physiological cause. When children who had never been able to go
for prolonged periods of time without wetting their beds were compared
with "normal" children, it was found that enuretics produced more
urine than the bladder could properly contain, according to Jens Peter
Norgaard, Institute of Experimental Clinical Research, University of
Aarhus, Denmark. Once the bladder filled to capacity, the child would
empty it. This pattern could be repeated several times a night.
Upon examination, bladder function, sleep patterns, and micturition
were all normal, Norgaard continued. So, the researchers took a look
at antidiuretic hormone, the substance that regulates urine
production. It turned out that levels of ADH increased at night in
the normal children. As a result, they manufactured smaller
quantities of more heavily concentrated urine. Because the enuretic
children didn't experience this nightly surge in ADH, they churned out
large amounts of very dilute urine.
"Desmopressin is the only relevant drug to use when it's
established that patients have a high urine output at night," Norgaard
said. The antidiuretic, now awaiting Food & Drug Administration
approval for treatment of bedwetting, is a synthetic analog of ADH.
Thus, it does the job when the endogenous substance is not present in
sufficient quantities to suppress urine production on its own.
In one six-month study, Norgaard said, 70% of the participants
responded to the drug completely during therapy. If used correctly,
desmopressin can be effective after the first night of treatment, he
added. About 15% of patients were markedly improved. The remainder
didn't derive any benefit from desmopressin. It may be that
nonresponders have a renal problem-that their kidneys won't react to
their own ADH or the synthetic analog-he suggested.
No 'cure': But the urologist is careful never to use the word "cure"
when speaking to children or their parents. Although many will remain
dry while on the drug, he has noted a high relapse rate once it's
withdrawn. In those cases, patients are placed back on the drug until
they outgrow the need for it.
No side effect: Neither Norgaard nor Miller has seen any significant
side effects from desmopressin. Miller pointed out that, because the
drug is instilled into the nose, colds or allergies may inhibit
absorption. In almost all cases, children will spontaneously overcome
enuresis, Norgaard remarked. Although the incidence decreases with
age, the problem can last into the teen years. For instance, 10%, to
15%, of all 7 -year-olds may wet their beds at night; by age 16, the
incidence drops to 2%, to 3%.
The failure to release enough ADH at night may just be "another
maturation problem," Miller noted. The body has an internal clock that
regulates hormone secretion, and tapering desmopressin may allow it to
establish a normal rhythm, he concluded.
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