Bedwetting in Older Adolescents

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Bedwetting in Older Adolescents

Question:

My child is 18 and still struggles with bedwetting. Can you give me more information on treatment options for this, such as conditioning alarms and desmopressin tablets?

Answer:

While bedwetting (nocturnal enuresis) is quite common in younger children, at age 18 it is much less common. So if you haven't already done so, have your child thoroughly checked out by a doctor. Sometimes wetting can be caused by bladder or urethral problems, constipation, seizures or other neurological disorders, obstructive sleep apnea, or hormonal problems. If any of those are the case, there are specific treatments that may be helpful.

If your child has been checked out and diagnosed with "idiopathic" (the doctor term for we-don't-know-why-it's-happening) enuresis, there are various treatment options available. The two you mention, the conditioning alarm and desmopressin tablets, are the most frequently used.

The alarm has a success rate of around 68%. It can take months to be truly effective, and it takes a real commitment on the part of the family (as well as a willingness to have nearby sleepers woken by the noise of the alarm). Relapses are common. But it's absolutely worth a try.

Desmopressin tablets works by decreasing the amount of urine the body makes. The pill is safer, but it also comes as a nasal spray. To avoid serious side effects, it's important that people taking it limit the amount of fluid they drink with the evening meal and afterward. Talk to your doctor for exact instructions. It works in about half of the people who use it. Some people use it just for special occasions, such as sleepovers, instead of every night.

Other treatments include anticholinergic medicines such as oxybutynin, which helps bladder instability, or imipramine, a tricyclic antidepressant. Neither is as effective as the alarm or desmopressin, and both can have serious side effects.

Bedwetting can be an embarrassing, upsetting and difficult-to-treat problem. Working closely with your doctor, and perhaps a urologist, will give your child the best chance of staying dry.

Claire McCarthy, M.D., is a senior medical editor for Harvard Health Publications. She is an instructor in pediatrics at Harvard Medical School, an attending physician at Children's Hospital of Boston, and co-director of the pediatrics department at Martha Eliot Health Center, a neighborhood health service of Children's Hospital. The author of two books, "Learning How the Heart Beats" and "Everyone's Children", Dr. McCarthy was a regular columnist for "Sesame Street Parents Magazine" from 1995 to 1998 and is currently a contributing editor for "Parenting Magazine".

Last updated:	July 20, 2009