Certainly. Drug treatment for enuresis—typically referring to nocturnal enuresis (bedwetting during sleep)—is considered when behavioral strategies alone (such as alarms, fluid restriction, bladder training) are insufficient, especially in older children, adolescents, or even adults.
1. First, clarify the type of enuresis:
- Primary nocturnal enuresis: Never achieved consistent nighttime dryness.
- Secondary enuresis: Bedwetting recurs after a dry period (often linked to stress, trauma, or underlying conditions).
- Monosymptomatic: Bedwetting only, without daytime urinary symptoms.
- Non-monosymptomatic: Also has daytime symptoms (urgency, frequency, incontinence).
Drug therapy is most often used in monosymptomatic primary nocturnal enuresis, after age 6–7.
2. Pharmacologic Options
a.
Desmopressin (DDAVP)
–
First-line drug
- Mechanism: Synthetic analog of vasopressin (antidiuretic hormone); reduces nighttime urine production.
- Form: Oral tablet or melt (sublingual); older intranasal forms are less favored due to hyponatremia risk.
- Dose: Typically 0.2–0.4 mg at bedtime.
- Efficacy: Reduces frequency of wet nights in ~60% of patients.
- Cautions: Risk of hyponatremia, especially with excessive fluid intake. Fluids should be restricted 1 hour before and 8 hours after taking DDAVP.
- Relapse is common after stopping, so it’s best for temporary use (e.g., sleepovers).
b.
Imipramine
(a tricyclic antidepressant)
- Mechanism: Unknown, but likely involves anticholinergic and arousal effects.
- Dose: Usually 10–25 mg at bedtime (start low).
- Efficacy: Around 40–60% response, but high relapse rate on discontinuation.
- Cautions: Cardiac toxicity, risk of overdose (fatal in small amounts), mood side effects. Use with caution and only short-term.
- Mostly reserved for refractory cases or when desmopressin fails.
c.
Anticholinergic agents
(e.g.,
oxybutynin
,
tolterodine
)
- Use case: More useful in non-monosymptomatic enuresis, especially when associated with bladder overactivity, small bladder capacity, or daytime symptoms.
- Mechanism: Reduce bladder contractions and increase bladder capacity.
- Side effects: Dry mouth, constipation, flushing.
d.
Combination therapy
- In difficult cases, combinations (e.g., desmopressin + anticholinergic) can be more effective than monotherapy.
3. General Principles
- Drugs do not cure enuresis; they control symptoms.
- Best combined with behavioral interventions (e.g., enuresis alarms).
- Regular follow-up is essential to monitor side effects and adjust treatment.
- Spontaneous resolution occurs in ~15% of children per year.
4. Special Notes on Adults
- Adult enuresis is rarer and may indicate underlying pathology: sleep apnea, neurogenic bladder, urinary tract obstruction, diabetes, or trauma. Pharmacological treatment here must follow comprehensive assessment.
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