When I was a resident in training, researchers were actively trying to find a cause and cure for bedwetting. They thought that bedwetting was caused by having a small bladder and they thought that stretching the bladder would cure bedwetting. So they fed children diuretics that caused them to produce copious amounts of urine and asked them to sit in chairs and hold the urine. Needless to say the treatment didn't work, the children were miserable and today, more than 40 years later, a study from Denmark shows that bed wetting is not caused by having a small bladder (1a). This confirms several recent studies showing that wetting the bed is usually caused by lack of antidiuretic hormone that is produced by the brain at night to shut down the kidneys (2).
Lack of antidiuretic hormone is genetic because fathers and mothers have children who also are bed wetters. Bedwetting is common up to the age of eight, with most bed wetters growing up to become normal healthy adults. All children who wet the bed after age five should be evaluated by their pediatricians. They should have their urines checked for infection and perhaps a kidney x-ray to see if there is any abnormality in their urinary system. Most of the time, no cause is found. Bed wetters do not have more emotional or behavioral problems (11).
During the day, your kidneys are supposed to produce urine, but at night, your brain should produce an antidiuretic hormone called ADH, to shut down your kidneys. The brains of many bed wetters don't produce enough antidiuretic hormone at night, which causes their bladders to fill. When it happens to adults, they usually wake up and go to the bathroom, but bed wetters sleep through the night and wet the bed.
In the past, doctors treated bedwetting with a nasal spray containing an antidiuretic hormone called desmopressin, but many children continue to wet their beds. Intransal desmopressin is no longer recommended as a treatment of bedwetting. It can cause the body to retain water which can dilute blood sodium levels. Since the concentration of sodium in the brain becomes greater than the blood, fluid can move into the brain to cause swelling, seizures, and even death.
1a)The relationship between desmopressin treatment and voiding pattern in children. Bju International, 2002, Vol 89, Iss 9, pp 917-922. GM Hvistendahl, YF Rawashdeh, K Kamperis, MN Hansen, S Rittig, JC Djurhuus. Djurhuus JC, Aarhus Univ Hosp, Inst Expt Clin Res, DK-8200 Aarhus N, DENMARK.
1) Stenberg A, Lackgren G. Desmopressin tablets in the treatment of severe nocternal enuresis in adolescents. Pediatrics 1995(December);94(6):841-846.
2a) Efficacy of desmopressin in the treatment of nocturia: a double-blind placebo-controlled study in men. Bju International, 2002, Vol 89, Iss 9, pp 855-862. A Mattiasson, P Abrams, P VanKerrebroeck, S Walter, J Weiss. Mattiasson A, Univ Lund Hosp, Dept Urol, SE-22185 Lund, SWEDEN.
2) JM Monda, DA Husmann. Primary nocturnal enuresis: A comparison among observation, imipramine, desmopressin acetate and bed-wetting alarm systems. Journal of Urology 154: 2 Part 2 (AUG 1995):745-748.
3) HG Rushton, AB Belman, M Zaontz, SJ Skoog, S Sihelnik. Response to desmopressin as a function of urine osmolality in the treatment of monosymptomatic nocturnal enuresis: A double-blind prospective study. Journal of Urology 154: 2 Part 2 (AUG 1995):749-753. Desmopressin, DDAVP, brand name: Minirin 400 microgram tablets made by Ferring AB in Malmo, Sweden.
4) G Lackgren, B Lilja, T Neveus, A Stenberg. Desmopressin in the treatment of severe nocturnal enuresis in adolescents - a 7-year follow-up study. British Journal of Urology 81: Suppl. 3 (MAY 1998):17-23.
5) M Riccabona, J Oswald, P Glauninger. Long-term use and tapered dose reduction of intranasal desmopressin in the treatment of enuretic children. British Journal of Urology 81: Suppl. 3 (MAY 1998):24-25.
6) M Cendron, G Klauber. Combination therapy in the treatment of persistent nocturnal enuresis. British Journal of Urology 81: Suppl. 3 (MAY 1998):26-28.
7) R Butler, P Holland, H Devitt, E Hiley, G Roberts, E Redfern. The effectiveness of desmopressin in the treatment of childhood nocturnal enuresis: predicting response using pretreatment variables. British Journal of Urology 81: Suppl. 3 (MAY 1998):29-36.
8) J Vandewalle, P Hoebeke, E Vanlaecke, D Castillo, D Milicic, C Maraina, C Hussein, A Raes. Persistent enuresis caused by nocturnal polyuria is a maturation defect of the nyctihemeral rhythm of diuresis. British Journal of Urology 81: Suppl. 3 (MAY 1998):40-45.
9) R Medel, AC Ruarte, R Castera, ML Podesta. Primary enuresis: a urodynamic evaluation. British Journal of Urology 81: Suppl. 3 (MAY 1998):50-52.
10) A Vongontard, B Lettgen, H Olbing, C Heikenlowenau, E Gaebel, I Schmitz. Behavioural problems in children with urge incontinence and voiding postponement: a comparison of a paediatric and child psychiatric sample. British Journal of Urology 81: Suppl. 3 (MAY 1998):100-106.
11) PC Friman, ML Handwerk, SM Swearer, JC Mcginnis, WJ Warzak. Do children with primary nocturnal enuresis have clinically significant behavior problems? Archives of Pediatrics & Adolescent Medicine 152: 6(JUN 1998):537-539.
12)YV Natochin, AA Kuznetsova.Defect of osmoregulatory renal function in nocturnal enuresis.Scandinavian Journal of Urology and Nephrology, 1999, Vol 33, Suppl. 202, pp 40-44.
13) S Rittig, TB Matthiesen, EB Pedersen, JC Djurhuus. Sodium regulating hormones in enuresis.Scandinavian Journal of Urology and Nephrology, 1999, Vol 33, Suppl. 202, pp 45-46.
14)T Aikawa, T Kasahara, M Uchiyama. Circadian variation of plasma arginine vasopressin concentration, or arginine vasopressin in enuresis. Scandinavian Journal of Urology and Nephrology, 1999, Vol 33, Suppl. 202, pp 47-49.
15)J Hunsballe, S Rittig, EB Pedersen, JC Djurhuus. Fluid deprivation in enuresis - Effect on urine output and plasma arginine vasopressin. Scandinavian Journal of Urology and Nephrology, 1999, Vol 33, Suppl. 202, pp 50-51.
16) WLM Robson.Enuresis treatment in the US.Scandinavian Journal of Urology and Nephrology, 1999, Vol 33, Suppl. 202, pp 56-60.
17)K Hjalmas. Desmopressin treatment: Current status. Scandinavian Journal of Urology and Nephrology, 1999, Vol 33, Suppl. 202, pp70-72.
18) IN Jensen, G Kristensen.Alarm treatment: Analyses of response and relapse.Scandinavian Journal of Urology and Nephrology, 1999, Vol 33, Suppl. 202, pp 73-75.
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