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Although a considerable number of research studies have been conducted to enhance understanding of this child incontinence problem, many aspects of Enuresis (Bed-wetting) are still not fully understood. However, there are a few characteristics commonly agreed upon by professionals around the world:
- 1)80% of the patients treated by the Bedwetting Alarm achieve complete dryness. Failure comes in most cases as a result of noncompliance with treatment instructions.
- 2)Those who suffer from bedwetting are normal children, healthy both physically and mentally, and function well in all aspects of life.
- 3)There are more boys (65%) than girls (35%) amongst bedwetting children.
- 4)85% of the bed-wetters have a hereditary background (one of the parents or other relatives suffered from bedwetting as a child)
- 5)Children who wet their beds don’t sleep as well as children who don’t suffer from this problem.
- 6)Recovery from bedwetting has substantial positive effects in a number of areas. It improves the general atmosphere in the home environment (as a result of relief from the burden surrounding washing the sheets, unpleasant odors, feelings of anger towards the child, and the need to keep a “secret.”) It improves the self-image of the child, who perceived himself as a failure and was ashamed of his bed wetting problem. It contributes to building self-confidence and enhances a child’s social adjustment abilities as a result of lifting limitations regarding trips, sleeping over at friends’ homes etc., which came out of fear of bed-wetting. These known facts put special emphasis on the importance of treatment at an early age.
- 7)Treatment with the bed wetting alarm is considered the most effective for the problem. Below is an abstract from Nelson Texbook of Pediatrics, commonly believed to be the world’s leading authority in pediatric medicine.
Child incontinence – Nelson Textbook of Pediatrics
The ” Bible” of child medicine clearly states that treatment of Nocturnal Enuresis with the Bedwetting alarm should always be the first choice:Behrman, R. E., Kleigman, R., & Jenson, H. B. (2004). Nelson Textbook of Pediatrics (17th ed.). Philadelphia, PA: Saunders.
Nelson, 2004 page 74 section 20.4
Textbook of Pediatrics
Enuresis (Bed Wetting)
Treatment management of the child with enuresis should begin with behavioral treatment
Pharmacotherapy for enuresis is second-line treatment and should be reserved for those patients who have failed
Head to head comparison studies of the bell and pad (alarm) versus imipramine and demopressin acetate (DDAVP)
Reveal significantly lower relapse rates for the bell and pad (alarm), although the initial response rates are similar.
The fast action of DDAVP suggests a role for special occasions (such as overnights) when rapid control
of enuresis is desired.
Unfortunately, the relapse rate upon discontinuation of DDAVP is very high.
One month of treatment typically costs as much as bell and pad (alarm) system that can be used for as many
Months as needed.
The above conclusion is based on findings of many studies. The abstracts of two of them are presented below:
Primary Nocturnal Enuresis: A Comparison Among Observation, Imipramine, Desmopressin Acetate and Bed-Wetting Alarm Systems.
Journal of Urology. 154(2):745-748, August 1995.
Jeffrey M. Monda; Douglas A. Husmann
Patients with primary nocturnal enuresis were entered into 4 treatment groups:observation, imipramine, desmopressin acetate or alarm therapy. Patients were weaned from therapy 6 months after inclusion in the study and were evaluated for continence at 3, 6, 9 and 12 months after beginning the study protocol. Of the 50 patients under observation 6 percent were continent at 6 months and 16 percent were continent within 12 months. Of 44 patients treated with imipramine 36 percent were continent at 6 months on medication; however, only 16 percent were continent at 12 months, off medication. Similarly, of the 88 patients treated with desmopressin acetate 68 percent were continent at 6 months but only 10 percent were continent at 12 months. Of the 79 patients treated with alarm therapy 63 percent were continent at 6 months and 56 percent were dry at 12 months. Although each form of therapy improved continence over observation alone (p less than 0.01), only the bed-wetting alarm system demonstrated persistent effectiveness (p less than 0.001).
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):749-753, August 1995.
H. Gil Rushton; A. Barry Belman; Mark Zaontz; Steven J. Skoog; Stephen Sihelnik
To determine if urine osmolality parameters can predict whether children with primary monosymptomatic nocturnal enuresis will respond to desmopressin, we conducted a prospective, double-blind, placebo-controlled study in 96 children 8 to 14 years old. Following a 2-week baseline screening interval patients with at least 6 of 14 wet nights were randomized to double-blind regimens of desmopressin or placebo. Urine specimens for osmolality were collected at 6 p.m. and 6 a.m. on 3 consecutive days during the baseline and the 2, 14-day treatment periods.
A significantly greater proportion of desmopressin treated children had an excellent (2 or fewer wet nights in 14 days) or good (greater than 50 percent reduction in wet nights) response compared with placebo treated children (p = 0.004 and p = 0.002 for treatment periods 1 and 2, respectively). Children treated with desmopressin reported a significantly lower number of wet nights than placebo treated children during both treatment periods (p = 0.0258 and p = 0.0136, respectively). Children treated with desmopressin had a significantly higher 6 a.m. urine osmolality during both treatment periods and a higher 6 a.m.-to-6 p.m. osmolality ratio (p = 0.004) in the first treatment period compared with the placebo group. Within the desmopressin treatment group clinical responders had a higher 6 a.m. urine osmolality and 6 a.m.-to-6 p.m. urine osmolality ratio than nonresponders during both treatment periods but these differences did not achieve statistical significance.
In conclusion, treatment with desmopressin is associated with a significant decrease in the number of wet nights, and a significant increase in nocturnal urine osmolality and nocturnal/diurnal urine osmolality ratios. However, clinical response was not predictable based on baseline or treatment osmolality parameters.
For a complete list of references related to child incontinence, please press here.