Archive for the ‘relapse’ Category

Bed Wetting Medication

Wednesday, March 10th, 2010

My son is 8 and wets every night. My doctor mentioned that he can prescribe a medication to help. I’m a little nervous about giving my son medicine for this. Can you tell me more?
The most frequently prescribed medication for bedwetting is DDAVP (desmopressin). This synthetic form of the natural hormone vasopressin decreases the quantity of urine produced for the next eight to 12 hours. It begins to work quickly, usually within one hour of taking it. This medication is designed to curb bedwetting by making the urine more concentrated and decreasing the total amount of urine produced that night.

Medication often has immediate results, but when you stop it, the relapse rate is high-about 80 percent. DDAVP allows about half the children who use it to sleep dry that night, which makes it particularly useful for sleepovers and camps. DDAVP is available in two forms: a nasal spray and tablet. The tablet is now preferred because it delivers a more consistent and convenient dose. The nasal spray has a Black Box Warning because of some reported cases of seizures and death because of water intoxication. Also, children with allergic congestion can get erratic results with the nasal spray.

Dosage of DDAVP must be individualized, with one to three tablets (0.2 mg.) each night before bed as the recommended dose. The greatest number of dry nights is achieved by 0.4 to 0.6 mg. nightly. If your child is taking the medication for a situation outside of his home, such as sleepover camp, start it ahead of time to establish the appropriate dose. Your child’s doctor or nurse practitioner is responsible for determining your child’s dosage, but the general recommendation is as follows:
• If your child wets when taking one tablet, increase it to two.
• If wetting occurs with two tablets, his dosage should be three tablets.
• Three tablets is the maximum amount recommended for any age group.

DDAVP is generally safe with few side effects. Reported side effects include headache, stomach ache or water intoxication if a large amount of water is ingested after taking it. The manufacturer provides fluid guidelines, recommending no more than four ounces of water before bedtime. This medication can be safely used for three- to six-month intervals with a one week break. If wetting persists, it can be used for another interval. DDAVP is expensive, as much as $3-4 per tablet. The cost should be taken into account when considering long-term use.

DDAVP does not stop wetting in every child. Increasing the length of time taken will not make it work. The expected results should be seen in a week or two. Parents should realize that this medication does not provide long-lasting effects, but it does provide short-term dryness for many children. For long lasting results, getting to dryness by using a bedwetting alarm has a more permanent response.

How to Stop Bed Wetting Relapse

Thursday, February 18th, 2010

SH writes, My son age 11 has used the wetting alarm and seemed to be cured. He stopped wetting the bed and didn’t get up to pee. He just held it till morning. Once in a while he would have a wet night. We just assumed it was from drinking too much late at night. Recently he has started having basketball practice at night which makes him drink fluids more. He has had several wet nights this month. When he has a wet night he does not realize that he has wet himself until he is cold and wet. It is quite alot of pee. Does this mean he is actually not trained and needs to start all over again after a couple years of sucess?

I do occasionally see relapses just like you’ve described. It sometimes does occur in kids who mostly just sleep through until morning dry. Because he has more fluid in his system before he goes to bed, his bladder isn’t able to hold it all night and he must get up to urinate. For some reason, the ability to wake to a full bladder isn’t there and he wets. I recommend restarting the alarm as soon as possible so that he can be alerted when the wetting is occurring. Over time, his body should be able to put together the sound with getting up. If he doesn’t respond to the loud sound, you go to his room and remind him what he should be doing. Most of the kids can get back on track by doing this. It’s better to restart the alarm for a few weeks and conquer the problem again than wait longer, hoping it will just go away.

Sleepwalking and Bedwetting

Monday, January 25th, 2010

My 7 year old son has a Malem Ultimate alarm he’s been using for 5 months. We’ve had success with it in that he has gone from nightly heavy wetting to being dry many nights. Though he has not yet had a full 14 days of his alarm staying silent, he was waking to the alarm, or self-waking and we thought we were well on the road to being done with this issue. The last 2 months however he has completely slid backwards. His alarm has gone off almost every single night.
The only other thing I can think of that might be meaningful is the fact that he gets up almost every night without fail and moves from his bed to ours. That usually happens around 1:30 – 2 a.m., and then the alarm goes off around 3 (but on some mornings, it goes off at 6 – and it’s usually just those two times, oddly enough.) I wonder if he’s waking up because he feels like he needs to go (but is choosing not to because he’s tired….)

You have brought up a couple of good points. He may certainly be getting
partial messages from his bladder but he isn’t quite interpreting them as
such. Instead, he’s finding his way into your room and not the bathroom. I
know that many nights you may not even know that he’s coming into your bed.
Is there any way that he could be prompted to use the bathroom on his way to
your room? One family that I worked with put a baby gate across the door to
their room. It was enough to signal their child that he needed to stop and
go to the bathroom before he walked in his sleep to his parents’ room. This
gentle reminder broke his pattern of getting into their bed without first
stopping at the bathroom.

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