In general, medications are used in bedwetting for two reasons
to either increase bladder capacity or to reduce the amount
of urine produced by the kidneys. No medication "cures"
enuresis, however they serve a useful role for some children on
a short term basis to help them get to the point where they are
able to wake at night on their own and void. The use of medications
in combination with alarms is well documented (1-6). In
addition, the use of desmopressin acetate (DDAVP) for symptomatic
relief (i.e. dry night) has increasingly gained acceptance for use
on an as-needed basis for children who need temporary relief of
enuresis, such as for sleepovers and camps.
Desmopressin acetate is a synthetic version of antidiuretic
hormone (ADH), a hormone produced by the body's pituitary gland
that affects the kidney's urine production. In children without
enuresis, ADH typically increases during the night and reduces the
amount of urine produced (7,8). The administration
of either the nasal inhalation or tablet, before bed, reduces urine
production at night.
(Ditropan) Oxybutynin is an anticholinergic (antispasmodic)
medication that relaxes smooth muscle and therefore reduces the
bladder's ability to contract (9). It helps decrease
muscle spasms of the bladder and the frequent urge to urinate caused
by these spasms.
Imipramine is from the medication class known as tricyclic
antidepressants. These agents have been used widely over the past
twenty years for primary nocturnal enuresis, although their specific
mechanism of action (10) is not well established. They
have fallen out of favor due to their potential for major side effects
and the danger they present for accidental overdose (11,12).