Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
Desmopressin acetate is a synthetic form of antidiuretic hormone (ADH), a substance that occurs naturally in the body and is responsible to limiting the formation of urine.
It has been in use for the treatment of bedwetting for about 10 years and is generally the first medication prescribed.
This drug imitates ADH in the body, which is secreted by the brain; it increases the concentration of the urine and reduces the amount of urine formed. It is recommended to be taken just before going to bed.
Its main use is for children who have not been helped by an alarm. It is also used as a stopgap measure to help children attend camps or sleepovers without embarrassment.
DDAVP comes as a pill and is taken before bedtime. Side effects are uncommon but include headache, runny nose, nasal stuffiness, and nosebleeds. A previously manufactured nasal spray form is generally not used since it is more likely to be associated with potentially severe side effects.
The dose is adjusted until effective. Once it is working, the dose is tapered if possible. About 25% of children with enuresis will have total dryness with desmopressin, while approximately 50% will have a significant decrease in bedwetting. When compared with alarm devices, however, approximately 60% of patients will return to bedwetting when DDAVP administration is stopped.
Imipramine is a tricyclic antidepressant that has been used to treat bedwetting for about 30 years.
How it works is not clear, but it is known to have a relaxing effect on the bladder and to decrease the depth of sleep in the last third of the night.
Initial cure rates range from 10%-60%, and it has a relapse rate of up to 80%.
Side effects tend to be rare with correct dosage, but nervousness, anxiety, constipation, and personality changes have been reported.
It can have toxic side effects if taken improperly or as an accidental overdose. Deaths have been attributed to accidental overdoses
-- most commonly associated with abnormal heart-rhythm patterns.
It may be combined with desmopressin if desmopressin alone is not effective.
Oxybutynin and hyoscyamine are medications that reduce unwanted bladder contractions. They help relieve daytime urgency and frequency in addition to uncomplicated bedwetting. Their side effects include dry mouth, drowsiness, flushing, heat sensitivity, and constipation.