Treating Enuresis

[SpongeBob DoctorPants]

Does anyone here have experience treating enuresis in children? In my fellowship training, this never came up as all of my patients with this problem were already on desmopressin or imipramine, started by their pediatricians. In my current practice, however, I have had a number of kids who are wetting the bed but aren't taking anything for it. So far I have just been recommending that the parents get a bell and pad device, which is usually effective anyway. I have also considered prescribing medication in some cases, but since I haven't ever prescribed for enuresis and have only seen it done by pediatricians, I wonder if this would be an unusual practice for a psychiatrist, or outside the scope of mental health care.

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[wolfvgang22]

Child psychiatrists often prescribe these medications, but pediatrics does often beat us to it. If pediatrics wants to manage the medication, that's fine.

 

[shahseh22]

Child psychiatrists often prescribe these medications, but pediatrics does often beat us to it. If pediatrics wants to manage the medication, that's fine.

Yes. Also, many of my patients are on welfare/SSI, they don't have the funds to pay for an bed alarm, at least that is what they tell me. At least insurance will cover medication.

 

[WisNeuro]

Isn't medication only effective in like <20% of cases, with positive effects stopping after medication is stopped anyway for many, though?

 

[TexasPhysician]

Isn't medication only effective in like <20% of cases, with positive effects stopping after medication is stopped anyway for many, though?

Peds sees this a lot more, but I’d say effective about 80% of the time anecdotally. Add lifestyle changes and maturity, end result is good. Counseling/lifestyle changes can play a big role.

 

[Shikima]

Check for snoring/OSA.

 

[WisNeuro]

Peds sees this a lot more, but I’d say effective about 80% of the time anecdotally. Add lifestyle changes and maturity, end result is good. Counseling/lifestyle changes can play a big role.

I was curious, haven't heard anything about treatment since grad school (we had a children's elimination clinic on site). Cochrane reviews show about 20% effectiveness with desmo and/or tricyclics, with remission after treatment is stopped. Also, the desmo doesn't seem to add any benefit above and beyond an alarm alone. Looks like psychoed and lifestyle changes are the primary driver here of outcome.

Desmopressin for bedwetting in children | Cochrane
Tricyclics and related drugs for treating bedwetting in children | Cochrane

 

[SpongeBob DoctorPants]

I was curious, haven't heard anything about treatment since grad school (we had a children's elimination clinic on site). Cochrane reviews show about 20% effectiveness with desmo and/or tricyclics, with remission after treatment is stopped. Also, the desmo doesn't seem to add any benefit above and beyond an alarm alone. Looks like psychoed and lifestyle changes are the primary driver here of outcome.

Desmopressin for bedwetting in children | Cochrane
Tricyclics and related drugs for treating bedwetting in children | Cochrane

Thank you for the links you shared. Interesting info there.