Home Remedies: Patience to reduce bed-wetting

• By

  Dana Sparks

  June 26, 2019

Most children outgrow bed-wetting on their own. If treatment is needed, it can be based on a discussion of options with your health care provider and identifying what will work best for your situation.

If your child isn’t especially bothered or embarrassed by an occasional wet night, lifestyle changes — such as avoiding caffeine entirely and limiting fluid intake in the evening — may work well. However, if lifestyle changes aren’t successful or if your grade schooler is terrified about wetting the bed, he or she may be helped by additional treatments.

If found, underlying causes of bed-wetting, such as constipation or sleep apnea, should be addressed before other treatment.

Options for treating bed-wetting may include moisture alarms and medication.

Here are changes you can make at home that may help:

• Limit fluids in the evening.  It’s important to get enough fluids, so there’s no need to limit how much your child drinks in a day. However, encourage drinking liquids in the morning and early afternoon, which may reduce thirst in the evening. But don’t limit evening fluids if your child participates in sports practice or games in the evenings.
• Avoid beverages and foods with caffeine. Beverages with caffeine are discouraged for children at any time of day. Because caffeine may stimulate the bladder, it’s especially discouraged in the evening.
• Encourage double voiding before bed. Double voiding is urinating at the beginning of the bedtime routine and then again just before falling asleep. Remind your child that it’s OK to use the toilet during the night if needed. Use small night lights, so your child can easily find the way between the bedroom and bathroom.
• Encourage regular toilet use throughout the day. During the day and evening, suggest that your child urinate every two hours or so, or at least often enough to avoid a feeling of urgency.
• Prevent rashes. To prevent a rash caused by wet underwear, help your child rinse his or her bottom and genital area every morning. It also may help to cover the affected area with a protective moisture barrier ointment or cream at bedtime. Ask your pediatrician for product recommendations.

Alternative medicine

Some people may choose to try complementary or alternative medicine approaches to treat bed-wetting. For approaches such as hypnosis, acupuncture, chiropractic therapy and herbal therapy, evidence of effectiveness for bed-wetting is weak and inconclusive or such efforts have proved to be ineffective. In some cases, the studies were too small or not rigorous enough, or both.

Be sure to talk to your child’s health care provider before starting any complementary or alternative therapy. If you choose a nonconventional approach, ask if it’s safe for your child and make sure it won’t interact with any medications your child may take.

Coping and support

Children don’t wet the bed to irritate their parents. Try to be patient as you and your child work through the problem together. Effective treatment may include several strategies and may take time to be successful.

• Be sensitive to your child’s feelings. If your child is stressed or anxious, encourage him or her to express those feelings. Offer support and encouragement. When your child feels calm and secure, bed-wetting may become less problematic. If needed, talk to your pediatrician about additional strategies for dealing with stress.
• Plan for easy cleanup. Cover your child’s mattress with a plastic cover. Use thick, absorbent underwear at night to help contain the urine. Keep extra bedding and pajamas handy. However, avoid the long-term use of diapers or disposable pull-up underwear.
• Enlist your child’s help. If age-appropriate, consider asking your child to rinse his or her wet underwear and pajamas or place these items in a specific container for washing. Taking responsibility for bed-wetting may help your child feel more control over the situation.
• Celebrate effort. Bed-wetting is involuntary, so it doesn’t make sense to punish or tease your child for wetting the bed. Also, discourage siblings from teasing the child who wets the bed. Instead, praise your child for following the bedtime routine and helping clean up after accidents. Use a sticker reward system if you think this might help motivate your child.

This article is written by Mayo Clinic staff. Find more health and medical information on mayoclinic.org.

Related post: Mayo Clinic Q and A: Helping your child with bed-wetting

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Treatment of Bladder Control Problems & Bedwetting in Children

How can my child’s doctor and I treat a bladder control problem?

When a health condition causes the wetting—such as diabetes or a birth defect in the urinary tract—doctors will treat the health problem, and the wetting is likely to stop.

Other common treatments for wetting include bladder training, moisture alarms, medicines, and home care. Teamwork is important among you, your child, and your child’s doctor. You should reward your child for following a program, rather than for staying dry—because a child often cannot control wetting.

If your child wets both day and night, the doctor is likely to treat daytime wetting first. Children usually stay dry during the day before they gain bladder control at night.

Daytime wetting

Treatments for daytime wetting depend on what’s causing the wetting, and will often start with changes in bladder and bowel habits. Your child’s doctor will treat any constipation, so that hard stools don’t press against the bladder and lead to wetting.

Bladder training

Bladder training helps your child get to the bathroom sooner and may help reset bladder systems that don’t work together smoothly. Programs can include

• urinating on schedule every 2 to 3 hours, called timed voiding.
• urinating twice during one visit, called double voiding. This method may help the bladder empty completely in children who have an underactive or “lazy” bladder or vesicoureteral reflux (VUR)
• relaxing the pelvic floor muscles so children can empty the bladder fully. A few sessions of biofeedback can retrain muscles that don’t work together in the right order.

In extremely rare cases, doctors may suggest using a thin, flexible tube, called a catheter, to empty the bladder. Occasional use of a catheter may help develop better bladder control in children with a weak, underactive bladder.

Medicine

Your child’s doctor may suggest medicine to limit daytime wetting or prevent a urinary tract infection (UTI).

Oxybutynin (Ditropan) is often the first choice of medicine to calm an overactive bladder until a child matures and outgrows the problem naturally.

If your child often has bladder infections, the doctor may prescribe an antibiotic, which is a medicine that kills the bacteria that cause infections. Your child’s doctor may suggest taking a low-dose antibiotic for several months to prevent repeated bladder infections.

Home care and support

Changes in your child’s routines and behavior may greatly improve daytime wetting, even without other treatments. Encourage your child to

• use the bathroom whenever the urge occurs.
• drink more liquid, mainly water, if the doctor suggests doing so. Drinking more liquid produces more urine and more trips to the bathroom.
• take extra time in the bathroom to relax and empty the bladder completely.
• avoid drinks with caffeine or bubbles, citrus juices, and sports drinks. These drinks may irritate the bladder or produce extra urine.

Children need plenty of support from parents and caregivers to overcome daytime wetting, not blame or punishment. Calming your child’s stresses may help—stresses about a new baby or new school, for example. A counselor or psychologist can help treat anxiety.

Bedwetting

If your child’s provider suggests treatment, it’s likely to start with ways to motivate your child and change his or her behavior. The next steps include moisture alarms or medicine.

For a bedwetting treatment program to work, both the parent and child must be motivated. Treatment doesn’t always completely stop bedwetting—and there are likely to be some setbacks. However, treatment can greatly reduce how often your child wets the bed.

Motivational therapy

For motivational therapy, you and your child agree on ways to manage bedwetting and rewards for following the program. Keep a record of your child’s tasks and progress, such as a calendar with stickers. You can give rewards to your child for remembering to use the bathroom before bed, helping to change and clean wet bedding, and having a dry night.

Motivational therapy helps children gain a sense of control over bedwetting. Many children learn to stay dry with this approach, and many others have fewer wet nights. Taking back rewards, shaming, penalties, and punishments don’t work; your child is not wetting the bed on purpose. If there’s no change in your child’s wetting after 3 to 6 months, talk with a health care professional about other treatments.

Tracking good bathroom habits may help children develop fewer wet days or nights over time. Rewards are given for effort, because a child can’t always control wetting.

Moisture alarms

Moisture alarms detect the first drops of urine in a child’s underwear and sound an alarm to wake the child. A sensor clips to your child’s clothes or bedding. At first you may need to wake your child, get him or her to the bathroom, and clean up wet clothes and bedding. Eventually, your child learns to wake up when his or her bladder is full and get to the bathroom in time.

Moisture alarms work well for many children and can end bedwetting for good. Families need to use the alarm regularly for 3 to 4 months as the child learns to sense his or her signals and control the bladder. Signs of progress usually appear in the first few weeks—smaller wet spots, fewer alarms each night, and your child waking on his or her own.

Medicine

Your child’s doctor may suggest medicine when other treatments haven’t worked well.

Desmopressin (DDAVP) is often the first choice of medicine for bedwetting. This medicine slows the amount of urine your child’s body makes overnight, so the bladder doesn’t overfill and leak. Desmopressin can work well, but bedwetting often returns when a child stops taking the medicine. You can use desmopressin for sleepovers, camp, and other short periods of time. You can also keep a child on desmopressin safely for long periods of time.

Home care

Changes in your child’s routines may improve bedwetting, when used alone or with other treatments. Encourage your child to

• drink most of his or her liquids during the morning and early afternoon.
• urinate regularly during the day—every 2 to 3 hours—and just before bed, which is a total of about 4 to 7 times a day.
• urinate twice before bedtime (about a half hour apart) to fully empty the bladder and allow room for new urine made overnight.
• avoid drinks with caffeine or bubbles, citrus juices, and sports drinks. These drinks may irritate the bladder or produce extra urine.

Children who wet the bed should use the bathroom just before bedtime.

How can I help my child cope with bladder control problems?

Your patience, understanding, and encouragement are vital to help your child cope with a bladder control problem. If you think a health problem may be causing your child’s wetting, make an appointment with your child’s health care provider.

Clothing, bedding, and wearable products

For children with daytime wetting, clothes that come on and off easily may help prevent accidents. A wristwatch alarm set to vibrate can privately remind your child to visit the toilet, without help from a teacher or parent.

For children who wet the bed, the following practices can make life easier and may boost your child’s confidence:

• Leave out dry pajamas and towels so your child can clean up easily.
• Layer waterproof pads and fitted sheets on the bed. Your child can quickly pull off wet bedding and put it in a hamper. Fewer signs of wetting may help your child feel less embarrassed.
• Have your child help with the clean-up and laundry the next day. However, don’t make it a punishment.
• Be sure your child showers or bathes every day to wash away the smell of urine.
• Plan to stop using diapers, training pants, or disposable training pants, except when sleeping away from home. These items may discourage your child from getting out of bed to use the toilet.

Don’t make a habit of waking your child during the night to use the bathroom. Researchers don’t think it helps children overcome bedwetting.³

Easy clean-up routines may give children a sense of control while they outgrow bedwetting.

Emotional support

Let your child know that bedwetting is very common and most children outgrow it. If your child is age 4 or older, ask him or her for ideas on how to stop or manage the wetting. Involving your child in finding solutions may provide a sense of control.

Calming your child’s stresses may help—stresses about a new baby or new school, for example. A counselor or psychologist can help treat anxiety.

References

modern approaches to treatment uMEDp

Urinary incontinence is one of the significant problems of neuropediatrics. Nocturnal enuresis occurs in children with significant frequency, being a source of stress for patients and their parents [1-3]. The prevalence of nocturnal enuresis in the general and pediatric populations decreases as the age of individuals increases, but even among people over the age of 18, this urinary disorder occurs with a frequency of 0.5–1% [1, 3]. C.A. D’Ancona et al. (2012) consider enuresis in childhood as a risk factor for the formation of bladder dysfunction upon reaching adulthood [4].

More recently, in an attempt to classify enuresis, various authors used numerous terms: neurotic enuresis, neurosis-like enuresis, organic and inorganic enuresis, primary and secondary enuresis, daytime and nocturnal enuresis, etc. [3]. Such an abundance of terms is the result of differences in the approach to urination disorders by urologists, neurologists and psychiatrists.

The problem of nocturnal enuresis and other urinary disorders (disorders) was devoted to the three-day International Symposium “Diagnostics and treatment of children with urinary disorders”, held in Moscow on October 18-20, 2011 within the framework of the X Russian Congress “Innovative technologies in pediatrics and pediatric surgery” “. Russian and foreign urologists and neurologists who spoke at the symposium comprehensively covered various aspects of the diagnosis and treatment of primary nocturnal enuresis and presented the recommendations of the International Children’s Continence Society (ICCS) on these issues [5].

Previously, for the treatment of primary nocturnal enuresis, which is increasingly called monosymptomatic (or monosymptomatic) nocturnal enuresis, dozens of drugs of various pharmacological groups were used, but at present there is agreement among neurologists and urologists regarding the choice, volume and direction of pharmacological effects in the described urination disorders [6–9].

Non-pharmacological treatments for nocturnal enuresis

Urotherapy is a complex of non-invasive drug-free treatment methods based on recommendations and education of patients suffering from bladder emptying dysfunction. Urotherapy is aimed at normalizing the functions of the bladder in the course of active cooperation on the part of the patient (training and acquisition of practical skills) [10]. These simple recommendations (in particular, sleep in a volume corresponding to the age of the patient; regular emptying of the bladder; correct / comfortable posture when urinating; the prevalence of the proportion of drinking during the day; limiting fluid intake and normalizing the salt load in the evening; micturition before bedtime, etc. .d.), in some cases allowing to achieve adequate control over urination, are presented in the work of L.M. Robson and A.K. Leung (2002) [10].

In one of the many systematic reviews by C.M. Glazener and J.H. Evans (2004), describes the methods of “simple behavioral” and “physical” treatment of nocturnal enuresis in children, which is directly related to urotherapy [11]. The authors come to the conclusion that the described approaches (cognitive therapy, etc.) can be effective in some children and be used as an alternative treatment (have no side effects) [12].

The use of urinary “alarms” (alarm clocks) is a method of non-pharmacological treatment of enuresis, which has found a relatively wide distribution in many countries of the world. This therapeutic strategy is the subject of another systematic review by C.M. Glazener and J.H. Evans (2005) [12]. The authors come to the conclusion that urinary “alarms” are a highly effective treatment for nocturnal enuresis in children [12]. Unfortunately, in the Russian Federation, urinary “alarms” are practically not used.

The use of laser therapy (laser acupuncture) in the treatment of primary nocturnal enuresis is reported by C. Radmayr et al. (2001) [13]. The treatment consisted of placing a laser sensor on each of the seven pre-selected points (30 seconds each) with the procedure repeated 10–15 times. After 6 months, a complete response to the described laser treatment was observed in 65% of patients [13].

Ultrasound therapy with the placement of an ultrasound probe in the lumbosacral spine of patients (6–14 years old) with primary nocturnal enuresis (10 treatment courses) is described by A. Koşar et al. (2000) [14]. The results of treatment, evaluated after 1 week, 3 months, 6 months and 12 months after the end of the course of procedures, revealed a statistically significant decrease in the number of episodes of bedwetting per week [14].

Methods of diet therapy (neurodietology) for nocturnal enuresis are not limited to the Krasnogorsky diet. J. Egger et al. (1992) report on the experience of effective use of a low calcium diet in the treatment of nocturnal enuresis associated with hypercalciuria, and G. Valenti et al. (2002) about the use of oligoantigenic diets in the combination of enuresis with migraine and/or attention deficit hyperactivity disorder (ADHD) [15, 16]. In the dietary treatment of nocturnal enuresis, it is also recommended to use nutritional supplements containing eicosapentaenoic and docosahexaenoic fatty acids (500–1000 mg/day), to supplement zinc (10–15 mg/day) and magnesium (100 mg/day) [17].

Methods of pharmacological treatment of nocturnal enuresis

Among the methods of drug therapy for primary nocturnal enuresis, the leading position is occupied by the use of desmopressin, which has been available since the 2000s. in the Russian Federation under the trade name Minirin in two dosage forms and various dosages (tablets of 0.1 mg and 0.2 mg, sublingual tablets of 60 mcg, 120 mcg and 240 mcg). The preference of desmopressin over the so-called “behavior modification” as an initiating therapy for primary nocturnal enuresis is indicated by P. Fera et al. (2011) [18].

According to the Federal Guidelines for the Use of Drugs (Formula System) (2012), the drug oxybutynin, sometimes used in the treatment of enuresis, belongs to the drugs of the target category 12. 1.1 “Increased urination and urinary incontinence”, and not to the category 12.1 .2 “Enuresis” as desmopressin (Minirin) [19]. Nevertheless, P. Montaldo et al. (2012) report the possibility of using a combination of desmopressin with oxybutynin in primary monosymptomatic nocturnal enuresis in cases of disease resistance to pharmacotherapy with desmopressin alone [20]. Trospium chloride, like oxybutynin, is an antispasmodic for urinary frequency (section 12.1.1) and not a treatment for primary nocturnal enuresis. In addition, trospium chloride has age restrictions for use (age up to 14 years) [19].

Carbamazepine is a traditional antiepileptic drug used for focal seizures with secondary generalization, as well as for primary generalized tonic-clonic seizures. In addition to the direct anticonvulsant and antiepileptic action, carbamazepine is characterized by antidepressant and normothymic effects. The drug has a chemical affinity for imipramine. In this regard, if necessary, the drug can be used in the treatment of nocturnal enuresis. In particular, in the article N.S. Al-Waili (2000), based on data from his own double-blind study, describes the results of observation of children with primary nocturnal enuresis (age 7–15 years) who received carbamazepine [21]. Of the 26 patients in 20 cases, the onset of “dry” nights was noted with a frequency of 7-30 per month, and in 6 children – 0-5 per month (the average number of “dry” nights was 18.8 ± 8.82, while differences from placebo group were statistically significant – p

The results of a number of tricyclic antidepressants (TCAs), including imipramine, amitriptyline, viloxazine, nortriptyline, clomipramine and desipramine, in the treatment of nocturnal enuresis in children are presented in a systematic review published by C.M. Glazener et al. (2003) [22]. Treatment of enuresis with the listed TCAs was accompanied by a moderate decrease in the number of “wet” nights (by an average of 1 night per week). Mianserin was even less effective [22]. The authors emphasize that although imipramine and some other TCAs lead to a partial positive effect in primary nocturnal enuresis, most children experience a return of symptoms after the completion of active treatment [22]. S. Gepertz and T. Nevéus (2004) believe that among TCAs, it is imipramine that is most suitable for the treatment of resistant enuresis in children, while the authors note frequent side effects associated with the use of the drug (nausea, etc.) [23]. Please note that viloxazine, nortriptyline and desipramine are not listed in the Federal Guidelines for the Use of Medicines (2012) [19].

Of particular interest are the publications of T. Nevéus (2006), as well as E. Lundmark and T. Nevéus (2009), devoted to the use of reboxetine in treatment of enuresis resistant to ongoing therapy [24, 25]. Reboxetine is a noradrenergic antidepressant and norepinephrine reuptake inhibitor that does not have a pronounced cardiotoxic effect. According to Scandinavian researchers, the use of reboxetine (alone or in combination with desmopressin) can be shown to children in the described clinical situation as an alternative to imipramine [24, 25].

The possibility of using indomethacin for enuresis was previously pointed out by N. S. Al-Waili (1989, 2002), B. Varan et al. (1996), F. Sener et al. (1998), emphasizing the phenomenon of increased nitrite excretion in primary nocturnal enuresis [26–29]. B.A. Kogan (2012) describes the positive effect of indomethacin not only on the level of urinary nitrite excretion, but also on the osmolality of urine and blood serum, as well as on the electrolyte balance in the body [30]. Among 28 different drugs used to treat nocturnal enuresis in children (in addition to desmopressin and TCAs), C.M. Glazener et al. (2003, 2005), as well as T. Huang et al. (2011) highlight the therapeutic efficacy of indomethacin and diclofenac, noting that it is inferior to that of desmopressin [31-33].

Nootropic drugs are widely used by domestic neurologists, including for conditions related to neurourology (including nocturnal enuresis and other urination disorders). L.M. Kuzenkova et al. (2007) consider calcium hopantenate as one of the main nootropics in the treatment of enuresis in children [34]. We have previously indicated the possibility of using this and many other drugs with a nootropic action [35]. The available international literature on the use of nootropic drugs for nocturnal enuresis does not report, which in no way indicates the expediency of abandoning the use of this group of pharmacological agents, but only reflects the current approach to the therapeutic strategy. Apparently, the desire to use nootropics in the complex treatment of primary nocturnal enuresis is one of the characteristic features of Russian neuropediatrics.

In addition to nootropics, tranquilizers (nitrazepam, etc.) are often used as an auxiliary treatment in neurology – to normalize sleep, anxiolytics (hydroxyzine, etc.) – to reduce the level of neuroticism, as well as CNS stimulants (mesocarb) [3]. The latter are prescribed extremely rarely and are intended only for cases where patients have pathologically deep sleep (profundosomnia). The use of such a representative group of pharmacological agents is partly explained by the fact that in the practice of neurology there are clinical situations when enuresis is a manifestation of a particular disease of the nervous system (with epilepsy, multiple sclerosis, some types of somato-neurological pathology – malabsorption syndromes, food intolerance, etc. ) [ 3]. The use of the drug atomoxetine for ADHD associated with enuresis cannot be considered as a method of targeted therapy for nocturnal enuresis.

Evidence-based medicine for the treatment of nocturnal enuresis

Above, we have already presented data presented in several updated systematic reviews on various methods of treatment (drug and non-drug) of nocturnal enuresis in children [9, 11, 12, 22, 31 , 32 , 33]. If we summarize the basic information that evidence-based medicine has on this issue, it turns out that of the non-drug methods of treating enuresis, the use of urinary “alarms” should be recognized as the most effective strategy [12, 33, 36, 37]. Laser acupuncture, the use of which is promoted by C. Radmayr et al. (2001), corresponds to the rubric “efficacy is expected” [36, 37].

The effectiveness of the ultrasound therapy described by A. Koşar et al. (2000), is not considered established (“effectiveness not established”) [14, 36, 37]. The situation is similar with training the ability to wake up and empty the bladder on its own at night, as well as emptying the bladder at a certain time (“efficiency not established”) [36, 37]. C.M. Glazener et al. (2004) in a systematic review on the evaluation of complex behavioral therapy and education of children with nocturnal enuresis, conclude that the effectiveness of the described therapeutic strategy is doubtful in the absence of the simultaneous use of urinary “alarms” [38].

Among the methods of pharmaceutical treatment of nocturnal enuresis, only one drug has proven efficacy – desmopressin (Minirin) [9, 36, 37, 39, 40]. For the use of indomethacin in the form of rectal suppositories, “effectiveness is currently expected” [36, 37]. With regard to the use of TCAs in systematic reviews, the rubric “advantages and disadvantages are comparable” is used [36, 37]. Efficacy in nocturnal enuresis of carbamazepine presented by N.S. Al-Waili (2000), from the standpoint of evidence-based medicine is considered unidentified [36, 37]. In this regard, in the clinical guidelines of the English National Institute for Health and Clinical Excellence (NICE), presented in the publication of N. O’Flynn (2011), desmopressin (Minirin) appears as the main pharmacotherapy for primary nocturnal enuresis in children [8].

Desmopressin dosage forms: a visual evolution

The first dosage form of desmopressin was nasal drops, used for a number of years. Subsequently, they were replaced by desmopressin in the form of tablets for oral administration (0.1 mg and 0.2 mg), which turned out to be much more convenient to use. Desmopressin in the form of a nasal spray is essentially a continuation of the practice of using the drug in nasal drops. Unfortunately, the bioavailability of nasal forms of desmopressin is far from ideal [41]. It decreases if the patient has rhinitis (acute or chronic). In addition, there are cases of atrophic rhinitis caused by the prescription of the drug desmopressin in dosage forms for oral administration [3].

According to modern ideas, the use of nasal forms of desmopressin is ideologically outdated and does not seem to be completely safe. In particular, in the United States, since 2007, desmopressin in the form of a nasal spray has been banned for use in the treatment of nocturnal enuresis, which was associated with a high number of adverse events associated with the use of the described dosage form (including convulsions and two deaths) [42]. The Food and Drug Administration (FDA) emphasizes that “Children taking intranasal forms of desmopressin for the treatment of enuresis are particularly susceptible to severe hyponatremia and seizures.” The situation with the ban on the use of nasal dosage forms of desmopressin in the treatment of nocturnal enuresis in children was recently commented by T. Gomes et al. (2012) [43]. Situations associated with severe hyponatremia and seizures with the use of desmopressin intranasal spray have been repeatedly reported by D.C. Apakama and A. Bleetman (1999), S. Sarma et al. (2005), as well as H.B. Kelleher and S.O. Henderson (2006) [44–46].

Oral desmopressin tablets were found to be more effective and safer than nasal spray. In particular, the safety of using desmopressin for 30 years (to date – 35 years) is shown in the work of J. Vande Walle et al. (2007) [47]. A similar opinion is shared by H.B. Lottmann and I. Alova (2007) [48]. In turn, W.L. Robson et al. (2007) note the safety of oral forms of desmopressin in the treatment of enuresis in children (compared to nasal forms) [49]. The latest advance in the pharmacological treatment of monosymptomatic nocturnal enuresis can be considered the appearance of desmopressin in the form of sublingual (soluble) tablets. Minirin in sublingual tablets is not only convenient to use (instantaneous dissolution in the oral cavity, no need to drink water, etc.), but also has stable pharmacokinetics and no dependence on food intake.

The main advantages of Minirin in sublingual tablets include, first of all, the high bioavailability of the drug, which makes it possible to achieve a therapeutic effect when using this oral form of desmopressin in smaller doses (compared to standard tablets). In addition to the exceptionally good tolerance of the described dosage form of desmopressin,

H.B. Lottmann et al. (2007) indicated that more than 60% of patients with primary monosymptomatic nocturnal enuresis preferred Minirin sublingual tablets compared to conventional tablets (the results obtained are statistically significant – p = 0.009) [50].

A. de Guchtenaere et al. (2011) note the advantages and better bioavailability of the oral lyophilized form of desmopressin (Minirin sublingual tablets), which is due to the low interaction of the drug with the food taken [51]. Minirin tablets and Minirin sublingual tablets (for resorption) are distinguished by a higher safety of use; when used, the risk of accidental overdose of desmopressin is minimized or virtually absent.

K.V. Juul et al. (2011) found that patients require a lower dose of Minirin sublingual tablets to achieve a therapeutic antidiuretic response [52]. Minirin sublingual tablets (60 mg, 120 mg, 240 mg) has been available in the Russian Federation since 2011. The ratio of doses of desmopressin that have an identical therapeutic effect when using Minirin in standard tablets and sublingual tablets is presented in the table. As can be seen from the table, the use of the drug Minirin sublingual tablets allows you to achieve a similar therapeutic effect when using a lower dose of desmopressin than when using the standard tablet form of the drug Minirin. This is due to the better bioavailability of Minirin in the form of sublingual tablets compared to standard tablets – 0.25% versus 0.16%, respectively. An additional advantage of Minirin sublingual tablets is the absence of lactose and starch in the dosage form, as a result of which it should be preferred in the treatment of nocturnal enuresis in children with lactase deficiency and various forms of food allergies.

Conclusion

Desmopressin is a high-tech pharmacological preparation. The role of oral forms of desmopressin (Minirin) in nocturnal enuresis is recognized by foreign and domestic specialists in urinary disorders in childhood [53–55].

Effective treatment of enuresis is not only a solution to a medical and social problem, but also a way to improve the quality of life of patients. Desmopressin (Minirin) is the most effective drug available for the treatment of nocturnal enuresis. Minirin sublingual tablets is currently recommended by the European Medicines Agency (EMA) as the drug of choice for the treatment of primary nocturnal enuresis in children.

Ayurvedic treatment of bedwetting: preparations and recommendations

Bedwetting is usually normal in the development of the child. This is usually not a concern until the age of 5. If this violation continues, treat the problem with patience and understanding. If a child is over 5 years old and wakes up at night in a wet bed at least twice a week for three months, this is considered a disease called bedwetting or enuresis. In Ayurveda, it is known as Shayamutra.

Symptoms of the disease

Bedwetting – involuntary urination during sleep. Symptoms include: Urinary incontinence during daytime or nighttime sleep.

Causes of bedwetting

• The main causes of bedwetting are:
• The bladder is not strong enough to hold urine all night.
• Delayed maturation of the bladder.
• Lack of coordination between bladder and brain.
• Excessive fluid intake in the evening or at night.
• Psychological problems such as stress, anxiety and other emotional problems.
• Constipation.
• Intestinal worm infestation.
• Excessive sleep.
• Some medical conditions, such as diabetes or a urinary tract infection, can also cause bedwetting.
• Genetic factors.

Complications

Bedwetting can cause some problems for a child:

• Guilt and embarrassment, which can lead to low self-esteem.
• Loss of opportunities for social activities.
• Rash on the child’s body.

Diagnosis of the disease

Depending on the circumstances, the child may need a physical examination or test:

• Urinalysis to check for signs of infection or a disease such as diabetes.
• X-ray or other imaging modality to check for a structural problem in the bladder or kidneys.
• Medical history of the child.

An Ayurvedic perspective on enuresis

In Ayurveda, bedwetting is known as Shayamutra. Prana, Vyana and Apana Vata and Avalambaka Kapha help the process of urine formation with complete mind control. Urination is one of the functions of normal apana vata. The activity of Apana is regulated by Prana and Vyana Vata. Apana promotes active secretion of urine, movement of sperm, etc. After reaching the level of maturity of development, control over these actions, initiated by Prana and Vyana, appears. But in this state, the general control over Apana activity is not developed, which leads to loss of control over urination. This condition may also be due to the Kapha environment (avarana) of the apana, which speeds up the excretion of urine.

The brain plays an important role in both the physiological and pathological processes of the body. It functions constantly even during sleep. According to Ayurveda, when tama and kapha hide the mask, sleep occurs. This can happen during the day, but at night the loss of control of Prana and Vyana over Apana and the encirclement of Apana by Kapha and Tama occur together, and the child unknowingly wets the bed.

Ayurvedic Bedwetting

Himalaya Herbals offers effective herbal remedies for bedwetting (enuresis). These remedies are made from the highest quality herbs and strictly follow the principles of Ayurveda. All preparations are 100% pure, natural and vegetarian. They do not contain chemicals, additives or preservatives. Safe to use as they have no side effects.

Mentox

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Mentox activates the brain, improves memory and concentration. Increases the body’s ability to withstand stress, eliminates mental and psycho-emotional stress.

Ashwagandha

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Ashwagandha is used for stress, weakness, fatigue, which are the psychological causes of bedwetting.

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It has a positive effect on the nervous system, which promotes coordination between the components of the nervous system, which improves brain function. Therefore, it is used as a brain tonic. The drug increases mental capacity and alertness.

Mentat Syrup

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Mentat Syrup is an Ayurvedic patent medicine used to improve neurological function, improve cognitive function and improve memory. Mentat has antidepressant and anxiolytic effects in the body.

Punarnava

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Punarnava is used in the treatment of kidney disease, rheumatism, edema, fever, alcoholism, eye disorders, vulvodynia, splenomegaly and liver disorders. Punarnava acts as an anti-aging agent, reduces inflammation, prevents bloating, improves heart health and increases hemoglobin levels in the blood.

Bangshil

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Bangshil is an Ayurvedic remedy for the treatment of diseases of the genitourinary system of men and women. It has the richest formula: it contains strong anti-inflammatory and antibacterial ingredients. Improves the condition of the pelvic organs, quickly solves problems with difficult urination.

Enuresis Home Remedies

1. Some home remedies can be used before using medications that may be helpful for bedwetting, such as:
2. Restriction of fluid intake in the evening.
3. Make sure your child goes to the bathroom before bed.
4. Reassure the child that nothing bad has happened.
5. If these measures do not help, it is recommended to set an alarm to help teach the child to wake up when the bladder is full.
6. Treat constipation if present.

Enuresis drugs

There are three main drugs used to treat bedwetting, which are described below:

• Desmopressin : This is a synthetic version of a hormone that regulates urine production called vasopressin. Provides short-term relief from incontinence problems.
• Anticholinergics : Another option is a combination of desmopressin and the anticholinergic drug oxybutin.