Options for difficult-to-treat bedwetting

Options for difficult-to-treat bedwetting

If the bedwetting has not improved after treatment with an alarm and/or desmopressin, the healthcare team may consider the following further options.

Anticholinergics combined with desmopressin

The healthcare team may consider offering an anticholinergic drug to take with desmopressin (see box 4) following assessment by a healthcare professional with expertise in the management of bedwetting that has not responded to initial treatment. If there is an improvement, the child or young person may be advised to continue with this combination as bedwetting may carry on improving for up to 6 months.

If the bedwetting starts again after stopping treatment with an anticholinergic combined with desmopressin, the healthcare team may offer to repeat the treatment.

If the child or young person has daytime symptoms as well as bedwetting, treatment with an anticholinergic combined with desmopressin may be offered, but only following assessment by a member of the healthcare team who has expertise in giving this combination of drugs for bedwetting.

Anticholinergics alone should not be used for children and young people with bedwetting and no daytime symptoms.

Box 4 Using an anticholinergic with desmopressin

If an anticholinergic combined with desmopressin is offered for bedwetting the healthcare team should explain that:

  • more children and young people are drier using this combination than with desmopressin alone

  • desmopressin and an anticholinergic can be taken together at bedtime

  • treatment should be continued for 3 months and may then be repeated.

Imipramine

If no other treatment has been successful, a drug called imipramine may be offered (see box 5), but only after assessment by a member of the healthcare team who specialises in the management of bedwetting that has not responded to treatment.

Imipramine should not be offered as an initial treatment and it should not be offered in combination with an anticholinergic.

Your doctor should carry out a check every 3 months for children and young people having repeated treatment with imipramine. It should be stopped gradually when treatment is finished.

Box 5 Using imipramine for bedwetting

If imipramine is offered for bedwetting your healthcare team should explain that:

  • imipramine reduces wetness in many children and young people

  • the drug works to improve the bladder's ability to hold urine

  • it should be taken at bedtime

  • the dose should be increased and stopped gradually

  • for safety reasons, it is very important to take only the prescribed amount and to store the bottle securely out of the reach of children

  • many children and young people start wetting the bed again after 3 months of treatment

  • treatment should continue for 3 months. It may then be repeated, but only if it is helpful.

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