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Bed-wetting: Approaches to nocturnal enuresis in children

Scheffel E.C., DeSimone E.M., Davidian M. H.

Commentary by Charlotte van Herzeele

In the treatment of enuresis the role of the pharmacist is often neglected. Even though they can play an important role to encourage the family to fully adhere to the prescribed treatment and to stimulate to revisit the medical doctor if treatment success is not reached.

Because this article is published in a leading and clinically-focused pharmacy journal many pharmacists will read it. Therefore it is important that all information is correct. The article state that nighttime bladder control is not expected until age 5 to 7 years. However, it is well reported that 85% of all children become spontaneously dry at night (be achieving bladder control) between the age of 2 and 5 years. Resulting in a prevalence rate of 15% in 5-year olds.

The pathophysiology of bedwetting is complex, but can be explained in many patients by an imbalance between the nighttime urine production and the amount of urine that the bladder can hold at night. This is not clear in the article. This pathophysiological background is important to select the appropriate therapy. The authors raise the importance of voiding diaries but it should be added that nighttime urine production should be measured as well to screen for a possible overproduction of urine at night (nocturnal polyuria). Children with nocturnal polyuria will benefit most from desmopressin.

Schedule a void just before bedtime is a good advice because the child can start the night with an empty bladder. But schedule a void during the night is more controversial. It is true that it increases the chance of being dry that particular night but on the long term there are no beneficial outcomes. The opposite is possibly true, the disturbed sleep might cause negative daytime consequences.

Motivational therapy is very important. But if bedwetting is not your fault and you have no control, would you be motivated if you cannot earn a star because you are wet? Probably not. Reward systems are very powerful but only if they are used in a correct way. Children should only be rewarded for their effort (e.g. void before bedtime), not for the result (wet or dry night).

Involving pharmacists in the treatment of bedwetting can be beneficial but correct information dissemination is crucial in order to help the patients to overcome their stressful condition.