Medication for bedwetting?

I have a five-year-old girl who is wet almost every night. She wears pull-ups to prevent the sheets from getting wet each night. We have done all the "right stuff." We have reduced fluid intake, had her empty her bladder before bed, get her up when we go to bed, but she is still wet. I have read there is a medication (nasal spray?) available that can help prevent bed wetting. Could that help my daughter?


Robert Steele

Robert W. Steele, MD, is a board certified pediatrician at St. John's Regional Health Center in Springfield, MO. He graduated from medical... Read more

The nasal spray you have heard about is called desmopressin acetate, or DDAVP. Interestingly, it is now made in a pill form (rumor has it the company is going to discontinue making the nasal spray form.) It is a synthetic version of a hormone called vasopressin which is normally made in the body. Vasopressin serves several roles, one of which is in water regulation. When the body needs more water in the blood stream, it produces higher levels of vasopressin which in turn causes more water to be absorbed from the kidney. Less urine is made and the urine becomes more concentrated.

This drug had been used for some time with other disorders when someone got the bright idea that by causing the body to retain more water and decrease the amount of urine produced, it might be useful in treating nighttime bedwetting. Initially, there were concerns that use of this medication would cause serious side effects due to water intoxication. Water intoxication is when the body holds on to too much water and the salts of the body become too diluted. This can cause seizures and brain swelling. As it turns out, water intoxication rarely occurred and when it did, it happened in children who already had recognized disorders involving the regulation of salts.

So, what do we know about DDAVP when it is used for bedwetting?

  1. It definitely decreases bedwetting in most children.
  2. It does not completely eliminate bed wetting in most children.
  3. Almost all children begin bedwetting again within six months of stopping the medication.
  4. The dose at which DDAVP is used to eliminate bedwetting is safe for most children.
  5. The most common side effects are nose bleeds, headache, and stomach aches.
  6. It is a very expensive medication.
  7. While the dose of DDAVP is not generally considered high enough to alter the body salts, many physicians check this once after about three days of starting the medication. This is done with a blood test.
  8. It appears that its use for many months causes few, if any, problems.

When considering the use of DDAVP for bedwetting, the question you should ask yourself is "What is the ultimate goal I want to achieve?" If the answer is to have your daughter stop bed-wetting forever, then this is not the way to go. Many studies have shown that while DDAVP is effective in stopping the bed-wetting while on medication, almost all children begin bed-wetting again after it is stopped. This is opposed to bedwetting alarms which require a lot more work on you and your daughter's part, but are a lot more effective in stopping the bed wetting for good. The only problem with the alarms is that it really requires cooperation from the child which generally doesn't occur until age six, at the earliest. However, if the answer to the question is to achieve a dry night for a special occasion, then this is a great medication. The use of DDAVP when staying overnight at a friend's house or to build confidence by having a "successful" night using the alarm system is great. Some physicians have advocated using the alarm system in conjunction with DDAVP. The jury is still out as to whether this approach is any better than using the alarm system alone.

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