Medication Treatment

There are a number of drugs which can help enuresis. Medication treatment is favored by perhaps 30% of pediatricians in the U.S. – but it does have certain drawbacks. The biggest one, which is true of ALL the drugs used, is a high relapse rate. Drugs tend to work while you’re taking them, but they really are just covering up the problem rather than fixing it. Once you stop giving the medication, the chances the bedwetting will return are about the same as the odds that it would have still been there if you had never treated in the first place. The most popular and effective medication is Tofranil (Imipramine). This drug is used as an anti-depressant in adults, and no one knows why it helps enuresis. Nevertheless, it works about 80% of the time. Tofranil is a rather dangerous drug, however – an overdose is very hard to treat and can be fatal. The “margin of safety” between a therapeutic and a toxic dose is pretty narrow. Another somewhat less effective drug which has been heavily promoted for enuresis in the last decade is DDAVP (nasal spray or pills). This is a hormone which reduces the kidney’s urine production rate. It is safe, but it only works about 30-50% of the time, and it is rather expensive. For all of the above reasons, we don’t tend to favor using either of these medications in most cases. The least frequently used medications are smooth muscle relaxants, Ditropan& Levsin. They are safe & cheap, but work less than 20% of the time. Importantly, you can predict who they will work for. It works on the child for whom spastic bladder is the predominant contributing factor. Therefore, we do sometimes use smooth muscle relaxants, in carefully selected cases.