CONCEPT

The child who presents enuresis wets himself in the bed in involuntary form. It is a question of a problem that causes inconveniences to the parents, and that also affects emotionally the child.

In general, one does not begin treating these patients before 5 years of age; considering the possibility of spontaneous healing in 15 % of the patients, it is preferable to initiate the treatment between the 6 and 7 years. The treatment includes behavioral measurements, as well as medicines and the use of alarms.

GENERAL MEASUREMENTS OF TREATMENT

• To restrict the liquids ingestion to only 240 ml. (a glass) in three hours previous to that the child falls asleep.
• To lead it to urinating just before going to sleep.
• To do that it takes responsibility and is attentive to the evolution of his problem: that takes a record of the days that is wetted, that cooperates with the cleanliness of the bed and change of clothes, etc.
• To motivate him to that it remains dry, to praise his effort and to give him rewards for achieving it; it is never necessary to punish him nor to do mockery to him nor suppress it for wetting the bed.

TREATMENT WITH ALARMS

The alarms consist of an esponjita that is placed in the pajamas of the child and that is joined by means of a cable to a stamp that is fixed to the shoulder or to the arm of the child; when the esponjita is wetted the alarm sounds. At present there are wireless models of alarms, and that instead of making to dream a stamp work in vibratory form.

Any way when the sponge is wetted, the electrical circuit closes and the alarm sounds or vibrates. The child can answer to the noise or to the vibration getting up just after the alarm being activated, or, to the beginning of which it begins wetting itself, what allows to him to stop doing it in the bath.

The alarm helps to determine the child to whom it contracts the sphincter and gets up to the bath to stop emptying the bladder. His action mechanism can incluír that the brain learns to lighten the sleep, or that the muscle that forms the bladder (called detrusor) learn to relax during the sleep, increasing this way his capacity.

In general, several nights after the use of the alarm many children will wake up in spontaneous form. It can take up to several weeks that the child achieves to stop wetting the bed. It is recommended to suspend the alarm when the child is capable of staying dry the whole night in spite of having a normal liquids ingestion. In case of a relapsing, there is begun again the restriction of liquids and the use of the alarm until it is reached one month without be wetting.

The percentage of children who recover with this treatment is variable. The alarms that exist at present are sure and they do not have collateral effects. The price of the models of alarms can be of up to $ 50 dollars (about 8.000 pesetas or 55 euros).

TREATMENT WITH MEDICINES

Between the medicines that are used for the treatment of the enuresis there is the acetate of desmopresina (DDAVP) and the antidepressants tricíclicos like the imipramina.

• The DDAVP is a similar synthetic one of the hormone called vasopresina or antidiuretic hormone, which it helps in the treatment of the enuresis, since it diminishes the urinal volume during the sleep. It exists in nasal spray and in tablets. It is necessary to give from 30 until 60 minutes before going to the bed and it is necessary to restrict the liquids ingestion from the evening. The treatment with DDAVP diminishes the number of nights that the child wets, but on having suspended the medicine, the problem appears again. The treatment with DDAVP has high cost: A month of treatment it costs approximately $ 90 (100 euros ó 16.000 ptas).
• The imipramina is an antidepressant tricíclico. His action mechanism in the enuresis includes changes in the depth of the sleep, its own antidepressing effect and the secondary stimulation of the production of the antidiuretic hormone. It is not effective in a lot of time on having discontinued the medicine. A problem of this medicine is that it causes many collateral effects, and it can go so far as to cause poisonings. It is of lower cost.

CONCLUSION

The night enuresis will recover spontaneously in most of the patients. Treatment alternatives exist to accelerate his healing. The children answer more quickly to the medicines that to the alarms, but with these they tend to remain more time dry on having suspended the treatment.

Considering cost, efficacy and safety, in patients very ready to solve the problem, the advisable initial treatment is the alarm, continued by the DDAVP and in the third place the imipramina.

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