Most children who bedwet have a functional bladder capacity that is smaller than normal, only a minority of children who bedwet have a normal or greater than normal bladder capacity. So a small functional bladder capacity is likely to slow your child progress toward dryness. Because this treatment for small bladder capacity involves taking a medication dispensed by prescription, you will need to consult your doctor before proceeding.
This is specially important if your child also has history of urine infection or day wetting. Show the doctor your diary notes and discuss your conclusions about your child's bladder capacity. If you need to add this treatment to your child's program, follow the instruction below, and keep your doctor informed of your child's progress.
Oxybutynin
Oxybutynin (trade name Ditropan) is a medication commonly prescribed to treat day wetness. By itself, with no other simultaneous treatment, Oxybutynin has not proven effective in treating bed wetting. But when this medication plays a support role, as a helper to the main treatment (the alarm), oxybutynin is very beneficial. Some families say:
"Gee, I think the medicine got him dry....He used to use the bathroom so often in the day time, and we measured how small his bladder was."
Other families say:
"Gee, I think the alarm did it, He was just so sleepy."
Ether way, the medication seem to be beneficial, and the children get to dry.
Why might Oxybutynin work? There are three likely reasons, 1- It reduces the sense of urgency that children feel when the bladder is about to contract, 2- It reduces the intensity, or strength, of bladder contractions, and 3- It prolongs the time it takes the bladder to empty. Before taking Oxybutynin, a child may have a brittle bladder, in other words, it may empty when it holds only a small volume of urine, and do it so quickly that the child does not have time even to sense the contraction. Once the medication is used, however, a child who wets by day will likely now be able to sense the bladder contraction before it's too late or at least have enough time to try delaying the contraction either by inhibiting the bladder muscle or tightening hid external sphincter.
In case of night wetting, Oxybutynin (When used with the alarm program) seems to give parents a bit more time to respond to the alarm. So when thy bring the child to the toilet, the bladder is not totally empty, and the child can void on the toilet. An the bed may only get damp instead of soaked. So Oxybutynin give everyone some much needed breathing room while the child learns to master his bladder.
For children with small bladder capacity who are dry by day but wet by night, taking small doses of Oxybutynin during the day as well as at bedtime has proved helpful in alleviating the nighttime wetting. (for the 10 percent of children who wet only at night but have normal bladder capacity, Oxybutynin may not be helpful) Your doctor needs to evaluate your child's bladder capacity before prescribing the medication for this purpose.
Families may be reluctant to choose medication treatment for their children because they are apprehensive about short or long terms side effects of the medication. If you have such concerns, discuss them with your doctor. One common additional effect of Oxybutynin is red cheeks, which is cause by the relaxation of the smooth muscle that cover the blood vessels in the face. This effect is usually harmless, although in the summer months, children may feel slightly over heated because of it.
In fact this effect is so predictable that doctors some time judge the effectiveness of Oxybutynin by looking for red cheeks. If the child has shown no improvement after a month of taking Oxybutynin and her cheeks are not red, perhaps a higher dose is warranted. In any case, it is rare for a family to be so apprehensive about Oxybutynin that they decide against it. In our experience, i is an effective, safe medication.
Oxybutynin may actually increase bladder capacity over many month's time. Remember though, that becoming dry at night depends not so much on how big the bladder is, but rather on how well the child can sense and inhibit an imminent bladder contraction during sleep. Children with normal bladder capacity who usually do not wet may do so under special circumstances (if they are overtired, if they over drink, and so on).
So, children who become dry while taking only Oxybutynin with out other treatments may wet again once they stop taking the medication. In the majority of cases, when prescribed properly, Oxybutynin will enable the child with a small functional bladder capacity to hold urine more effectively, thereby improving his chances to be successful with other treatment.
Children with typical bedwetting who take Oxybutynin in conjunction with the alarm, the bowel program, and the bladder diet, come to show new dryness within month and usually remission of wetting by three months. When one component of that plan is omitted, say the medication, dryness will come a lot more slowly, possibly in six months. Because it can take so long to see results this way, many families conclude that the plan doesn't work and give up trying after months of treatment.
Keep this in mind when you are considering whether or not to choose Oxybutynin influence his and your outlook. Without medication, progress toward dryness maybe so slow that failure is likely. On the other hand, if Oxybutynin helps the wetting improve within a month after treatment begins, which is typical, everyone will feel hopeful. That positive outlook will boost progress all the more.
Choosing Oxybutynin
There a few possible effects associated with Oxybutynin, but they can easily be corrected with a lower dose. In fact, because only small doses of the medication are needed to show good results, such reactions are infrequent, occurring perhaps in about 5 percent of children treated.
To understand these reactions, it is helpful to know that Oxybutynin reduces the activity of the smooth muscle of the bladder. In rare cases, it may also affect other muscles of the body. Because you may have heard stories about the negative effects of medications, here we present the facts about the most notable one regarding Ditropan (in order of occasional to no cases reported):
- Dry mouth
This effect, which may accompany a sensation of overheats, could cause children to over drink. - Constipation
Oxybutynin may slow the activity of the colon and contribute to abdominal pain or constipation. - Blurry vision
This is a very unusual adverse effect, caused by an alteration in the function of the eye muscles. If your child does begin to take Oxybutynin, you should ask his teacher to tell you if he begins to squint or needs to come closer to the board. - Nosebleeds
In some children, Oxybutynin may cause the nose's mucous linings to dry out, resulting in nosebleeds. - Crabbiness
For reasons that are not understood, the medication has been seen to make children irritable or act strangely. This effect disappears after the medication is stopped. - Asthma
Oxybutynin may also act on the muscles in the body's airways passages. Theoretically, the medication could cause those muscles to contract more strongly and so theoretically enhance a child's tendency to be asthmatic. We have never noted this adverse affect in our practice, and we have never heard of a single case in which it has accrued. Nevertheless, it is worthwhile to be aware that the possibility exists. Naturally, as with any medication, inform the doctor who is treating your child for asthma about your child's medication for wetting, and follow the doctors advice.
Please remember that the infrequency with which these effects occur is largely related to the dosing schedule used in the treatment. Other programs, which may prescribe the dose of Ditropan by weight, the common method of prescribing medication, are likely to show such side effects more frequently. Our dosing schedule is based not on children's weight but on their age, the extent of their reduced bladder capacity, and their voiding symptoms.
For example, when bed wetting is due to enuresis and children show reduce functional bladder capacity, the approach doses Ditropan as follows:
5-7 years - Ditropan 1/2 tsp. 8 A.M 4 P.M and bedtime.
8-12 years -Ditropan 1/2 tsp. at 8 A.M and 4 P.M and 1 tsp.
at bedtime. (for children in this age group who show a normal bladder capacity, only give Ditropan 1tsp. at bedtime.
12 years and older -Ditropan 1/2 tsp. at 8 A.M and 4 P.M and 1-2 tsp. at bedtime.
These doses may be adjusted by increasing the doses by a half teaspoon (or tablet) every two weeks according to the child's need (until conventional dose limits are met). Bear in mind that these amount are given only as an example of what we think would typically be appropriate treatment. Each case is different, however, and must be evaluated individually and thoroughly by your doctor. Your doctor will determine the dosage for your child and solely responsible for that determination.
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