Roanoke Times
Copyright (c) 1995, Landmark Communications, Inc.
DATE: TUESDAY, May 10, 1994 TAG: 9405100133
SECTION: VIRGINIA PAGE: C1 EDITION: METRO
SOURCE: LISA APPLEGATE STAFF WRITER
DATELINE: LENGTH: Medium
``It would happen three or four times a week. And as he got older, he was so embarrassed he'd take the sheets off himself and put them in the laundry, hoping we wouldn't find out,'' said David's mother, Cary.
David (his and his mother's names have been changed for this story) suffered from primary nocturnal enuresis - bed-wetting.
It caused him problems until he was 10 years old.
Before the age of 6, bed-wetting is a fairly normal occurrence for about 15 percent of children.
``At younger ages, it's a purely developmental problem - the brain has not matured ... enough to wake up when the bladder is full,'' said Physicians to Children pediatrician Robert Collins.
But Collins said bed-wetting is a more severe problem for older children because social stigmas are added, and fewer children experience - and understand - the embarrassment.
``It really became a problem [for David] when he was about 10 and he couldn't go to camp or stay the night at friends' houses,'' Cary said.
She said David grew frustrated as he watched his sister spend the night away from home.
Cary finally took David to his pediatrician, who gave him a nasal spray called DDAVP.
``He was one of the first kids to use [DDAVP] for bed-wetting in the Roanoke Valley,'' she said. ``I just can't say enough good things about it.''
The drug originally was used to treat diabetes insipidis, a disease that affects the pituitary gland. But one of the synthetic hormones used in the drug was found to benefit bed-wetters.
The hormone, called ADH, reduces urine production and essentially blocks urine in the kidneys. For most people, the hormone is naturally released from about 7 p.m. to 10 p.m. Researchers have found that some children who wet their beds don't release enough of this hormone at night.
Scott Moir, a Rhone-Poulenc Pharmaceuticals representative, said that when used at bedtime, ``DDAVP essentially gives bed-wetters the spike of ADH they need to last through the night.''
Moir said many parents aren't aware that something can be done about bed-wetting, and some doctors don't address the issue.
``Parents ignore it or hope their children will grow out of it. And some doctors wait for the parents to bring it up,''Moir said.
Dr. Joseph Duckwall, with Lewis-Gale Children's Clinic, said he consistently asks patients over the age of 5 about bed-wetting. He recommends DDAVP because it is ``probably the most consistently effective medication available.''
Duckwall said that although some parents are reluctant to talk about bed-wetting in front of their children, he tries to lessen the negative aspects and show the problem as common and often part of the family history.
Bed-wetting has a high heredity factor - close to 80 percent - and is more common in boys.
Cary said David's father and uncle were bed-wetters, ``so that made it easier for him to talk about it.''
Other drugs have been used for bed-wetting, according to urologist Joseph Hayes. He uses Imipramine, which strengthens the bladder neck muscles, and Oxybutanin, which increases bladder capacity. Both of these drugs, however, cause side effects such as a dry mouth and a feeling of being hot.
``Most people seem to tolerate DDAVP better than anything else,'' he said.
For some children, bed-wetting can be brought on by psychological or emotional disturbances, such as moving to a new town or a divorce in the family.
For these bed-wetters, DDAVP is not as effective, and Collins often uses an anti-depressant called Elavil.
``I give it to patients with other problems, such as attention deficit disorder, who need behavior modification'' along with bed-wetting treatment.
As for David, who used the drug for two years, DDAVP was a cure for his embarrassment and a relief for his family.
Cary said David, now 13, plans to spend this summer staying with friends and going to camp with his sister.
by CNB