Dr Margaret answers e-mailers' embarrassing problems in this biweekly problem page.

Bed-wetting

We have had a lot of queries about bed-wetting in children and adults. Here are just two of them.

Dear Dr Margaret
Why is there nothing on your site regarding bed-wetting? I have just spent 2 embarrassing weeks in a hotel abroad avoiding the maids, because of this very subject. I ended up buying an airbed and sleeping on that, dealing with what I was using as bedding in the morning, then slipping into bed when I knew it was safe to do so (after 6a.m.). I am a 47-year old male and obviously holiday time is very stressful for me. I cannot deny my family a decent holiday just because of my problem. I have attended hospital and taken pills, even hypnotism, all to no avail.

Point taken about the omission of bed-wetting from this site. In a couple of weeks time, we will be adding new sections on ‘Bed-wetting in Children’ and ‘Bed-wetting in Teenagers and Adults’. Your problem is more common than you might think - about 1 in 100 adults wets the bed regularly, mostly men. You have obviously taken the first important step, which is to consult your doctor and have a check-up to ensure there is nothing seriously wrong with your bladder system. I am sure your doctor will also have checked for a urine infection and for diabetes (both of which can cause bed-wetting in some people).

You don’t say what pills you took and when. If it was a few years ago, you were probably prescribed imipramine. A completely different drug, desmopressin, is now the first-choice drug. It is taken as a nasal spray or as tablets. It works by concentrating your urine so that there is not such a large volume to cope with. It works quickly, so it would have been an ideal choice for your holiday. Although it stops bed-wetting completely in less than a third of people, most find it reduces the number of wet nights. It also doesn’t cure the problem - when you stop taking it, the bed-wetting often recurs - but it is safe to take it over a long period.

Have you tried a bed-wetting alarm system to train yourself? These can produce a complete cure and are the best solution for children who bed-wet, but they also work for teenagers and sometimes for adults. Your GP can advise you about obtaining an alarm and show you how to use it. Alternatively, you can buy one from ERIC, the Enuresis Resource and Information Centre, a not-for-profit organization. (In any case, take a look at ERIC’s excellent website www.eric.org.uk.) If the alarm has not produced any improvement after 3 months, talk to your doctor about combining it with desmopressin. If none of this works, you could try imipramine again in combination with another drug, such as tolterodine.

One small point - are you overweight and a snorer? If so, it is just possible you have sleep apnoea, which can sometimes cause or worsen bed-wetting. See our snoring section for more information.

So my advice is that you should talk to your doctor again, to see what new treatments have become available since you last saw him or her.

Dear Dr Margaret
My husband has a problem with wetting the bed. He is obviously very embarrassed about this. He has been to see our GP and was told it is a fairly common problem but that there was nothing that could be done for him other than to take tablets for the rest of his life. He prescribed him Tofranil, which did help for a while. He is reluctant to go back to our GP as he says he will only be given more tablets and he doesn’t like to take tablets really. I love my husband dearly, we have been married 12 years now and although I get annoyed I never have a go at him as I know it isn’t his fault but I am getting more and more frustrated by this. I have checked on the net for any info but I got lots of conflicting opinions as to the cause . American sites seem to go with the idea that it is an inherited condition while the British sites say it isn’t.

To answer your last point first, if he has always had this problem it is probably because his bladder has not developed the necessary nerve and muscle control, so the bladder muscle contracts and empties the bladder when it is only half full of urine. Alternatively, he may be producing a lot of urine at night, because the mechanisms that reduce urine production at night are not working efficiently. There does seem to be an inherited element in some people, involving chromosomes 13q and 12q, but it is not well understood.

Most of my reply to the first problem also applies to your husband. Tofranil is imipramine and it has some side-effects such as dry mouth, constipation and blurred vision. He should talk to his doctor about desmopressin, which does not have these side-effects. In fact, desmopressin is very similar to vasopressin, the natural substance that inhibits urine production while we sleep.

Any more questions?
Do you have any more questions about dentistry? If so, send an email to info@healthpress.co.uk. I am sorry that I cannot send you an individual reply, but I will try to answer some of them on this page.

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