The myth behind the drug DDAVP for bedwetting treatment

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One medical theory regarding bedwetting claims that it is caused by a deficiency of ADH (antidiuretic hormone).  This hormone is particularly important for regulating the body’s retention of water; the brain releases the hormone when the body is dehydrated and causes the kidneys to conserve water. They slow urine production, and only a small amount of urine is transferred to the bladder.

DDAVP has been widely prescribed by doctors for more than 20 years. It is true that when this drug is administered bedwetting frequency will be reduced, but when bedwetters stop using the drug, 60% to 90% of them will relapse. In most cases, DDAVP simply does not solve the bedwetting problem and only works while the drug is being used. It can be used for sleepovers as a temporary solution.

There is no clear scientific proof that bedwetters have ADH deficiency; in fact, many researchers’ findings contradict this theory. Moreover, if this theory were valid, CBT treatment with a bedwetting alarm couldn’t solve the bedwetting problem since we don’t make any changes in the ADH level. The very high success rate of TheraPee (over 90%) is ultimate proof that bedwetting doesn’t stem from ADH deficiency.

Regression to bedwetting as a result of sexual abuse

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One of the most common regression symptoms of children that have been sexually abused is diurnal and nocturnal enuresis (mainly nocturnal). Such children have difficulty sleeping and experience nightmares, anxiety, guilt, and shame. These cause him to use defensive mechanisms, one of which is regression to an early development stage (bedwetting). There is also a relationship between the sexual trauma, which is related to sex organs, and the type of regression.

I once treated a 12-year-old girl that had been sexually abused by her uncle (her mother’s brother) when her parents weren’t at home. This sexual abuse had been committed by a close relative she was supposed to trust. For a long time, the girl kept the horrible secret. She was afraid that no one would believe her. Her uncle threatened to hurt her if she revealed what had happened. Her parents didn’t notice her distress, which was reflected by a loss of appetite, difficulty concentrating, falling behind in her studies, withdrawal, a loss of joy, and bedwetting.

The school counselor had noticed her extreme behavior changes and encouraged her to talk. She started to cry bitterly and told her everything.

If this trauma weren’t enough for the poor girl, her grandmother, in an attempt to protect her son, the sex offender, accused her of lying and threatened to expel her from the family. Believe it or not, her parents didn’t support or believe her.

It was quite clear to me that under those circumstances there was no point in focusing on the bedwetting problem. Rather, the entire situation needed to be treated. In most cases, bedwetting is a learning problem and should be treated as such, namely, by working directly on the bedwetting symptom through a process of learning.

It goes without saying that in this case we couldn’t relate to the bedwetting issue because of the overall situation. I recommended that the child be placed in a supportive and caring foster home and receive intensive psychological treatment.

The girl progressed tremendously, and the bedwetting issue has disappeared with no need to address it directly. Sometimes, however, under those circumstances, a child might still manage to progress, but the bedwetting issue still exists since the early learning has been forgotten. In this case, the child will need go through relearning to get back on track.

The uncle, however, has plenty of time to think about his deviant behavior behind bars.