Pharmacological Therapy
Different medicinal options exist to treat nocturnal enuresis. These may be used alone or combined with some of the behavioral treatments listed above, which generally has proven to be more effective.
Many studies have shown, however, that while pharmacological treatment may be initially effective in lowering the number of wet nights, the medicine is often effective only as long as it is taken. In other words, relapse rates are high once treatment has stopped, as only symptoms are addressed by the medication rather than the underlying condition or causal factors. The professional medical advice of a healthcare provider should be sought before starting any of these treatments.
Surgical Methods
The involvement of surgery when attempting to treat severe detrusor overactivity is limited and should only be considered when all other less invasive treatment options have proven to be unsuccessful. All of the procedures mentioned below have associated risks that must be considered and discussed with a healthcare professional.
Sacral Nerve Stimulation: Sacral nerve roots are stimulated by neuromodulation, a process where neurotransmitters control various neuron groups. This increases the external sphincter tone causing the detrusor muscle neurons to stop activity. When detrusor muscle neurons have a decreased activity level the muscle will not contract constantly, which ultimately causes less frequent urination episodes. SNS is recommended for people with moderate to severe urge incontinence and for whom other treatments have not been helpful or for whom prescriptions are contraindicated.
Clam Cystoplasty: This is a surgical treatment where the bladder is cut open and a patch of intestine is placed in between the two halves. The goal of this procedure is to reduce bladder instability and increase bladder capacity.
Detrusor Myectomy: This process is also known as auto augmentation that involves removing a portion or all of the exterior muscle surrounding the bladder. It intends to strengthen bladder contractions and reduce the number of them.