Diplomate, Board Certification of Emergency Medicine
Chairman, Department of Emergency Medicine Ma'ayenei Hayeshua
Hospital
EBM -- evidence-based medicine -- is the rage these days in
the medical literature. This theory states that proper
medicine should be based on evidence, not on experience,
experts or hunch. The main source for this is the Cochrane
coalition, which is accessible via the Internet.
EBM can be tricky. Often it is dependent on how much
investigating the researcher has done, his expertise in
evaluating the evidence and assumptions that are made in the
studies. The British Medical Journal produces updates
of their investigations, and we will discuss a few of
those.
Bedwetting is a common problem among kids and even adults.
Called nocturnal enuresis, it is considered a problem in
children over age 5 who bedwet without evidence of any
defects in the nervous system or in the urinary tract. It can
be genetic, and can be related to a small bladder, infection
or deep sleeping.
We know what doesn't work: threatening, embarrassing and
cajoling will not help. Desmopressing -- D_AVP which is a
nasal spray -- can help. Rebound after ceasing therapy can
occur, however. In deep sleepers, often an alarm wakes up the
rest of the family and not the bedwetter. Indometacin, a pain
and fever reliever, and acupuncture may help, we don't know
why. Tricyclic drugs, which were in the past used for
depression, work well here as well.
But these are drugs that have many side effects which may
make them not worth the try. They can cause constipation,
irritability, headaches, sleep disturbance and vomiting.
We do not know if a standard alarm clock, trainers, and
carbamazine -- a seizure drug -- work. There is just not
enough evidence.
If you have tried these therapies without success, do not
despair. Even without treatment, 15 percent of children
become dry every year, with only 1 percent carrying it into
adulthood.
Encoporesis is soiling the undergarments with stool and is
due to psychological problems such as unexpressed anger, or
due to functional disorders such as constipation. Often if
the child is asked, a solution is obvious. Many times it is
due to schools where the teachers do not let the children go
out in time to use the bathroom, or else by dirty bathrooms,
or the absence of toilet paper in the restrooms. Again, do
not despair.
Elderly incontinence is often due to a neurological
condition, or to infection. This is a whole different
disease, with often disappointing results. Write me in care
of the Yated.
A message from GlaxoSmithKline, sponsor of this
column. Seroxat is an effective medicine against
depression, a disease that does not have to impair one's
lifestyle. This medicine has been part of a revolution
against earlier medicines (tricyclics) in a humane and safe
fashion. Few side effects and it works.
