Nocturnal Enuresis and Homeopathy Healing

The word enuresis commonly known as “Bedwetting” was evolved from a Greek word ‘enourein’ meaning ‘to void urine’. Enuresis is defined as a normal, nearly complete evacuation of the bladder at a wrong place and time at least twice a month after 5 years of age. Daytime wetting is called Diurnal enuresis while involuntary urination at night is called Nocturnal enuresis. It is a common problem among children, even after they have been toilet trained.

Enuresis is a complex problem involving various causative factors including psychosocial development of child. This problem can be upsetting for children and family.

HOW COMMON IS ENURESIS

It is a common childhood problem. Estimates suggest that 7% of boys and 3% of girls age 5 have enuresis. These figures reduce to 3% of boys and 2% of girls by age 10. Most of the children combat this problem by the time they become teens, with only about 1% of males and less than 1% of females have this disorder at the age of 18.

TYPES OF NOCTURNAL ENURESIS

There are two types of nocturnal enuresis

1. PRIMARY ENURESIS– when the symptoms has always existed and the child has not been dried for a period longer than 6 months which means a child has never had bladder control at night and has always wet the bed. This type is more common among children.
2. SECONDARY ENURESIS– when there has been a symptom free interval of 6 months or years and then begins to wet the bed.

CAUSES OF NOCTURNAL ENURESIS

The exact cause of bedwetting is still not completely understood. It can be a result of physical and psychological cause. Some of the possible causes are discussed below: –

1. GENETIC CAUSE– children with this problem often have a parent who had the same problem at about the same age.
2. BLADDER PROBLEM– this can cause nocturnal as well as diurnal enuresis. Too many muscles spasm can prevent the bladder from holding a normal amount of pee.
3. HORMONAL PROBLEM– in person whose body does not make sufficient amount of Anti Diuretic Hormone, likely to suffer from enuresis.
4. STRESS– this is one of the commonest causes for secondary enuresis. Children suffer from stress when moving to new place, school, home, experiencing a parental fight or divorce or when they lose any of the parent, or any loved ones etc. These all can have a long-lasting effect on children’s psychological aspect. Treating the cause of stress can stop the bedwetting.
5. CONSTIPATION– a full rectum can also reduce the amount of urine that the bladder can hold or prevent it from emptying completely during urination.
6. SLEEP PROBLEM– some children are unable to wake up in time to get to the bathroom.
7. SEXUAL ABUSE– in some case, history of abuse can be traced down after which this problem started. Other symptoms include frequent urinary tract infections, pain, itching, unusual discharge etc.
8. SLEEP APNEA– sometimes bed wetting occurs due to obstructive sleep apnea. It is a condition in which the child’s breathing is interrupted due to inflamed or enlarged tonsils or adenoids.
9.  CERTAIN MEDICAL CONDITIONS– children suffering from diabetes, sickle cell disease, worm infestation, any trauma, after circumcision operation, any neurological problem, kidney diseases etc. can cause the problem of bedwetting. Children with ADHD are more likely to develop bedwetting.

GENERAL PREVENTIVE MEASURES TO BE FOLLOWED

1. DIET MANAGEMENT– child should be refrain from taking liquid diet like juice, milk etc. and also much salty and spicy food items in the evening as these things tends to increase the urine output. These things should be given in daytime.
2. SLEEP-child should not be set to bed immediately after eating. Before going to bed child should be taken to bathroom for urination.
3. IMAGINE YOURSELF DRY– the technique called positive imagery in which you think about waking up dry before you go to sleep, can help some people stop bedwetting.
4.  USE OF BEDWETTING ALARM– alarm can be used to elicit a conditioned response of awakening to the sensation of a full bladder. These alarms buzz or vibrate when a child’s underwear gets wet. This therapy requires active participation of parents too. They should make sure that the child fully wakes up and goes to the bathroom when the alarm goes off.
5. SAY NO TO PUNISHMENT– the parent should try to understand that it is not the fault of child and they should avoid any yelling and punishment on them. This will not only embarrass the child as well as lowers the self-confidence.
6. PARENTS SUPPORT AND ENCOURAGEMENT– parents should encourage child to go to the bathroom regularly during the day, every two to three hours. They should also reward the child for waking up dry. This will boost the confidence of child and also make them to work better for the same.

BIOLOGICAL CONFLICT OR THOUGHT PROCESS ASSOCIATED WITH NOCTURNAL ENURESIS

Nocturnal enuresis or commonly called Bed Wetting greatly affects the wellbeing of the child as well as parents. Not only child but parents and other family members are also stressed by a child’s bedwetting. Psychological impacts of bedwetting are more important than the physical considerations. These children have significantly lower self-esteem and often humiliated and teased by peers, punished by parents and being afraid that friends will find out. Children with bedwetting may desire they cannot attend sleepovers with their friends or overnight camps. This thought process greatly affect their relationships, quality of life, and schoolwork.

The biological conflict linked to the bladder muscle and external bladder sphincter is “not having the ability to sufficiently mark one’s place”. Children suffer territorial marking conflicts with their siblings or schoolmates or when they are physically, verbally, or socially bullied. They often face behavioral issues which is the result of low self-esteem. They usually remain in a state of fear that what will happens one anyone finds out this. Parents punished child for this activity which makes them feel shame and embarrassed and a loss of self-confidence. These children also lag behind in academics performance as they are unable to focus and lack the power of concentration.

HOMEOPATHIC REMEDIES FOR NOCTURNAL ENURESIS

Bedwetting is a multi-factorial disease involving both physical n psychological cause. While prescribing a homeopathic medicine one should inquire about every possible aspect of patient life and the surroundings. As homeopathy works on the principle of Individualization, treating every patient as a new one. Here, few commonly indicated general medicines are described which can guide in the selection of simlimum

1. Argentum Nitricum– Indicated when urine passes unconsciously, day and night with inflamed and painful urethra and associated with much nervousness and restlessness.
2. Benzoicum Acidum- Indicated when urine odor is highly repulsive and of changeable color with inflammation of bladder.
3. Calcarea Carb– Can be given as an excellent constitutional remedy in children when urine is dark, brown, sour, foetid with white sediment and irritable bladder.
4. Causticum– Indicated when urine is involuntary during first sleep at night. Urine passes involuntary while coughing, sneezing and from the slightest excitement.
5. Cina– Indicated when bedwetting is mainly due to worm infestation. Urine is turbid, white, turns milky on standing. Involuntary at night.
6. Equisetum hyemale– Indicated for frequent urging with severe pain at the close of urination. Sharp, burning, cutting pain in the urethra while urinating.
7. Kreosotum– Indicated for enuresis in the first part of night. Dreams of micturating. Offensive urine and must hurry when desire come to micturate.
8. Sepia– indicated for enuresis during first sleep with red, adhesive, sand in urine. Chronic cystitis, slow micturition with bearing down sensation above the pubis.
9. Silicea– indicated for nocturnal enuresis in children suffering from worms. Enuresis with red or yellow sediment.

10. Sulphur– indicated for frequent micturition, especially at night in scrofulous, untidy children. Burning in urethra during micturition. Great quantities of colorless urine.

11. Viola odorata– indicated for enuresis in nervous children. Urine is milky and strong smelling.

SOME IMPORTANT RUBRICS FOR NOCTURNAL ENURESIS:-

Some commonly used rubrics from Kent repertory are given below which can be used along with the physical and mental generals to form the complete totality of the case.

1. [Bladder] Urination: Involuntary: Night (incontinence in bed)
2. [Bladder] Urination: Involuntary: Night (incontinence in bed): Morning, toward
3. [Bladder] Urination: Involuntary: Night (incontinence in bed): midnight to morning:
4. [Bladder] Urination: Involuntary: Night(incontinence in bed): Midnight to morning: After, 5am
5. [Bladder] Urination: Involuntary: Night(incontinence in bed): Difficult to waken the child:
6. [Bladder] Urination: Involuntary: Night(incontinence in bed): Dreaming of urinating, while:
7. [Bladder] Urination: Involuntary: Night(incontinence in bed): First sleep:
8. [Bladder] Urination: Involuntary: Night(incontinence in bed): Spasmodic enuresis
9. [Bladder] Urination: Involuntary: Night(incontinence in bed): Tangible cause except habit, when there is no:

REFERANCES:-

1. Ghai Essential Paediatrics, Eighth Edition.
2. webmed
3. German New Medicine, Enuresis
4. Boericke’s New Manual of Homeopathic Materia Medica with Repertory, William Boericke.
5. Repertory Of The Homoeopathic Materia Medica, James Tyler Kent