A very commonly seen problem in the clinic for which parents seek treatment and get concerned out of proportion. Children vary in the age at which they gain nocturnal continence of urine. About 10-15% of normal children at the age of 5 years still wet the bed at night. Boys slightly predominate over girls (as girls generally attain nocturnal bladder control early than boys), and there is increased incidence in some families. The factors leading to gaining in the bladder control are complex and involve maturation of the necessary neurological pathways as well as emotional factors.
Though there can be physical or organic causes also for the bed wetting such as Urinary Tract Infection, Constipation, Diabetes Mellitus or the Laxed Urethral Sphincter or it can be the effect of extreme cold or damp climate. Otherwise more often it is again psychological in origin, may be associated with emotional anxieties. On detailed history it is normally revealed that either of the parents also had similar problem in their young days. A homoeopath can definitely point it out that the child is very likely to be fearful in nature. The child may have the fear of darkness, of being alone and of being harmed. The occurrence of enuresis in day-time is particularly significant and may be related to Urinary Tract Infection or Diabetes Mellitus.
For the management of the cases of nocturnal enuresis, some significant actions are to be followed:
(i) It is important to carefully explain to the anxious parents the nature and course of nocturnal enuresis and that all children in the course of time will become continent of urine. This is important to explain to the child as well, as he may feel that he never will be dry at night. As it further aggravates the problem and the child start developing some kind of frustration and guilty also.
(11) Asking the child to empty the bladder before going to bed and waking the child again and asking him/her to urinate before the parents go to bed often helps. Avoiding excessive fluid intake before bedtime also helps but it should be remembered that the children require a relatively higher fluid intake than adults and so fluids before bedtime can be restricted reasonably only. Children should be asked to refrain from reading very exciting, thrilling comics and story books also should restrict them from watching very exciting movies etc. on T.V and Videos. Eating very heavy food or over eating in dinner should also be avoided.
(iii) Child can be asked to put a mark of right on a diary or colander on the day he does not pass urine in the bed and put a mark of wrong the day he wets his bed at night and ask him to show after a week, this keeps a psychological awareness and pressure at the subconscious level and he passes more dry nights. Parents can be asked to praise or give some kind of incentives to the child during the days he does not pass urine in the bed and can be given a very light kind of punishment such as asking him to wash his dirty clothes by himself/herself which makes him/her realize about it, also found effective measure. I have found this method very helpful in my clinical practice, whereas I had seen young adult girls and boys also having the problem of nocturnal enuresis, there it has to be tackled more tactfully by making them take out their fears and inhibitions or by making them feel the sense of shame or so but without affecting their normal life pattern. For the younger children enuresis alarm beds are probably a safe and effective method.
(iv) Children who have some other physical or organic cause e.g worms and infection etc. should be treated for that also.
(v) In certain cases, I have seen that the children draw pleasure whenever the mother gets irritated by this act of bed wetting of the child, here it is very important to understand the cause and explain the irritating mother about the whole psychological development as it has been seen that the children were deprived of the mother’s affection and care earlier and later the child develops the sadistic pleasure by seeing their mother in such situation. In this case the understanding and the bondage between the mother and child has to be established.
Homeopathically these children can be helped to a greater extent. I have seen wonderful results in certain obstinate cases of nocturnal enuresis where the patient was treated even by sedatives and tricyclic drugs etc. without much benefit under other system of medicine.
1.) SEPIA : Involuntary urination during first sleep, on coughing, sneezing, laughing, hearing sudden noise, fright or in attention especially in females. Slow urination with bearing down sensation above pubis. Urine thick, foul, white gritty or adherent red sediment. Urine feeble, slow cutting pain in bladder before urination. Urine bloody milky, shuddering if desire is resisted.
2.) KREOSOTE : Involuntary urination when lying, on coughing. Can urinate only while lying. Dreams of urinating. Enuresis in the first part of the sleep at night, difficult to waken the child. Urine offensive. Frequent urination, with copious urine during daytime. Drinks much but passes little at a time.
3.) NITRIC ACID : Urine smells like as of horse, cold when it passes alternately profuse and scanty. Urine contains oxalic acid, uric acid and phosphates. Haematuria with shuddering along the spine, as of a hot wire in urethra. Infective nephritis. Stream thin as from stricture. Red scurfy spots in prepuce or on corona glandis. Painless retention or incontinence of urine.
4.) EQUISETUM H. : Nocturnal enuresis of children, without any tangible cause except habit. Incontinence in children, dreams or nightmares when passing urine. Incontinence in old women also with involuntary stools. Much mucus in urine,. Albuminuria. Constant desire to urinate and passes large quantities of clear, light colored urine without relief.
5.) CAUSTICUM : Bed wetting during first half of the sleep at night. Paralysis of bladder, from retention of urine and consequent incontinence as in sleep or in school girls. Involuntary passage of urine on coughing, vomiting, blowing nose, sneezing or laughing. Retention of urine after labor, after surgical operations. Burning in urethra when urinating. Urine dribbles or passes slowly. Insensibility of urethra while urinating. Urine is passed better when sitting. Urine black cloudy white, itching of meatus. Child does not want to go to bed alone.
6.) BELLADONNA : Incontinence, continuous dropping. Frequent and profuse, involuntary urination, on lying down, or when standing, or at night, when sleeping during daytime. Retention of urine with paralysis of bladder. Haematuria without pathological conditions. Sensation in bladder as if worms were turning in, without desire to micturate.
7.) APIS MEL : Incontinence of urine at night, during coughing. Can not urinate without a stool. Burning micturation. Dysuria with stinging pains,. Urine scanty foul smelling high color, last drops burn and smarting at the end. Albuminuria, nephritis, cystitis. Retention of the urine in new born. Difficult, frequent or slow urination.
8.) ARGENTUM NITRICUM : Incontinence of urine day and night. Urine passes less easily and freely. Cutting in the urethra with painful erection. Incontinence of urine after straining for the stool. Divided stream of urine. Emission of few drops after having finished. Incontinence of urine while walking.
9.) SILICEA : Nocturnal enuresis in children from worms. Nightly incontinence after a blow upon the head. Prostatic fluid discharged when straining at stool. Frequent urination with tenesmus, chronic urethritis, foul discharge from urethra, thick curdy, purulent, bloody pus in urine.
10.) SULPHUR : Bed wetting specially in scrofulous, untidy children. Mucus and pus in urine. Great quantities of colorless urine. Must hurry, sudden call to urinate. Sits with forward inclination. Involuntary urination while passing flatus, or on coughing. Painful ineffectual efforts to urinate, retention every cold settles in the bladder. Itching and burning in urethra, during micturation lasting long after , stream thin and intermits.
Other effective remedies can be Arnica; Benz.Ac; Graph; Lac.Can; Cina; Mag.Ph; Nat.M; R.T.; Ammon.C and Zinc etc.
Sr. HOMOEOPATHIC CONSULTANT
Director-OVIHAMS ( Sh.Om -Vidya Institute Of Homoeopathy and Allied Medical Sciences)
Recipient- Internaional Hahnemann Award of the Millennium; Gold Medalist,
Lord Dhanwantri Award, Dr.Yudhvir Singh Award, Life Achievement Award
Member- Homoeopathic Advisory Committee Govt. of NCT Delhi.
Author- The Problem Child and Homoeopathy
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