Nocturnal enuresis, otherwise known as night-time incontinence or simply bedwetting, not able to control urine is a common condition in children. It is involuntary urination that generally happens at night while sleeping after a certain age when a child should have attained good bladder control. Involuntary urination during daytime is called diurnal enuresis. Bedwetting causes a condition of substantial psychological distress in children. It is a problem that is faced by children with the age of five or more. 1-2 out of teens is suffering from this condition of poor bladder control. Boys are suffering from severe bedwetting as compared to girls. The frequency is >2-3 nights/week.
What Happens in Normal Enuresis?
The urinary bladder is a muscular vessel that holds urine. It expands as urine enters and contracts when it pushes urine out of the system. In a person with normal bladder control, the nerves send a message to the brain when the bladder is full of urine. As a result, the brain sends a message back to hold the urine until the person is ready to empty the bladder voluntarily.
Normally nocturnal urinary continence is dependent on:
- Nocturnal urine production
- Nocturnal bladder function.
- Sleep and arousal mechanism.
There are two types of nocturnal enuresis:
- Primary nocturnal enuresis: The person has a history of bedwetting since he/she was a baby.
- Secondary enuresis: This condition develops after 6 months or more after he/she develops a good control over their bladder.
Cause for Nocturnal Enuresis:
There are multiple factors for poor bladder control and nocturnal incontinence. Thus, pointing out a single factor will be elusive and vague. Numerous etiologic factors and theories are proposed to be the cause for nocturnal enuresis. Some of them are explained below.
- Genetics- Many studies have shown that children suffering from nocturnal enuresis come from parents who were facing the same problem in their childhood.
- Hormones- A hormone called ADH i.e. Anti-Diuretic Hormone keeps the urine in check while you are asleep. Some people lack this hormone in their body and thus body makes more urine causing nocturnal enuresis.
- Psychology- Psychological stress, fear, frights, worry, anger, jealousy, demanding attention along with lack of proper parental guidance and improper toilet training during the crucial stage of learning muscular control.
- Bladder problems- Children suffering from this condition might have a lower urine holding capacity in their bladder. A congenital weakening of urethral sphincter, urethral stricture, stones, and anatomic problems might be the cause.
- Sleep disorders- Sleep disorders like night walking, night terrors, confused awakening might have a relation with nocturnal enuresis. Sleep apnoea with or without enlarged tonsils and adenoids may be associated with bedwetting.
- Medical condition- Medical conditions like diabetes, urinary tract infections (UTI), constipation cause secondary enuresis.
- Arginine vasopressin- Studies have been postulated that bedwetters have a poor circadian rhythm that causes a delayed rise in arginine vasopressin, the antidiuretic hormone. This delay is one of the causes of poor urine holding capacity of the bladder till the morning and nocturnal bed wetting.
- Caffeine- An increased level of caffeine in blood makes more urination.
Bedwetters are more likely to suffer from behavioral problems like confidence issues, irritation and increased stress along with other developmental issues.
Bedwetting is one of the most stressful events in a child’s life. It may cause lower self-esteem and psychological stress in children with bedwetting than from those who do not. The child may also present with a fear of embarrassment from wearing a diaper to bed at night.
Many studies have shown that children facing this condition may be facing social problems in daily life such as being teased by siblings and friends, sibling jealousy from the arrival of a new baby, being ignored or punished by parents, parental conflicts like divorce, sexual abuse.
Treatment for Nocturnal Enuresis:
- Parental care, guidance, and support are very important demands of a child during his growing years. A poor family environment not only has a negative impact on the mind but also affects the physical wellbeing of the child. Along with any other therapy, parental supports work as a miraculous treatment for a child. Punishing and shaming a child for bedwetting will make the situation worse. Parents should try to understand child psychology as involuntary urine secretion is not a mistake and is not in control of the child. Start bedtime urine voiding -training by setting alarms.
- Management of food and drinks before bedtime is necessary. Intake of milk and water before sleeping increases the chances of bedwetting.
- Medical treatment for children suffering from hormonal imbalance and poor secretion of ADH hormone is available and can be prescribed under strict medical supervision.
Homeopathic treatment available for nocturnal enuresis:
This homeopathic medicine is indicated in the children suffering from bedwetting, poor voluntary control over bladder sphincter. Also prescribed in nocturnal enuresis of psychosomatic origin. This homeopathic medicine can also be indicated in involuntary urine flow at night of functional origin due to bladder dysfunction such as weak muscular contraction of bladder walls or a stricture. This is the best medicine prescribed in the children of five years or more suffering from nocturnal enuresis along with poor social interactive behavior. Homeopathic medicine works wonder in such cases without any side effects. It is found very effective in controlling the frequency of urination during night hours. It also calms and soothes the irritable tempers and nervous behavior of physically and mentally disturbed children.
Dose: In acute cases, 2-5 tablets every half an hour.
Each tablet of 10g is composed of the following ingredients:
- Ferrum phosphoricum 8x
- Atropinum purum 6x
- Acidum phosphoricum 2x
- Kreosotum 6x
- Staphysagria 4x
- Petroselinum 3x
- Tabacum 4x.
Indications: It can be indicated in clinical cases where children have difficulty in establishing good bladder control even after therapy.
Side effects: No known side effects of EnukindTM to date.
Contra-indications: No known contra-indications for the use of EnukindTM. It is very safe to use and can be prescribed in children of growing age.
Interactions: There are no registered interactions between EnukindTM and other known products.