Bed Wetting and It’s Homeopathic Approach

Abstract   

Nocturnal enuresis, commonly known as bed wetting is a common disease in children occurring due to underdeveloped micturition reflex. The article gives an overview of the epidemiology, its causes, types, clinical presentation, prevention, management and homoeopathic approach with repertory and Materia medica. Homoeopathy being an individualized method enhances the power of long-term amelioration than temporary relief.

Keywords: Bed wetting, Children, Homoeopathy, Nocturnal enuresis

Introduction: Nocturnal enuresis is very common in children as they did not develop the micturition reflex of bladder fullness. There are two types:

1. Primary – Never attained the bladder muscle control mechanism at the age of 3years.
2. Secondary – Due to some pathological cause or diseased condition.

The condition is defined as involuntary urination during sleep which can occur in an inappropriate place and time. Leading to negative impact on a child’s mental health and the family. The child should be trained that before or after every feed he needs to practice the toilet mechanism or the hissing sound which initiates the emptying of bladder leading to proper bladder muscular activity to retain or excrete.1,2,3,4,5

Epidemiology: Nocturnal enuresis is more common in boys than girls with highest occurrence in the age group of 5 to 8 years in India which ranges from 7.61%-16.3%. Global affection lies between 1.4%-28% with common prevalence between 6 to 12 years of children.1,2,5

Aetiology:

It can be divided under 3 causes3,4,5 –

1. Psychological – Parental separation or fight, punishment or rejection from care giver, disturbed sleep.
2. Physiological – Defective cortical mechanism and reduced functionality of anti-diuretic hormone production at night, delayed training for toilet reflex.
3. Genetic – Defect in chromosomal genes of 12 and 13q which are responsible gene for enuresis. Positive family history plays a great role. 

Clinical presentation5

Nocturia with urgency more during daytime along with hesitancy. The flow is weak with much straining. There may be post-void dribbling and pain with unfinished sensation of urination.

Clinician’s key points1,2,3,4,5

• Presence of daytime incontinence – time and quantity.
• Presence of any urinary tract infection.
• Stooling history along with worms, constipation and straining.
• Family history
• Psychological effects
• Medical history
• Fluid intake

Prevention and management1,4,5

• Parental counselling as they are the ones who can give them proper mental support and not criticize or scold them. 
• Bladder exercise which will help to build strength.
• Limiting fluid intake if required.
• Using alarm system to teach when to hold the feeling. 
• Schools should have proper toilet breaks.

Homoeopathic approach

Homoeopathy plays a crucial role in treating diseases of children as its principles and approach of treatment is bases on individualization of the patient and not on nosological name of the disease. According to Master Hahnemann diseases in children are due to the inherited chronic miasm i.e. Psora, Sycosis and Syphilis.

Repertorial rubrics: 

KENT6 

• Bladder: Urination: Dysuria: alternating with enuresis
• Bladder: Urination: Involuntary: Night: (incontinence in bed) Spasmodic enuresis

BOERICKE10

• Urinary System Bladder: Enuresis, incontinence, remedies in general
• Urinary System Bladder: Enuresis, incontinence, remedies in general: Diurnal
• Urinary System Bladder: Enuresis, incontinence, remedies in general: Nocturnal
• Urinary System Bladder: Enuresis, incontinence, remedies in general: Cause: First sleep during, child aroused with difficulty
• Urinary System Bladder: Enuresis, incontinence, remedies in general: Worms

MURPH’S REPERTORY7

• Bladder, bed wetting, enuresis  
• Bladder, bed wetting, enuresis children in 
• Bladder bed wetting, enuresis, dreams of urinating while 
• Bladder bed wetting, enuresis, first sleep 

THE ESSENTIAL SYNTHESIS8

• Bladder, urination, involuntary night 
• Bladder urination children in 

Therapeutics:9,10

1. Argentum nitricum – Urine passes unconsciously day and night with occasional pain, burning and itching. 
2. Belladonna – Simple nocturnal enuresis in profound sleep. 
3. Calcarean carbonica – Frequent wetting the bed at night with profuse perspiration, wetting pillow far around. 
4. Causticum – Involuntary urination during first sleep at night and from slightest excitement. Loss of sensibility on passing urine. Paralysis of muscles with loss of muscular strength.
5. Cina – Involuntary urination with passage of profuse white foetid urine, soon becoming turbid. From irritation from worms. Prescriber. 
6. Dulcamara – Catarrhal ischuria in grown-up children, with milky urine passed involuntarily. 
7. Equisetum hyemale – Profuse urination occurring day and night. Dreams of crowds or gathering of people. Incontinence due to dreams or nightmare in children.
8. Ferrum phosphoricum – Incontinence of urine chiefly during the daytime. 
9. Kreosotum – Enuresis during first part of night. Dreams of urination. Cannot get out of bed at night leading to copious pale discharge. 
10. Medorrhinum – Nocturnal emission followed by great weakness; the flow of urine is very slow.
11. Natrum muriaticum – Urine passes involuntarily when walking or coughing.
12. Opium – Involuntary urine slow to start feeble stream with loss of power or sensibility of bladder. 
13. Pulsatilla – Dribbling while sitting and walking; on coughing; on emitting flatus; in bed especially at night. 
14. Sepia – Involuntary urination as soon as the child goes to sleep, first sleep only.
15. Squilla maritima – Painful pressure on bladder with tenesmus after micturition increased at night. Involuntary urination especially when coughing with inability to retain urine. Enuresis nocturne.

Discussion and Conclusion

Nocturnal enuresis popularly known as bed wetting a common condition among children which can easily be managed by Homoeopathic individualized remedy. This review piece discusses about the brief description of the disease, its causes, clinical presentation, its management and prevention along with the common repertorial rubrics which can easily be found for clinical use and few therapeutic remedies which have shown its effective result in day-to-day clinical practice. 

References

1. Wikipedia Contributors. Nocturnal enuresis. Wikipedia. Wikimedia Foundation; 2024.
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8. Schroyens F, Currim A. The essential synthesis. London: Homeopathic Book Publishers; 2012.
9. Allen HC. Keynotes and Characteristics with Comparisons of some of the Leading remedies of the Materia Medica with Bowel Nosodes. 8th ed. Delhi: B Jain Publishers(P)Ltd.; 2002. 
10. Boericke W. Pocket Manual of Homoeopathic Materia Medica and Repertory. Reprint ed. New Delhi: B Jain Publishers(P)Ltd.; 1998.

Authors

• (Prof.) Dr. Prasoon Choudhary – HOD

Dept. of Paediatrics

• Dr. Kamal Nainawat – PG Scholar

Dept of Paediatrics

Dr. MPK Homoeopathic Medical College, Hospital and Research Centre, Homoeopathy University, Jaipur, Rajasthan