Enuresis is the involuntary discharge of urine, and is generally called bed wetting and assumes clinical importance after the age of three years.
True enuresis is considered a purely functional disorder and has no connection with organic disease of the nervous or urogenital system. Enuresis, as commonly diagnosed, is considered the involuntary discharge of urine during sleep-a purely functional disturbance such as neurotic, idiopathic and poor habit training, and so forth. A small percentage of cases may be caused by an organic lesion. To-day, almost all pediatricians appreciate the possibility that organic disease may be present in their medicinal resistant cases of enuresis. In my experience, this is a confirmed fact.
In nearly sixty years of treating this condition. I have found Enuresis to be one of the most common disturbances of the young. I have found Enuresis to be one of the most common disturbances of the young. I have also observed this condition to exist to a large extent in institutions, probably due top defective habit training; excessive fluid intake, particularly after 4 P.M. was supposed to have been a positive factor in enuresis. Disturbances of the renal function producing the polyuria of diabetes insipidus or diabetes mellitus is not true enuresis, although wetting is the chief complaint in many children with diabetes.
General Treatment. A long experience in the treatment of enuresis has taught me that the removal of the causa excitans” is the chief factor necessary in the during of a cause of enuresis. I know of no other pathological condition of childhood where it is more necessary to remove the exciting cause than in nocturnal enuresis.
Various alarm devices set off by urine contact at the beginning of wetting have been employed in the past and at the present time the4re is being resurrected the electric bell alarm which is a signal to go to the toilet. Some of the older children have been broken of the habit in this manner, but in my experience the younger children relapse and go back to bed wetting a few weeks after the electric apparatus has been discontinued. Discussion of all causative factors could not possibly be incorporated in so small a paper as this.
Enuresis frequently disappears spontaneously by the twelfth year in males. If it does not do so after the beginning of the twelfth year the outlook is less favourable. In girls it usually disappears after menstruation is established. If it persists, the prognosis is serious and the condition usually bespeaks a deep seated psychogenic problem. Any case of enuresis that is not cured in four to six months of careful medical treatment demands a complete urologic examination, at least adequate to identify any existing etiologic disease.
I have seen two dramatic cures after the existing pathology had been removed. In all cases, careful history taking will usually suggest important factors underlying the condition.
Prophylaxis-In normal intelligent children, a major consideration is the training of the infant in regular habits of micturition and defecation.
Drug Therapy. The chief remedy with the dominant school is Belladonna, or atropine. Pharmacologically., atropine is a parasympathetic inhibitor and on this basis is indicated in cases of parasympathetic imbalance (hypertonic bladder) to achieve relatively greater tonicity of the vesical outlet and greater relaxation of the detrusor with corresponding increased vesical capacity. For this reason the use of Atropine is Pharmacologically contraindicated in atonic type of bladder disturbances in which the administration of small doses of ephedrine is sometimes effective.
Homoeopathic Therapy. The remedies with their indications given here have been personally confirmed during my many years of labor in the field of strict Homoeopathic Therapeutics.
Belladonna. The plethoric child with light hair, blue eyes, fine complexion, delicate skin, sensitive, nervous, restless sleep. sudden starts; moaning and screaming; involuntary urination in deep sleep, scrofulous, glandular enlargements. Involuntary urination usually takes place after midnight or towards morning. “No remedy has greater irritation in the bladder and along the urinary tract than Belladonna.” (Staff.)
Constant urging; dribbling, burning like fire along the whole length of the urethra; spasmodic retention or involuntary passage; dreams of passing urine, and involuntarily passes it. Dribbling when standing or walking, or the urine spurts from mere motion (the reverse of Rhus). When chilled or cold they lose their urine. (Dulc., Rhus, Caust.) Starts in sleep and wets the bed after midnight or towards morning.
Causticum. Children with black hair and eyes pass urine unconsciously during their first sleep. or in cold weather; day and night, or when coughing or sneezing. Urine deposits urates; nocturnal epilepsy with enuresis. Causticum has weakness or paralysis of single parts: Paralysis of face, or of anus, or of bladder, etc. Expectoration slips back. Or anus prolapses on coughing. Or urine spurts on coughing. Paresis of vocal cords.
“Unconscious of urine as i passes.” (Aloe, of stool.) “Urinates so easily that he is not sensible of the stream.” Useful in children who wet the bed, especially in first sleep (Sepia, Kreos). Typically CAUSTICUM is worse from cold dry weather and winds. (Rhus and Dulc.worse for cold wet.).
“Worse in clear fine weather; better in wet weather”.
Worse changes of the weather.
Sulphur.Pale, lean children with large abdomen who love sugar and highly seasoned food. Hate being washed; are worse after midnight; the great energizer when the well selected remedy fails to improve or cure; when excoriation of the muco- cutaneous junctions is present. Constant desire to urinate; a few drops pass involuntarily. Nocturnal enuresis. Sudden. imperative desire, if not gratified, urine passes involuntarily (Thuja, Nat, M., Kreos.) Cant wait.
Irresistible desire to urinate on seeing water running from hydrant. (Canth., Lyssin.).
Must rise at night to urinate; rushes away from work to relieve bladder, or wets clothes.
“Enuresis in pale, lean children, with large abdomen, who love sugar and HIGHLY-SEASONED food and hate to be washed.” (Psor). Hungry at 11 a.m. wont be covered at night.
Kreosote., Incontinence of urine when he patient dreams he copious pale urine., Wets the bed at night. Wakes from very deep sleep but cannot retain the urine. Worse lying down; better when walking or standing sudden urging to urinate; cannot go quick enough.
Sudden urging first, or in a very profound sleep; (Caust., Sepia) wets the bed.
Frequent urging; at night cannot get our of bed quick enough. Wakes with urging, but cannot retain urine; or dreams he is urinating and wets the bed; (Bell). Urine flows during the first deep sleep. from which the child is aroused with difficulty.
Medorrhinum. It has cured some intractable cases. Nocturnal enuresis, large quantities of pungent smelling urine,or scanty and highly colored, or copious pale urine with pungent odor. Ammoniacal urine covered with thick, greasy pellicle; urine is urinate, Cannot wait a minute; WORSE DURING MENSTRUATION dribbling urine. Painful; tenesmus of the bladder; severe pain at the conclusion of urination.
Soreness of vulva and anus in little girls; often when patient has bad G.C. Vulva-Vaginitis in early childhood. (Compare Thuja.) chilliness with full bladder.
Sepia is compelled to keep her mind on the neck of the bladder or she will lose her urine.
Involuntary urine as soon as the child goes to sleep at night. The bed is wet as soon as the child is asleep. (Caust., Kreos.) Typical Sepia is sallow; indifferent; hates sympathy; wants to get away alone. (Nat. Mur).
Apis. Incontinence of urine with great irritation of the parts. Worse at night and from coughing.
(It may also have incontinence of stool, as if anus were constantly open. Phos.).
Typically Apis is apathetic, indifferent; joyless; jealous. It pains, burns and stings.
Intolerance of heat. Thirstless (Puls.).
Lycopodium,. Involuntary urination during sleep.
“A marked feature of Lyc. is polyuria during sleep at night. Passes enormous quantities of clear urine. During the day the quantity is normal”.
Urine dribbles away after 4 p.m. and evening. Urine reddens and irritates the skin; especially in babies- if left in contact with a wet diaper.
Another leading symptom, red and in urine; on childs diaper. Typical Lyc. craves sweets, sugar, hot drinks; has afternoon or evening aggravation of symptoms; especially after four to eight P.M. Lyc. is more alive mentally than physically. :Ugly on waking.” Otherwise better in the morning. May have the curious symptom of weeping when thanked.
Equisetum. I have never cured a case of nocturnal enuresis in children with this remedy although highly praised by some.
Enuresis day and night; profuse, watery urine; has many urinary troubles. Pain in bladder as from distention; tenderness.
Constant desire to urinate and pass large quantities of pale urine without relief.