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.
“Rapidly restored control over stools and urine in an old woman with general paralysis” and carcinoma of the uterus. Argentum Nit., Urine passed unconsciously and uninterruptedly. Spasmodic enuresis night and day. Typical Arg. nit. Patient craves sugar. which disagrees; craves salt; cool, open air; is worse in high places.
Cina. Urine copious and involuntary, with worm symptoms and ravenous appetite. Typical Cina is cross and “Ugly”; wants to be carried; or wont be looked at or touched. Wants things and throws them away. Bores in nose with finger. Urine turns milky on standing or strong ammoniacal odor.
Thuja. Involuntary urination at night or when coughing; Got up at least six times nightly; saturated the bed frequently; urine highly colored strong odor.
Incontinence of urine (Sulph. Nat. mur., Kreos., etc.).
Sudden desire, unable to retain it without grasping penis; cannot hold urine when riding, or during a long walk.
Chronic incontinence from paralysis of sphincter.
After vaccination. From tea drinking.
“Dribbles in sleep;” worse from onions.
Little girls who have had Vulva-Vaginitis, even specific G.C.
Rhus. Tox. Urine involuntary at night; when at rest (reverse. Bell.). Weakness of bladder in girls and women, with frequent desire to urinate. Constant dribbling in boys.
Dribbling of urine in cold air, and on becoming very cold. (Compare Dulc.).
May be violent tenesmus of bladder, with dribbling of bloody drops. Typical Rhus in much affected by damp and cold weather; by washing (Sulph. Psor.). Better with heat. Relieved by motion.
Pulsatilla. Involuntary micturition; urine dribbles while sitting or walking, while coughing (Caust), or passing wind; at night in bed, especially in little girls; frequently changing symptoms. Especially after measles; worse in autumn.
The typical Pulsatilla patient is changeable and fickle; touchy and weepy. Loves sympathy. worse heat; stuffy room; fat and rich food, Better moving about in the open air.
Staphisagria. Teasing and tearing all night long in the bladder and urethra. Bloody urine; involuntary urine, acrid and corroding, with burning (Bell). Worse from motion (Reverse of Rhus). In young women after marriage; in old men with prostatic troubles, continued teasing with dribbling (Bell). After urination feels bladder is not empty since urine continues to dribble away.
Staph is a great remedy for sphincters; for sphincters stretched during operations. Also a great remedy for bad effects for suppressed anger, suppressed wrath and suppressed feelings. Irritable bladder after suppressed wrath; after insults.
“Great indignation about things done by others or by himself. “Hypersensitive spots and areas; little points.”Whole mind and nervous system in a fret”.
Psorinum. Vesical Paresis. Obstinate cases of enuresis; wets the bed during full moon.
Typical Psor. is chilly. Dreads washing (Sulph) is greasy and “Offensive to sight and smell. “Has also a great deal of itching of the skin when warm in bed which disturbs sleep. Enuresis, following suppressed eczema or a severe acute illness, has been frequently confirmed.
Sycotum. (Paterson). The use of this remedy has been one of my bright spots in the treatment of protracted enuresis. The patient, more than the local symptoms of enuresis, leads to the selection of this nosode. III tempered children, with fear of the dark and of being left alone; general irritability; twitching of the facial muscles; blinking of the eyelids; sallow complexion; oily skin; the pre-tubercular look; low grade inflammation around the genitals, particularly in females; vulvo Vaginitis; nocturnal enuresis occurring anytime during the night.
With this remedy I cured a young lay of enuresis; also a co-existing orthostatic albuminuria. The result was positive and prompt with improvement in her general health. The case had existed for at least 14 years. There was no recurrence of the symptoms after a periods of six weeks treatment, and she has remained completely cured.
1326 N. 12TH STREET,
Sept. 3. 1952. Large, stout, ruddy complexion, rather jolly female, single, 25 years old.
In early childhood began stammering; some of this ever since, greatly aggravated during the last year when mouth feels overfull of tongue.
Tongue large, heavy, in her way; wakes her from discomfort; any position, somewhat better lying prone. Numbness tongue marked. Much in the way when starts to talk; if talks on and on can do better. If stops liable to stammer badly. Sensation as if region of tonsils too full of tissue, in the way (tonsils removed twice).
Sometimes can form the words by the sound will not come. Sometimes lips tremble when word comes out.
Stammering. worse if excited, emotionally disturbed, etc. Blushes easily.
Head feels too heavy of sits in an audience long time.; wants to hold up with her hands. this slightly worse left side., No headache.
Desire fresh air always. Likes all kinds of weather.
Tendency to colds from other people.
Appetite very large, likes everything. Little thirst.
In June severe attack prevalent epidemic with high fever for a week.
Worse air-conditioning; fan blowing; never in outdoor air., R Belladonna 2c.
Sept 20: Can talk decidedly better; better when excited or emotionally upset any other way. Not so much pain or symptoms around mouth and chin, neck. Tongue not so much in the way. Sharp, stitching pains here and there over the body; come and go, remain for appreciable time but not long. Throat very sore on day after the last medicine.
Sept 26:Symptoms returning; even the speech worse again. Rx. Calc. c. 10 M.
Oct.20: Voice remains worse, quite difficult to get the words out; then cannot keep talking as long until gets caught again. Inflamed throat right side with pain face, neck. New inflamed area hard palate. Rx. Calc. c. 10M.
Oct.31: Voice ever so much better; all around her remarking how much better she is. Bad as ever occasionally after hurrying or if very nervous.
Nov.25: Going backward a bit in speech. Rx. Calc.c.10M. Jan. 10, 1953: Chronic symptoms worse again with sore throat added and some cough. Speech decidedly worse again though can finish long sentences when gets over the initial stammering. Rx. Calc. c. CM.
April 10: Last medicine worked like magic. Can talk almost like other people.