Homeopathy

The shame of children

A leak will sink a ship. Bedwetting - a leak of bladder at night - will sink the mind of the person. Usually, sleep is one of the best medicines since it supports and refreshes the body physically and psychologically, but, for bedwetting, deep sleep happens to be one of the prime causes. Children sleep with dreams of life that is full of beauty but wake up dirty...bedwetting.

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Bedwetting means "passing of the urine during sleep, involuntarily and unknowingly i.e., wetting the bed and clothing". It is also termed as nocturnal enuresis (night time urination) in medical terminology. After the age of five, the brain is expected to develop control over bladder. But, if it does not gain control in that period, bedwetting results. Bedwetting disturbs the patient psychologically more than with its symptoms. It is one of the hottest topics, often discussed among the parents of bedwetting children, but bedwetters never reveal or discuss them with his/her friends. Even though children are most commonly affected, sometimes teenagers or adults can also be affected. It is like habit forming and its incidence usually declines with age.

The kidney is the body's main drainage system rather than the bowels since it eliminates the toxins, chemicals and salts through urine, to purify our blood. Kidneys dribble urine into the bladder day and night, without any rest or interruption. Its restless function is absolutely needed for good health. Bowels can go on strike or perform alteration in its habit like constipation for 2-3 days or sometimes even more, whereas, even one day strike by the urinary system will complicate the body's functioning that day itself. So, Nature takes care of our body by automatically emptying of the bladder, until the brain gains control over the bladder.

Incidence - Bedwetting is one of the commonest complaints everyone has faced in childhood at one time or the other. It is not a disease but a symptom. For infants and children below age 3, involuntary wetting is quite normal. The age at which the bladder gains control varies with every child. Normally, children stop urinating at night around 4 years in the case of girls and 5 years in the case of boys. The reason for this delay in control in boys is less understood. Bedwetting affects up to 50-55 per cent of 5- to 6-year-old children, 25-30 per cent of 7 to 8-year-old children, and 15-20 per cent of 9- to 12-year-old children, 1-2 per cent of teenagers and rarely adults.

Pathophysiology - The bladder acts as a reservoir and maintains continence till a situation favours passing of the urine. The bladder is situated between the pubic bone and uterus in the case of women and between the pubic bone and seminal glands and rectum in case of men. Its capacity varies from 250 ml to 700 ml with age difference. The brain takes control and inhibits auto emptying, according to the situation, place and timing. Daytime control is first attained followed by nighttime control. After gaining brain control, we can advance or postpone it.

Urination is a complex process, with the correlation of two sphincters (valves). Action of the sympathetic and parasympathetic nerves is necessary, to correlate this urination process. For example, sympathetic nerves contract sphincters and relax the bladder for storage of urine, whereas the parasympathetic nerves relax the sphincter and contract the bladder for emptying. The main nerve supply for the bladder is from sacrum, so any injury to the sacrum, by a fall or surgery, will interfere or reflect in the process of urination. In the case of children, if the bladder gets filled up, pressure over the stretch receptors, on the walls of the bladder, will induce parasympathetic fibres to empty the bladder automatically, as a reflex action.

Types of bedwedding - There are two types of bedwetting.

1) Primary enuresis - Here, no known causative factor can be identified and the child is continuously wets the bed at nighttime from birth. In this primary enuresis, the child is capable of holding the urine in the daytime. This type is usually hereditary. 

2) Secondary enuresis - Appears in children after some period of normal control, due to any cause noticed or related. Here children often develop symptoms, particularly after anxiety, fear or neurological disorders. In this type, uncontrolled urine will be noticed in both day and night, so it is called diurnal enuresis.

Causes In children  Familial - Mostly bedwetting is found to run in families.  Sex - Boys are more commonly affected than girls.  Physical constitution - Flabby children are more commonly affected.  Growth - Retarded growth, immaturity of bladder or nervous system can cause bedwetting  Habits - Children having habits of thumb-sucking, nail-biting, attention deficient disorders are also common sufferers  Sleep disorders - Very deep sleep can also lead to bedwetting, since the person is unaware of a full bladder and the bladder works automatically. These children seem to be dry when they sleep at a friend's or a relative's house due to their anxiousness and light sleep.  Psychological - Fear, weeping in day, nightmares, worries, anxiety, stress, insecure feeling can also lead to bedwetting  Nervous disorders - Injury or disease of the nervous system or spinal column (for example - tabes dorsalis) can lead to bedwetting Infections - Urinary tract infections cause bladder irritation, urgency and bedwetting  Environmental - Rainy weather and air-conditioned room can influence bedwetting.

Additional factors which can also influence bedwetting are 

• Increased intake of fluid, which increases the urine output.

• Using diapers.

• Constipation

• Poor nutrition 

Associated disease or disorders

• Bladder- Small bladder can also cause bedwetting, where the child cannot hold much urine. Other reasons related to bladder are cystitis, trauma and surgical intervention 

• Brain and spinal column - Cerebral palsy, neurological disorders like epilepsy, muscular dystrophy, paralysis, paraplegia, autism, cerebral lesion and cerebellar lesion can also cause bedwetting, with loss of sensation of full bladder

In the case of adult - The habit is more common among males than females where they suffer from diabetes or neuralgic tremors or cerebral palsy or prostatitis. In the case of females, it is commonly found as spurt - while coughing the bladder cannot control the increased pressure of abdomen. In women, it can also be seen after delivery i.e., due to trauma.

In the aged - Prostate, diabetes, hypertension, paralysis, other neurological problems can cause incontinence or bedwetting. Fatigue, worries, overwork, stress and strain can precipitate bedwetting. Operations (prostate or abdomen operation), pelvic fracture, malignancy of bladder or prostate can also cause bedwetting.

Symptoms of bedwedding - Urination in sleep is the one and only symptom. The other accompanying or associated symptoms are screaming, rolling in bed, grinding the teeth, urgency for urination, worm's infestations, urinary tract infections, adenoids, nose block, bronchitis, sleep disorders, hyperactivity and constipation.

Effects of bedwetting - Any child who wets the bed does not do it on purpose. But, the child will receive curses or scolding or punishment for that incidence. These incidences usually make a bedwetting child suffer silently. The main effects of bedwetting are shyness, shame, guilty feeling, and being afraid of being teased by friends and relatives. Usually, children never bother about it till the parents scold them, but later they realise the condition and feel ashamed. They mostly do not like to travel to outstations which may hinder their future life setting behaviours.

Diagnosis and investigations - Diagnosis can be made with the history of the patient and investigations. Usually, nobody does any investigation for this complaint. But it should be analysed properly. The important checklists are 

• Routine urine analysis - to rule out any kidney involvement.

• Check bowel habits - since fecal impaction, due to constipation may not allow bladder, to expand more for holding much urine. Also, rule out worms infestations.

• Consult E N T doctor to rule out and treat adenoids, tonsils and bronchitis. 

• Ultra sound scan - to rule out urine retention, small bladder or any other pathology.

Preventive measures
Avoid 

• Milk at bedtime.

• Excess water, two hours before sleep.

• Air-conditioned room.

• Using diapers for children after the age of 2, which may arrest or delay the habit development of using toilets.

Build habits of 

• Urinating before going to bed.

• Regular bowel movement.

• Waking up at a regular time with alarm.

• Taking diets of greens and vegetables which are rich in vitamins, zinc and magnesium.

• Exercising the bladder, by holding and controlling while having urgency of urine with confidence or will power.

Expected parental care for bedwetters - Proper parental care is very much essential, since the attitude of the parents further complicates the condition. The parents should realise that the children are not aware of urination while sleeping. Support and reassurance is important, rather than blaming and punishing. 

• Don't be angry with children since they do not even know what they are doing. 

• Avoid beating or punishing or scolding the children which may worsen the condition. 

• Encourage the children with positive words and rewards to get out of this habit.

• Don't reveal the complaint to any relatives or friends, or otherwise the children may feel guilty and ashamed or get teased by them.

• Make the children realise about difficulties of washing and bed making.

Treatments for bedwetting - Bedwetting in children, below the age of 7 needs no treatment. Bedwetting tends to go away by itself. In Allopathy, treatment is mostly conservative and habit training. Children usually outgrow bedwetting as age advances, without any treatment. The start of treatment mostly depends on the age and attitude of the child, parent and doctor. If any organic cause has been found, treatment is mainly focused on it or otherwise on habit development. Habit formation can be enhanced with alarms (vibratory or buzzing or moisture alarms). If these things also go in vain, medicines are given to manage the situation.

Medicines - In absolutely serious conditions, Allopathy uses two types of drugs for controlling bedwetting. One type controls urine formation and another one relaxed the bladder for holding more urine and also for lowering the depth of sleep, fear, anxiety and screaming. To put it simply, they make the kidneys function less at night or make the bladder relax to hold more urine. Both have their own disadvantages and side-effects which include drowsiness, headache, restlessness, nervousness and constipation.

Homeopathic approach - Drugging the children is dangerous. Also controlling the urine production in the kidney and relaxing the bladder will not give a permanent solution and also it will have side-effects in future. Allopathy works against the disease. In the case of bedwetting, mostly no disease can be noticed or found. So the treatment with Allopathic drugs is questionable. But in Homeopathy, we treat the symptoms of patients rather than the disease or its effects. Homeopathy works by strengthening the child's bladder and nervous mechanism for proper functioning. Homeopathy acts neurologically, helping the brain to gain control, so it can give better improvement and permanent solution. It gives neurological and psychological support to withstand urine for a normal period.

Homoeopathy, with its dynamic approach, can cure bedwetting wonderfully. Bedwetting is totally a treatable condition. First of all a major credit point with Homeopathy is - No side-effects, Secondly - it is sweet and convenient, at all the times and for all ages. Lastly - it not only relieves the condition, but also cures the condition without any persistent usage of drugs or dependency or habit formation.

The results of Homoeopathy treatment through my experiences, in bedwetting cases, are far superior to usual ways of treatment with other systems of medicines. Homeopathic medicines commonly used in cases of bedwetting are Aconite, Acid phos, Arg nit, Benzoic acid, Equisetum, Sanicula, Cantharis, Causticum, Gelsemium, Selenium, Tarentula, Terebinth, Pulsatilla, etc. These medicines should be taken under the advice and diagnosis of a qualified Homeopath.

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Published on March 21^st, 2005