FUNCTIONAL ENURESIS

Functional enuresis is the repeated involuntary voiding of urine, occurring after an age at which continence is usual and in the absence of any identified physical disorder.

The condition may be nocturnal (bed-wetting), diurnal (occurring during waking hours), or both.

Nocturnal enuresis is referred to as primary if there has been no preceding period of urinary continence, and secondary if there has been a preceding period of urinary continence.there is no absolute period of continence needed to become secondary enuresis, but 6 months is a commonly used timeframe.

Most children achieve regular daytime and night-time continence by 3 or 4 years of age, and 5 years is generally taken as the youngest age for the diagnosis. Nocturnal enuresis can cause great unhappiness and distress, particularly if the parents blame or punish the child, and if the condition restricts staying with friends or going on holiday.

PREVALENCE

Nocturnal enuresis occurs in about 10 per cent of children at 5 years of age, 4 per cent at 8 years, 1 per cent at 14 years and 0.5 per cent in adulthood. The condition is more frequent in boys. Daytime enuresis has a lower prevalence and is more frequent in girls.

AETIOLOGY

 The majority of cases of nocturnal primary enuresis are idiopathic; there is simply a delay in maturation of the nervous system controlling the bladder. These children often have a family history of enuresis, as children who have either one or two parents who were enuretic have a 44 and 70 per cent chance, respectively;

COMMON CAUSES of nocturnal primary enuresis

• Idiopathic developmental delay
• Genetics Less common causes of enuresis (consider in secondary nocturnal or diurnal cases)
• Urinary tract infection
• Diabetes mellitus
• Abnormalities of the urinary tract (e.g. small bladder, vesicoureteric reflux) Structural abnormalities of the nervous system (e.g. spina bifida occulta) Chronic constipation
• Diuretics: caffeine, alcohol
• ADHD
• Learning disorders or syndromes of developmental delay
• Behavioural: being too engaged in play or ‘leaving it too late’
• Psychological: a response to bereavement, stress, abuse, or bullying Obstructive sleep apnoea
• Epilepsy

It is important to determine if the enuresis is primary or secondary, any family history.

GENERAL MEASURES

• Treat any primary physical or psychiatric disorders
• Education and reassurance for parents and child
• Practical advice
• Basic behavioural measures—rewarding success
• Reduce stressors For persistent cases
• Enuresis alarms (‘bell and pad’)
• Desmopressin
• Tricyclic antidepressants
• Bladder training and pelvic floor exercises.

HOMOEOPATHIC MANAGEMENT:

KREOSOTUM - Kreosotum is one of the most indicated medicines for bed wetting. Here bed wetting occurs in the first part of the sleep with dreams as if urinating in the urinals. The child finds it difficult to wake up from deep slumber.

EQUISETUM - Equisetum is another effective remedy for bed wetting where the urination is painful.

The child wet their pants or bed for no known reason other than out of habit.

CAUSTICUM -Causticum is prescribed when involuntary urination is worse in winter and better in summer.The children wet their pants when they cough or sneeze or even laugh.

CINA -Cina is best for bed wetting due to the presence of worms in children. There is irritation of the nose causing constant desire to pick, or scratch or press in it.There is extreme ill humour, heightened irritability and commonly gritting teeth during sleep.

BENZOIC ACID - Benzoic acid is prescribed for bed wetting where strong smelling urine of low specific gravity occurs. The child wet the bed several times during sleep. Another feature is urine smelling of ammonia, like horse’s urine.