Nocturnal Enuresis – Bed Wetting In Children: Treatment

Nocturnal enuresis refers to the condition where the child passes urine unknowingly during sleep at night. This is also called night wetting or bed wetting or in Ayurveda – Shayyamutra.
The word meaning of Shayyamutra is – urination (mutra)- during night -while lying in the bed (Shayya means sleep or lying down). 
Causes for bed wetting in children:
Child’s urinary bladder does not have enough strength to hold urine for the entire night
Child’s urine production is high at night
Excessive fluid intake during evening hours and night
Delayed bladder maturation – lack of co ordination between bladder and the brain
Food sweet foods at night
Excessive sleep
Constipation – filled up rectum (last part of large intestine) can put pressure on the bladder and empty it earlier than normal.
winter and rainy seasons
Child has not been trained with toilet habits
Stress, anxiety, underlying fear and such other emotional problems
Urinary tract infection or diabetes can also cause bed wetting.
In rare cases, structural abnormalities may cause it. But in such cases, the child cannot hold urine even during day time.

Tips to stop bed wetting:
Counselling: 

It forms the main basis for treatment. Both the kid and the parent need assurance. Many kids think that they are the only ones who wet the bed. This anxiety makes the problem worse. They feel guilty about it and continue to wet in the bed more and more.

They need to be assured that it is quite common and natural and most of the kids do wet the bed. There is nothing bad about it. It is just a temporary problem. It will go away with medicine.

Nocturnal enuresis in children

Nocturnal enuresis in children

Reward dry nights: In order to encourage the kid, whenever she does not wet the bed, encourage her saying she is improving, she is growing up and she is very good. This will boost her confidence.
Encourage her to empty the bladder before going to bed.

If the doctor has prescribed any medicine, daily, while giving the medicine to the kid, remind her saying that the medicines will help in avoiding bed wetting and everything will be all right soon.

Delay urination during day: During day time, when the kid tells that he wants to go to bath room, just delay the bathroom visit just by a couple of minutes by distracting him. Eventually the kid learns to control his bladder better.

Wake the kid up early in the morning. Allow him to visit bathroom and then to go to bed again.
Restrict excessive fluid intake during evening hours.

Some doctors encourage to wake up the child after 3 – 4 hours of sleep at night so that he can visit bathroom.
Avoid any liquid foods after 7 pm.

Ayurvedic Treatment For bed wetting child:
De-worming –
In many cases, treatment for intestinal worm infestation gives relief.

Medicinal herbs used in the treatment: 
Bimbi – Coccinia indica
Vishatinduka – Strychnos nuxvomica
Kataka – Strychnos potatorum
Khadira – Acacia catechu
Amalaki-Amla-Emblica officinalis
Hareetaki – Chebulic myrobalan -Terminalia chebula
Shilajatu-Black bitumen-Asphaltum punjabinum
Guggulu – Guggulu resin -Commiphora mukul
Shati -Heydichium spicatum
Haridra- Turmeric-Curcuma longa

Ayurvedic medicines for nocturnal enuresis:
Medicines are targeted to treat urinary tract infection, to improve nerve response.
Chandraprabha vati
Kathaka khadiradi kashaya
Kalyanaka ghrita
Mahakalyanaka ghrita
Triphala choorna
Tarakeshwara rasa
Nishakhadiradi kashaya
Triphala guggulu
Chandrakala rasa

Vishamushthi vati
Shilajatu vati

If emotional causes are found out, then medicines to improve mental strength with herbs like Brahmi should be used in the treatment.
If the cause is constipation, then Ayurvedic treatment for constipation should be adopted.

Home remedies: 
1 pinch (100 mg) of turmeric and 2 pinch of (200 mg) of Amla (gooseberry) powder are taken together and administered along with honey twice a day. This checks the complaint of bed wetting effectively.

Bimbi (Coccine fruit – Coccinia indica) fresh root is obtained and the fresh juice is collected. 2-3 ml of this is mixed with 3-4 ml of honey and administered to the children. But care should be taken so that excess administration may cause vomiting in the children.

Ayurvedic analysis of Nocturnal enuresis:
The process of urine formation is aided by Prana, Vyana and Apana vata and Avalambaka Kapha with the overall control of mind.
Micturition is one of the functions of normal Apana Vata. The activities of Apana are regulated by Prana and Vyana vata. Prana has an overall control over the organs of sense and mind. The Apana facilitates active excretion of urine, motion, semen etc. After attaining a level of developmental maturity, there develops a control over these activities initiated by Prana and Vyana. But in this condition the overall control of the activities of Apana is not developed resulting in vitiation which inturn result in loss of control of micturition. The vitiation may also be due to encircling (avarana) of Apana by Kapha which accelerates the excretion of urine. Mind plays an active role in physiological as well as pathological process of the body. It functions constantly even during sleep. When it is masked by tama and kapha, sleep is caused according to Ayurveda. This may happen in day time also, but in night, loss of control of Prana and Vyana over Apana and encircling of Apana by Kapha and tama happens together and the child unknowingly urinates in bed.
Thus results in Shayyamutra (nocturnal bed wetting).

Bed wetting is an embarrassing health complaint of the children. Treating possibly underlying urinary tract infection, constipation and counselling the kids and a few techniques can come in handy to solve this problem.
Article by Dr MS Krishnamurthy and Dr Hebbar


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