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Nocturnal enuresis: mainstream view


Nocturnal Enuresis is described as involuntary and repeated passage of urine during sleep. It is very common in young children. The age when it is considered to be a real problem depends on the child and the parents. To some parents it is more inconvenient than others and help is sought at an earlier age. To others the problem is manageable until the child starts to spend time away from home staying with friends when it is then an embarrassment. At this point the child starts to feel self-conscious and upset by the problem. However western medicine has little to offer in the way of cure, and what is on offer is by no means always effective. Acupuncture on the other hand is nearly always effective.


Simplified version Enuresis is due to a combination of two or more of the following factors:

Too much fluid enters the bladder at night time.

The sensation of a full bladder is only a weak sensation that the messages sent to the brain are only very faint.


Sleep is very deep, so it needs a strong sensation or a loud alarm clock to wake the child


The sphincter muscle is not very strong The TCM patterns given below are summaries of the reasons for these factors.


Western perspective

An “organic aetiology” i.e. something that can be identified as a real medical problem, is found in only 1% -2% of cases and then it usually involves a urinary tract infection. If no UTI is found then there are extensive test to rule out other diagnoses such as diabetes mellitus or insipidus, sacral nerve disorders, congenital abnormalities and so on. It is also recognised that enuresis can be due to psychological reasons, individual or family related.


Secondary enuresis: enuresis that starts after a period of dryness is usually attributed to psychological problems, however there is also a greater likelihood of organic aetiology than with primary enuresis.


Facts:

It is more common in boys than in girls.

It is present in v 30% of children before the age of 4 years.

10% of children before the age of 6 years.

3% of children before the age of 12 years.

1% of children at 18 years.

The problem tends to run in families.


Current western treatments:

There are four main western treatments offered:

Motivational counselling: this encourages the child to play an active role by keeping a calendar of wet and dry nights, talking to the physician him/herself, by urinating before going to bed and by changing the bedclothes him/herself.


Fluids are not drunk for 2 - 3 hours before going to bed.


The child is not punished and parents are encouraged not to become angry.


Positive encouragement is given for dry nights.


The aetiology and prognosis are explained in order to remove blame and guilt.


Bladder exercises to strengthen a weak bladder where this is believed to be the cause.


Enuresis alarms wake the child when they pass urine.


Imipramine which is not used so much now because of the side effects.


However it appears that these treatments are not always very effective and we see many children who have been put through many tests and therapies offered by the orthodox profession with little improvement. It must be said though that these methods are a vast improvement on making the child feel like a worthless wretch. It is at least recognised now that in the management of enuresis to punish children, drawing a lot of attention to the problem and the use of drugs are virtually of no use whatsoever in controlling the situation, the exception being perhaps the last case. Tricyclic drugs are sometimes still prescribed when a very rapid effect is necessary.


Instead enuresis clinics now address the problem with the parents and the child. The emphasis is on the child helping him/herself by getting them to pass urine before going to bed and not drinking 2 - 3 hours before bedtime. The parents help with suggestions and encouragement and perhaps lifting the child at night. In many cases an alarm is used, which is said to have a good success rate, although I have heard many parents speak disparagingly about them as they feel it makes the child even more self-conscious and upset.


As an alternative to all these methods, acupuncture is very effective. Provided there is a straightforward diagnosis and the emotional component is not too great then a cure is virtually guaranteed. This can come as a great surprise to many parents who have given up hope of finding help and just wait for the child to grow out of it. It is a great relief to both parents and perhaps more so to the child, nearly all of whom hate the fact that they wet the bed.

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