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Introduction
Ashima is a 7-year old girl who wakes up each morning only to cry
in shame. As usual she seems to have wet her bed once again. It
is the very same story each morning. Her father shouts, her mother
screams while her Gangubai grumbles and her little sister snickers.
But what can little Ashima do as she does not even feel the urge
or remember the sensation of passing urine. If only she could, she
certainly would not do it and have to face this filth and embarrassment
each and every day.
This has been going on for years and her parents are really worried.
They feel that she might never stop. They have shown her to their
family doctor who suggested that they take her for counseling to
a child guidance clinic.
Bed-wetting, also called Enuresis, is
one habit disorder that causes trauma, pain and disturbance to all
concerned. It is the parents who normally wake up each night to
check on the child, maybe even to disturb her sleep to check on
whether she wants to go to urinate. And then when she wets her bed,
it is the parents and the maid who have to change and wash the sheets
and air the room. And what about what the little girl has to go
through herself? Can you even begin to imagine her pain and shame
at having lost control once again? She feels inadequate and totally
at a loss, especially when she is aware of the trouble that she
is inadvertently causing to other members in her family.
History
The Ebers Papyrus documents that bed wetting was well
known in 1500 B.C. Enuresis is one of the most common and perplexing
problems brought to the attention of the physician.
By the 19th century doctors that no matter what sort of treatment
was suggested, if done with authority or zeal or kindliness, many
cases of enuresis could be ameliorated. Today more is known about
its causes and treatment possibilities but enuresis still defies
medical expertise.
The ubiquity and frequency of this minor malady oblige it to e
considered one of the most important pathologies of childhood. Further,
in a considerable manner of cases, enuresis persists into adulthood.
A few cases have been seen in persons in late life who have never
known dryness.
Definition
Enuresis is defined as repetitive, inappropriate, involuntary
bed wetting or clothes wetting in persons over the age of three,
who fail to inhibit the reflex to pass urine when the impulse is
felt during waking hours and those who do not rouse from sleep of
their own accord when the process is occurring during the sleeping
state.
Although bowel and bladder control at night is usually achieved
around the age of three years, a number of children have difficulty
with this stage of development.
A child becomes dry at night after she/he becomes dry during the
day. Having achieved daytime bladder control, she/he knows what
is required of her at night. The most common sign of readiness for
night training is when her nappy is regularly dry in the morning
when she wakes up. Girls frequently reach this stage earlier than
boys.
Toilet training is an important task for all children to complete.
It gives them a sense of accomplishment and control and relieves
the parents of diaper changing’s and washings as well! Even
in "normal" children, a large percentage might have "nighttime
accidents". For example, one study found that 56 percent of
boys and 40 percent of girls continued to wet at night.
Interestingly, the rate of enuresis in males is about twice that
of females.
Types of enuresis
Psychologists have identified two types of bed wetting, which occur
in children beyond the age of five years; "primary enuresis"
applies to a child who has never achieved bladder control at night,
and "secondary enuresis" applies to a child who has been
dry at nights consistently and then unexpectedly begins to wet her
bed.
Primary enuresis can be caused by many factors including:
Heredity - It is found that parents who themselves were slow to
achieve bladder control at night often have children who follow
a same pattern.
Maturation - In some children, enuresis may be caused by a delay
in the development of that part of the brain needed for bladder
control.
Poor training - Not all parents adopt a consistent method when
training their child to be dry, and sometimes the situation develops
into a battle; inconsistent strategies only confuse the child, or
make them anxious.
Urinary problems - Enuresis can be associated with physical abnormalities
or urinary tract infection, which is why medical advice should always
be sort in the first instance.
The cause of secondary enuresis is virtually always stress. Although
a child who starts to wet a night after she has been dry consistently
for a long period may be suffering from an infection or other physical
illness, it is more likely that the waiting is due to an emotional
difficulty (e.g. the birth of another child in the family, starting
playgroup or school, worries about friends and parental arguments).
Persons whose enuresis persists into adolescence show a greater
frequency of combination with one or more of the following disturbances:
- Passive aggressive or passive dependent reactions
- Past history of sleep walking
- Family history of sleep walking
- Inferior dentition as measured by decayed, filled or missing
index
- Chronic genitor-urinary tract complaints (urgency, frequency,
nocturia)
- Family history of enuresis
However in general, no psychiatric diagnosis is associated with
enuresis.
Normal Development of Sphincter Control
The frequency of urination in babies varies from child to child.
There is often a temporary phase of increased frequency at the age
of about 21 months. At two and a half years, there is often a retention
span of about 5 hours. The retention span then rapidly increases
with age.
Babies commonly empty the bowel and bladder immediately after a
meal, especially in the first 8 months, and they can often be ‘conditioned’
to use the potty any time after 2-3 months of age. This condition
frequently breaks down as a result of teething or some disturbance
of routine, particularly between 12 and 18 months. It is important
to realize that there is no voluntary control at this time, for
voluntary control does not begin till about 15-18 months of age.
The first indication of voluntary control is awareness at about
15 to 18 months of having passed urine, the child pointing it out
to the mother. He now begins to tell the mother just before he passes
urine, but he does not give her time to ‘catch’ him.
The urgency decreases as he grows older, and by 18-24 months he
tells the mother in sufficient time for her to place him on the
potty. By two to two and a half years, he is able to put his pants
down, and go to the lavatory and may limb on to the lavatory seat
unaided. These children take their responsibility for not wetting
their pants, and as a result the napkin is discarded during the
day, but they are still wet by night.
By two and a half, the retention span is longer, and between two
and a half and three, if lifted out at 10 or 11 p.m. he is dry in
the morning and the night time nappy is discarded. He rarely soils
his pants after age of 2 years, girls tend to acquire sphincter
control earlier than boys.
Mechanisms Involved
The mechanisms relevant to the acquisition of sphincter control
are mainly four – maturation, development, learning and conditioning:
Maturation:
The mechanism of sphincter control is a complex one, and one must
depend on the maturation of the nervous system. There is commonly
a familiar pattern; just as some children are earlier or later than
others in learning to sit, walk talk or use their eyes or ears,
so some children are earlier or later than others in controlling
the bladder or bowel.
Learning:
Children learn to control the bladder partly by instruction and
training. Training consists largely by helping the child when he
is developmentally ready. As one famous poet said, “When the
clock strikes certain hours, little pots are punctually applied
to little botts”.
Conditioning:
Here the babies empty the bladder when his buttocks feel the rim
of the potty.
Other Causes
Weak Emotional Foundation:
Bed-wetting is common in both timid and weak as well as in strong
aggressive children. The child has a basically weak emotional foundation
and could come from a broken home or any kind of disruptive, unstable
atmosphere. Either one of the parents could be physically or psychologically
missing and the child could be feeling insecure for some reason.
In highly aggravated cases, sometimes the child cannot even control
the urge during the day and could embarrass himself in public leading
to a further complex. Then it would be difficult to ever send him
anywhere, even to school.
In some cases placebo drugs are given to the child to make him
feel that he is being physically treated for the problem. But much,
much more important is his mental welfare and sense of belonging
as most of the time; enuresis has a deep psychological foundation.
Therefore it is important that both the parents accompany the child
for counseling.
New Environment:
I remember reading about the case of six year old Nitin. An extremely
well-adjusted child who had learnt to brush his teeth, change his
clothes and tie his shoelaces by the age of five. He performed very
well in school and was a well-behaved, intelligent young boy. He
displayed absolutely no signs of any sort of behavioral disorder
right until his mother was carrying her second child. One evening
she sat and explained to him that he would soon have a baby to play
with. And that very night little Nitin wet his bed for the very
first time.
All was well until his mother delivered a baby girl. Then the enuresis
started once again until the time that she was discharged from the
hospital. It seemed to have stopped for awhile as Nitin tried to
play and grow fond of his little sister. Then on her first birthday
it started once again and did not stop for about three to four months,
at the end of which his parents sought professional help.
After studying his case, the counselor realized that Nitin was
torn between hate as well as outward displays of love towards his
sister. These dual feelings in one so young were what had manifested
in the form of this habit disorder. The counselor helped him to
feel secure, loved and wanted once again and the enuresis disappeared
after about a year of therapy.
Delayed Developmental Milestones:
Sometimes, when the doctors are not able to pinpoint a physical
cause for this problem, the mental capacity of the child must be
looked into, as it is quite possible that the child could be mentally
deficient. In such cases, as a rule, most of the developmental milestones
are generally delayed and toilet training could start much later
than usual.
The child guidance clinic is a good place to start investigations
as the enuresis could be a case of serious maladjustment. Some children
do not want to accept basic responsibilities like tying their own
shoelaces or going to the toilet. They want to prolong their infancy
and total dependency much longer than is normal. This could even
be the result of sibling rivalry or jealousy. Because when a younger
child is born, most of the attention gets diverted and the older
one does everything possible to get it back, on a conscious or even
subconscious level.
Faulty Conditioning:
If the child is punished for not using the pottie when placed on
it he will become conditioned against it and may refuse to use it.
Faulty Learning:
If the mother fails to give her child an opportunity to empty the
bladder when he first begins to announce that he wants to void,
he is liable to be retarded in acquiring control.
The Child’s Developing Ego and Personality:
From about 6 months onwards the child is developing his ego and
his determination to be recognized as a person of importance. At
9 or 10 months he begins to repeat a performance laughed at. From
about 12 months he characteristically enters the stage of negativism,
so that if an attempt is made to try to force him to do anything
against his will, in this case to use the pottie, he will refuse.
Hence determined and overenthusiastic efforts to “train him”
will lead to the opposite of the effect desired.
The Personality of the Mother:
The mother who is determined to teach the child early and who is
determined to teach discipline early and who compels the child to
keep sitting on the pottie when he is trying to get off it, is the
mother who is likely to meet with refusal to use the pottie.
Ignorance of normal development and its variations:
Mothers often fail to realize that children vary greatly in the
age at which they acquire control and become worried when the child
is later than others. She is then liable to punish the child for
his failure and he responds by refusing to use the pottie or by
wetting.
Laziness:
On a cold night, particularly if the lavatory is at the other side
of a yard, the child may prefer to wet himself rather than to go
to the lavatory.
Depth of Sleep:
It is commonly said that bed-wetters are usually heavy sleepers.
Small Bladder Capacity:
It has long been thought that one of the problems of the enuretic
child had small bladder capacity.
Clinical Features of Enuresis
Essential Features:
1. Persistent involuntary voiding of urine by day or night that
is considered abnormal for the age of the patient.
2. Primary enuresis - passage of urine in inappropriate and unacceptable
circumstances with a frequency of at least one event a month after
age of 5 years.
3. Secondary enuresis - passage of urine in inappropriate and unacceptable
circumstances with a frequency of at least one event a month after
a period of urinary continence of at least 1 year.
Treatment:
The doctor first takes a detailed history and examines the child
to exclude structural abnormalities that may be the cause of bed-wetting.
In case a doubt persists after examination, the doctor will order
a urine test to exclude urinary infection. An ultrasound scan may
be done to evaluate the urinary system for structural abnormalities.
Rarely, special tests may be asked for, like intravenous pyelography
(IVP) that is a special X-ray test after an injection into the vein,
or cystometry in which the pressures inside the urinary bladder
are measured.
No treatment method is so successful as to win universal endorsement.
The management of a case of enuresis is difficult. That leaves the
following array of approaches in the armamentarium of the psychiatrist.
1. Placebos
2. Conditioning devices
3. Psychotherapy
4. Drugs
5. Bladder training
6. Sleep interruption
7. Hypnosis
1. Placebos:
In homeopathic literature marvelous cases of success are reported
by using placebos. Maybe, because it works at more of psychologically
making the child feel that he is under some treatment.
2. Conditioning Devices:
The most effective way of banishing the symptom of bed wetting
is to use a conditioning device that awakens the patient by an alarm
bell or buzzer as soon as a drop of urine contacts a wire pad on
which he is sleeping. The conditioning process quickly leads to
the cessation of bed wetting, since the patient learns to awaken
and void before the stimulation of the bell or buzzer.
Disadvantages: Conditioning devices are of little help and relapse
is bound to occur. The treatment according to many homeopaths is
cruel, punitive and insensitive. The other practical problem is
that when the buzzer sounds it also awakens other children sleeping
in the same room thereby spoiling peaceful sleep. Also false alarms
are very common because few children perspire a lot and these very
drops of perspiration stimulate the alarm.
3. Psychotherapy:
Critical to the management of any case of enuresis is psychotherapy.
The psychiatrist must be supportive and must be capable of promoting
and sustaining feelings of confidence and hope in the patient.
On guard, the psychotherapy involves encouragement sand patience
both in the consultation room and at home. The parents must be partners
in the process so that, with their co-operation the patient feels
that there are attitudinal changes in regard to bed wetting.
4. Drugs:
The array of drugs includes anticholinergics, sympathomimetics,
sedatives, relaxants, diuretics, anti-diuretics and antidepressants.
At the present time, antidepressants are the drugs of choice in
the treatment of enuresis for the allopathic physicians. However
it is seen in practice that those patients who were given tricyclic
antidepressants, including amitriptyline and nortriptyline by their
family physician, the children developed many side-effects like
dysuria, retention, dryness of mouth, dizziness, headache, constipation,
loss of appetite, weight loss, sleep disturbance and above all drug
addiction.
5. Bladder Training:
For a long time it has been known that some enuretics have smaller
than normal functional bladder capacities. That fact led urologists
to promote the treatment method of bladder training. In this therapy,
the patient is asked to quantify his ability to drink measured volumes
of fluid and to withhold the urination for as long as possible.
The desired result is that the patient becomes able to withhold
increasingly larger volumes of fluid over longer periods of time.
Hence, the vesicle is trained and becomes adaptive in accommodating
greater quantities of urine. At night the patient’s heightened
threshold for retention eliminates the problem of bed-wetting.
6. Sleep Interruption:
In view of the hypersomnia observed in enuretics long before the
era of laboratory sleep research, it has been suggested that parents
wake up the child to void during the night. Favourable responses
may have been due to positive behavioral reinforcement.
7. Hypnosis:
Hypnosis has been used in the treatment of enuretics in Europe
and in the United States. Like all treatment methods in enuresis,
there are enthusiastic claims and counter claims concerning its
success.
Alternative therapies
Herbal medicine:
Chewing on a piece of cinnamon bark several times a day is said
to reduce the need for night voiding. Another time honoured remedy
calls for taking corn silk extract just before bedtime. Some herbalists
also advocate uva-uris tea or elecampane decoction.
Self treatment:
If a child continually wets the bed, refrain from scolding, punishing
or embarrassing him. Instead give a reward for staying dry. If you
have a night voiding problem, drink fluids during the day and cut
back a few hours before going to bed. If you invariably have to
go the bathroom in the middle of the night but wake up too late,
set an alarm clock. The same tactic may help the child. Some people
find that avoiding certain foods reduces urinary urgency. Acidic
juices are a common bladder irritant. Coffee, tea and other sources
of caffeine not only may irritate the ladder but they also act as
diuretics, increasing output of urine. Nicotine is another bladder
irritant, as is alcohol, which also has a diuretic effect. If you
are taking a diuretic for high blood pressure, ask your doctor about
an alternative drug or about taking your medication in the morning.
Self-help groups often benefit people who have incontinence problems.
Adult diapers, waterproof bed pads, and similar products can help
in coping with night voiding. Pay extra attention to skin care if
you sleep with a device that rings the skin in contact with urine.
Shower in the morning, dry the area thoroughly, and apply cornstarch
or talcum powder.
Change in parents’ attitude:
In most cases, a simple change of attitude on the part of the parents
is all that is required to solve the problem. If your child feels
safe and secure in a home filled with love, most personality disorders
get sorted out on there own, if at all they were to arise.
The selection of the appropriate method depends on the individual
circumstances as comprehended by the physician. Usually, the clinician
elects a combination of methods.
Homeopathic Reportorial References
Bladder; URINATION; involuntary
Bladder; URINATION; involuntary; children, in
Bladder; URINATION; involuntary; children, in; nervous and irritable
Bladder; URINATION; involuntary; children, in; weakly
Bladder; URINATION; involuntary; daytime
Bladder; URINATION; involuntary; daytime; and night
Bladder; URINATION; involuntary; daytime; night, and
Bladder; URINATION; involuntary; night
Bladder; URINATION; involuntary; night, incontinence in bed; tangible
cause except habit, when there is no
Bladder; URINATION; involuntary; night; incontinence in bed; weakly
children, in
Bladder; URINATION; involuntary; night; children, in
Bladder; URINATION; involuntary; night; tangible cause except habit,
when there is no
Homeopathic Therapeutics of Enuresis
1. Belladonna
Time of enuresis: Generally after midnight or towards early morning.
Daytime
Sleep Pattern: Half opened eyes. Restless sleep with sleep. sudden
starts; moaning and screaming during Grinding, stertorous sleep.
Somnolence, sleepy yet cannot sleep. Sleeps with hands under the
head.
Cause: Eating too much sugar. Paralysis of bladder.
Character of urine: Yellow and scanty. Turbid. Dark red. Profuse
deposits of phosphate. Acidic.
Constitution: Scrofulous
Temperament: Anxiety. Quarrelsome. Bilious. Lymphatic
Accompaniment: Easy perspiration, faeces escape while urinating,
sensation of worms in the bladder.
2. Benzoic acid
Time of enuresis: During midnight in girls.
Sleep Pattern: Starts up, awakes with breathlessness and palpitation.
Character of urine: High coloured, smells like that of horse’s.
Sour. Ammoniacal. Hot, profuse, alkaline.
Constitution: Gouty, rheumatic
Temperament: Confused ideas, cross.
Accompaniment: Sheets are unusually brown stained.
3. Calcarea carbonica
Time of enuresis: Enuresis in bed when walking. After midnight.
Hysterical spasm of the bladder.
Sleep Pattern: Screams and cannot be pacified. Nightmares. Fearful
and fantastic dreams. Snoring.
Cause: Masturbation, loss of fluids, fright, egotism.
Character of urine: Dark brown. Strong odour. White sediment, offensive.
Constitution: Fat, flabby children with red faces. gouty, Tendency
to catch cold. Leucophlegmatic. Scrofulous. Plethoric, delicate.
Temperament: Dull, delayed, confused, fearful, forgetful. Nervous
bilious, sanguine.
Accompaniment: Pica. Pitutary and thyroid dysfunctions. Tendency
to take cold.
4. Causticum
Time of enuresis: During first sleep.
Sleep Pattern: Restless sleep. Starts laughs and cries. Drowsy-can
hardly keep awake. Sensitive wakes up. No sensation of passing urine;
scarcely believes until he makes sure of sense of touch.
Cause: Fright, grief, night-watching, retention.
Character of urine: Deposits of urates. Cloudy, uric acid, bloody.
Constitution: Children with lack hair and eyes and rigid fires.
Delicate skin, hydrogenoid, scrofulous.
Temperament: Nervous girls, slow in learning.
Accompaniment: Warts, weakness, stools passed in standing position.
5. Cina
Time of enuresis: During second half of the sleep. Full moon.
Sleep Pattern: Restless during sleep. Lies on abdomen, knee-chest.
Talks, cries, screams, wakes frightened. Hangs his head to one side.
Will not sleep unless rocked.
Character of urine: Copious. Turns milky on standing. Turbid white.
Constitution: Big, fat, rosy and scrofulous.
Temperament: Restless, touchy, capricious.
Accompaniment: Hungry, worms, grids teeth. Convulsions.
6. Ferrum Metallicum
Time of enuresis: More frequently in a day time than at night.
Sleep Pattern: Sleepy of debility. Restless lies o back. Vivid,
unpleasant, fell into water.
Cause: Weakness of the sphincter, vesicae. Worms.
Character of urine: Light colour of urine stains the sheet very
dark and smell strong ammonia. Hot, profuse, mucous sediment.
Constitution: False plethora, pale. Emaciated. Weak, delicate,
lymphatic. Hemorrhagic
Temperament: Sensitive, excitable, sanguine, choleric, phlegmatic.
Accompaniment: Allergies. Changeable.
7. Kali bromatum
Time of enuresis: 2 a.m. New moon.
Sleep Pattern: Somnambulism. Starts. Deep sleep, moans, cries,
grinding. Horrible dreams.
Cause: Nightmare worries. Spasmodic.
Character of urine: Pale, profuse, sugar+
Constitution: Obese
Temperament: Depressed, forgetful, weepy. Lymphatic. Sanguine.
Accompaniment: Thirst, appetite, constipation, tender liver, diabetic
headache.
8. Kali phosphoricum
Sleep Pattern: Night terrors. Somnambulism. Amorous dreams. Restlessness.
Wakes up with fright.
Cause: Nervous debility.
Character of urine: Saffron, yellow, milky.
Temperament: Nervous, sensitive, depressed, gloomy, forgetful,
fearful.
Accompaniment: Diabetics
9. Kreosotum
Time of enuresis: First part of night.
Sleep Pattern: Dreams of falling, poisoned, fire, of urination,
in a descent manner. Wakes with urinating from deep sleep but cannot
retain. Restless, tosses. Would not sleep until caressed and fondled.
Character of urine: Copious, pale urine. Offensive, brown red sediment.
Constitution: Overgrown, poorly developed children. Marasmus.
Temperament: Capricious, Leucophlegmatic.
Accompaniment: Black caries.
10. Lac caninum
Sleep Pattern: Screams, lies with one leg flexed and other stretched.
She dreams of urinating.
Character of urine: Scanty, dark, thick, reddish sediment.
Constitution: Dark hair, eyes. Rheumatic, enlarged glands.
Temperament: Forgetful, cross, irritable.
Accompaniment: Diphtheria, sore throat.
11. Mercurius
Time of enuresis: Night 3 a.m.
Sleep Pattern: Sleepless of anxiety. Restlessness, dreams of water,
thieves, animals.
Cause: Paralysis
Character of urine: Copious/scanty, urinates more than he drinks.
Mixed with blood white sediment. Strong smelling. Staining diaper,
hot acrid.
Constitution: Tendency to sweat profusely. Light hair with lax
skin and muscles. Scrofulous, strong, florid complexion. Lively,
brunette.
Temperament: Nervous, lack of will. Lymphatic, choleric.
Accompaniment: Easily suppurative tonsillitis. Thirsty, indented
tongue. Stomatitis.
12. Argentum metallicum
Time of enuresis: Nocturnal (spasmodic forms)
Sleep Pattern: Restless sleep, anxious, frightful dreams. Screams.
Character of urine: Turbid, pale, fetid, profuse, sweat odour.
Constitution: Lean, thin, robust, anaemic.
Temperament: Anticipatory anxiety, fear, depressed, irritable.
13. Baryta carbonica
Time of enuresis: Night
Sleep Pattern: Talks in sleep. Twitchings. Lies on one side.
Character of urine: Scanty, dark brown, copious.
Constitution: Dwarfish, retarded, scrofulous.
Temperament: Absent minded.
Accompaniment: Oversensitive to all impressions. Tendency to take
cold.
14. Natrum muriaticum
Time of enuresis: Alternate days, full moon.
Sleep Pattern: Somnambulism. Starts and talks in sleep. Dreams
of robbers, vivid, frightful
Cause: Fright, grief.
Character of urine: Clear, watery, red sediment, turbid, dark.
Constitution: Lean, thin, scrofulous, brown hair, blue eyes. Dark
complexion.
Temperament: Awkward, irritable, melancholic, nervous.
Accompaniment: Hopeless, school girl’s headache. Water brash,
diabetics.
15. Phosphorous
Sleep Pattern: Somnambulism, dreams of fire, lewd, vivid, business.
She couldn’t finish. Starts in sleep, lies on right side.
Cause: Anger, grief, diabetes, during typhoid.
Character of urine: Profuse, pale, haematuria, albumin, watery,
turbid, brick dust sediment, offensive.
Constitution: Lean, thin, tall, beautiful. Grow too rapidly, gouty,
scrofulous, fair, delicate eye lashes and smooth hair. Hemorrhagic.
Temperament: Sensitive, nervous, sanguine, quick, lively perceptions.
Accompaniment: Craving cold. Wants to be magnetized.
16. Pulsatilla
Time of enuresis: In little girls In autumn
Sleep Pattern: Lies with hands over head or crossed on abdomen
and feet draw up. Talks, screams. Restless. Tosses, Dreams-confused,
frightful.
Cause: Anger, spasm, measles after.
Character of urine: Mucus, scanty, red brown, profuse.
Constitution: Fair complexion. Sandy hair, blue eyes. Pale face.
Temperament: Mild, timid, weepy. Indecisive, slow, phlegmatic,
sanguine, hysterical.
Accompaniment: Thirstlessness.
17. Sepia
Time of sleep: First sleep.
Sleep Pattern: Talks loud, wakes up. Restless. Dreams of urinating.
Anxious.
Cause: Anger, vexation
Character of urine: Foul, sour, white, milky. Red, scanty, cloudy.
Constitution: Delicate, plethoric, yellow complexion, rigid Leucophlegmatic,
in boys of light complexion with onanist. Dark hair, fibres, scrofulous.
Temperament: Nervous, irritable. Bilious.
18. Silicea
Time of enuresis: Moon phases.
Sleep Pattern: Somnambulism. Talks loudly. Dreams of lascivious,
pleasant, murders, restless, wakes up frightened.
Cause: Worms, blow upon head. Diabetes.
Character of urine: Purulent, bloody, profuse.
Constitution: Emaciated, large head, open fontanelles, scrofulous,
rachitis.
Temperament: Sensitive, want of grit, lymphatic, phlegmatic, torpid.
Accompaniment: Constipation, night sweats.
Homeopathic Treatment of Enuresis: Cases Illustrated
1. Case 1- treated with placebo
A boy named XYZ aged 12 years, can]me with history of enuresis
since 10 years. The boy was the only child and was very nervous
and sickly. He had been given a lot of homeopathic and allopathic
treatment in the past without any benefit. He was warned by the
treating homeopath that if he does not stop bed wetting then the
surgeon will operate on him. Also the cut of the surgery will be
from head to foot. He was also given a bottle of S.L. pills and
told that if he desires to prevent this major surgery then he should
take 2 pills, three times a day for a fortnight. He took the treatment
for three months but till today he has spoiled the bed only twice.
He is still under observation. The success of placebo therapy largely
depends on the rapport between the homeopath and the patient. The
only demerit of this therapy is when the patient discovers the hoax.
2. Case 2:
Name - Master A. P.
Age - 8 years
Sex - Male
Occupation - Student 4th Std
Address - Mumbai
Chief Complaint - Passes large quantity of urine 2-3 times at night.
Every night.
- Lack of concentration
- Good at maths, calculations
- But is unable to cope up with longer answers as in history or
geography.
- Demanding, malingering
- Blames siblings
- Weeps much till other is punished.
- Perspiration – cold and profuse
- Biting nails
- Sleeps in knee chest position
- Salivation +
- Thirst+++
- Desires- sour, sweets
- Always at the fridge
- Appetite- eats much at a time.
- Eats slowly, relishes small morsels.
- Fussy about eating, never eats in
other’s plates.
- Would not share.
- Never takes from others.
- Attached to mother
- In physical contact with her
- Shares her household chores
- Puts something in front.
- Impelled to touch always behind mother.
- Dresses up
- Dresses like females, saree-dupatta
- Walks- thumak-thumak
- Dances
- Indolence on walking
- slow, dull, lazy, drowsy throughout the day, even at school
- Engrossed in play
- Can be busy and inquisitive, would break open the toy.
- Obstinate, never listens
- Always makes excuses
- Angry when teased
- Fights and strikes with siblings
- Playful, restless
- Tires easily
- Cannot tolerate heat and sun
- Plays with fire, frequent burns, cracking fingers
- Self care, fastidious, cleanliness plays in water
- Takes long baths.
- Cleans windows, washes himself often
- Washes plates himself, nothing should touch him.
Interview with child:
Sensitive to mocking - I feel very bad, insulted, hurt and angry
when they tease me.
Dreams - pursued by ghosts.
Perspiration - profuse on waking from dream.
Other considerations:
- When young, would like to be in the mother’s lap only.
- Wept frequently.
- Biting nails.
- Sour smelling, sensitive to beauty and nature.
- Shuns responsibilities, increased sensibility
- Knee chest position
-Weak concentration
- Profound exhaustion
- Ravenous hunger immediately after eating
- Cough > lying on stomach
- Perspiration easy sweating foot.
Nocturnal enuresis - passes large quantity of ammoniacal, high
coloured urine in bed every night.
< over work or over play, extreme of heat or cold.
Prescription: Medorrhinum 1 M three doses
Repertorial totality:
- Dreams - ghosts
- Dullness, sluggishness
- Forgetfulness - words while speaking
- Restlessness, nervousness
- Oversensitive
- Sensitive to reprimands
- Touched aversion to being
- Anger tendency to
- Destructiveness
- Egotism
- Fastidious
1st Follow Up:
Enuresis >>; Concentration improved; Anger- S. Q.; Sensitiveness-
S.Q.
Treatment: Medorrhinum 1 M one dose
2nd Follow Up:
Enuresis-stopped; Anger – decreased much; Concentration very
much better
Treatment:
Sac Lac 200 tds
No enuresis after that.
No dose repeated.
--------------------------------------------------------------
Dr. Sumit Goel M. D. (Hom)
Gold Medalist
Consultant Homoeopath and Teacher
www.homeopathyspace.com
DR. AMITA AGARWAL BHMS
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