Words: Dr Ambika P NAYAK
Nearly 99 per cent of normal, healthy children attain day-time bladder control by age five. However, about 20 per cent of boys and about 10 per cent of girls may as yet have nocturnal [night-time] incontinence, or bedwetting, at age 7.
Statistics suggests that 1 per cent of boys and 0.5 per cent of girls continue to wet their bed up to age 18. In terms of prevalence, day-time wetting is less common in girls than boys.
There are two types of incontinence.
- Bedwetting [nocturnal enuresis] with no day-time problems
- Diurnal [day-time] enuresis with, or without, bedwetting.
Primary enuresis. This is best elicited with a positive family history and lower developmental maturity in the first three years of life.
Secondary enuresis. This is best predicted by the child being ‘behind schedule’ to attain bladder control, or on the basis of unpleasant life events.
Whatever the type, it is important to establish whether the form of the behavioural disorder is primary, a continuing form of the normal incontinence of childhood, or secondary, which occurs after the child has been successfully dry.
During case analysis, a professional Ayurveda physician will inquire as to whether the child has certain motives, or has had certain delayed milestones, or development delays, with the presence of parallel emotional, or behavioural, problems — or, both.
Causal pathway
Nocturnal enuresis is evidenced to be hereditary. It tends to run in families. 70 per cent of parents who were late in becoming dry may have a child with incontinence. Twins are twice as likely to be affected.
The child with urinary incontinence may present with disturbed sleep patterns, nightmares, or trouble while waking from light sleep, especially when the bladder is full.
Laboratory tests may reveal increased levels of sodium excretion in the urine.
Apart from psychological distress, children with enuresis may also present with attention-deficit hyperactivity disorder [ADHD], lowered self-esteem, or self-confidence. What’s more, they may view their annoying problem as a highly stressful event.
This may often prompt them to keep it a closely-guarded secret — for the fear of being ‘caught,’ or ridiculed, in social situations.
A Case In Point
A petite teenager, accompanied by her mother, visited my clinic with complaints of bedwetting — at least four times a week. The family had tried a handful of self-help routines of clearing the bladder before going to bed, along with an alarm system to wake up in-between sleep. The practices had helped their daughter for some time, but things gradually returned to square one.
This led them to seek medical help. After a thorough analysis, through questioning, I found the bedwetting issue to be a distinctive case of secondary nocturnal enuresis. The causes seemed to be a weak bladder, juxtaposed by stress. I counselled the teenager, in the presence of her mother, with regard to her problems and assured her of a positive result — with her full co-operation.
The Ayurvedic approach relates to a certain imbalance in the vata dosha, for bedwetting, and a suitable treatment programme was, therefore, planned to restore balance.
First things, first. I advised the kid to have patience and get involved in different activities by keeping her mind fresh and letting stress not be a hurdle for treatment. The girl obliged and she made the necessary changes to help with this approach — just as much as she could.
I prescribed her an Ayurvedic proprietary medicine — Tablet Neo, a useful herbal combination with kapikacchu, shatavari, palandu, bhringaraj etc., and vidaryadi Kashaya — to address her weak bladder. I also advised her to practice pelvic strengthening exercises, on a daily basis, alongside dietary inclusion of gourd for a month. The response was positive during our follow-up, after a month. She was able to hold her urge better and the bedwetting happened only on occasions when the weather was cold [at night].
I followed up with a fresh prescription of indukanta kashaya, which is yet another herbal Ayurvedic medicine, to strengthen the bladder and handle vata dosha. I asked her to continue with her pelvic exercises for another month.
After two months, my teenaged patient had gained almost full bladder control. However, her stress continued to bother her. I now prescribed her saraswatarista and manasamitra vati, along with counselling, for a month — to treat her stress.
The girl soon emerged victorious and she was more than delighted that she’d beaten her bedwetting anguish.
