Bedwetting, or nocturnal enuresis, is the accidental or involuntary release of urine while sleeping. Bedwetting is common among children, even after toilet training.

Most children gradually stop wetting the bed on their own as they grow older. This usually happens between 4 and 6 years of age.

Bedwetting is a serious condition; it can cause stress for your child and family. Bedwetting isn’t the result of poor toilet training or laziness. Many factors lead to nocturnal enuresis among both children and adults.

Types of nocturnal enuresis

There are two main types of bedwetting:

• Primary nocturnal enuresis occurs when a person has never remained dry throughout the night for six months in a row or longer.
• Secondary nocturnal enuresis occurs when a person wets the bed again after not wetting the bed for six months or more. Secondary enuresis is usually the result of a medical or psychological condition.

Who does bedwetting affect?

Bedwetting affects people of all ages, from children to adults. Children are still learning to control their bladder, so the condition is more common before age 6.
Adults with nocturnal enuresis usually have an underlying medical or psychological condition that leads to bedwetting. Bedwetting occurs more often among boys or children assigned male at birth (AMAB). A person may be more at risk of nocturnal enuresis if he/she has severe emotional trauma or stress.

Symptoms and Causes

Waking up with wet pajamas or sheets from urine is the main symptom of bedwetting. You likely won’t know that you wet the bed until it’s too late. While it’s a physical condition, bedwetting can take an extreme emotional toll on anyone who experiences it.

Bedwetting can be a symptom of an underlying medical condition if it occurs in a toilet-trained person who has frequent bedwetting episodes after not having any for at least six months. Some signs that there may be an underlying medical issue causing bedwetting include:

• Changes to the frequency of when and how much patient urinate during the daytime.
• Pain while urinating.
• Having a small stream of urine.
• Urine color.
• Changes of mood.
• Lack of bowel movements during the day.

Causes of childhood bedwetting

The most common cause of childhood bedwetting is a lack of bladder control. Children usually learn to control their bladder between ages 2 to 4. The majority of children gain control of their bladders by age 7. After age 7 and throughout your child’s teenage years, accidents can happen.

In some cases, frequent or recurring bedwetting may be a sign of an underlying medical condition, like:

• A urinary tract infection.
• Constipation.
• Spina bifida or nerve problems.
• Diabetes.
• A urinary tract blockage or narrow urethra.
• Obstructive sleep apnea.
• ADHD.

Causes of adult bedwetting

People over the age of 18 can have nocturnal enuresis. Potential causes for adult bedwetting could include:

• Genetics: Some people have a genetic predisposition to bedwetting. This means that if a person’s biological parents had nocturnal enuresis, their children are more likely to have the same condition.
• Constipation: Pressure from extra stool inside rectum may interfere with the nerve signals that the bladder sends to the brain. A full rectum can also reduce the amount of urine that our bladder can hold or prevent it from emptying completely.
• Hormones: A hormone called vasopressin limits the volume of urine that a human body produces during the night. Vasopressin works by causing water in urine to be reabsorbed by our bloodstream. This causes a smaller volume of urine to enter our bladder. People who don’t produce enough vasopressin may be more likely to wet the bed.
• Small functional bladder capacity: People with a small functional bladder capacity have normal-sized bladders, but they sense that their bladders are full even when the bladder can still hold more urine. They tend to urinate more often during the day, and they might have a sudden urge to run to the bathroom to prevent an accident. This also makes them more likely to wet the bed during the night.
• Failure to awaken during the night: Sometimes people are unable to wake up in time to get to the bathroom. As your bladder fills with urine, it sends a signal to your brain. Your brain sends a signal back to your bladder to relax so it can hold more urine. A full bladder continues to send signals to your brain so that you’ll wake up. Sometimes, an underlying condition can interrupt these signals, which prevents you from getting up in the middle of the night.
• Psychological or emotional problems: Emotional stress caused by traumatic events or disruptions in our normal routine can cause bedwetting. For example, moving to a new home, enrolling in a new school, the death of a loved one or sexual abuse may cause bedwetting episodes. These can become less frequent over time.
• Medical conditions: An underlying medical condition may be the cause of adult bedwetting, like sickle cell disease, neurological changes and kidney or bladder abnormalities.

Diagnosis

A doctor will diagnose nocturnal enuresis after a physical exam and taking a complete medical history. Doctor may suggest tests, like a urine test, a blood test or an imaging test, to determine if an underlying medical condition caused bedwetting.

Allopathic Treatment for Bedwetting

Allopathic treatment for nocturnal enuresis varies based on the cause. Treatment options could include:

• Behavioral changes before or during bedtime like using an alarm.
• Managing or treating any underlying medical conditions.
• Taking medications that can reduce nighttime urine production.
• Refer to a health professional like psychologist or therapist to manage patient’s stress, trauma or emotional challenges.

Adults with nocturnal enuresis who tried all other noninvasive forms of treatment without success may be candidates for surgery. Surgery can stimulate the bladder, bowels and pelvic floor (sacral nerve) or remove muscle that surrounds your bladder to improve bladder contractions.

Allopathic medications

The following medications may be used for treating bedwetting:

• Desmopressin: This is the artificial version of the hormone vasopressin, which causes the kidneys to produce less urine. It’s effective in about half of all cases, with better results in older children who have normal bladder capacity. The medication can lower sodium levels in children who take it, so patient should limit the number of fluids or drinks after dinner.
• Oxybutynin or tolterodine: This drug treats an overactive bladder by reducing bladder contractions. You can advise it with desmopressin or the enuresis alarm method. It may be effective for children who wet the bed more than once each night and who also have daytime wetting.
• Imipramine: Imipramine prevents bedwetting in an estimated 40% of cases by increasing brain signals to different parts of the body, like our bladder.
• Solifenacin: An anticholinergic medication that controls nerve impulses to prevent an overactive bladder.
• Trospium chloride: A drug that helps our bladder relax by blocking muscle cell receptors on our bladder wall. It prevents bladder over-activity.

Homeopathic Treatment for Bedwetting

In Homeopathy there are too many well proven medicines for bedwetting; I’ll describe here only those which are in my experience:

Equisetum Hyemale

Severe, dull pain and feeling of fullness in bladder, not relieved by urinating. Frequent urging with severe pain at the close of urination. Urine flows drop by drop. Sharp, burning, cutting pain in urethra while urinating.

Incontinence in children, with dreams or nightmares when passing urine. Incontinence in old women, also with involuntary stools. Retention and dysuria during pregnancy and after delivery. Much mucus in urine. Albuminuria. Involuntary urination. Deep pain in region of kidney, extending to lower abdomen, with urgent desire to micturate. Lumbar region painful.

Benzoic Acidum

Strong smelling urine of low specific gravity. Wet the bed several times during sleep. Repulsive odor; changeable color; brown, acid. Enuresis; dribbling, offensive urine of old men. Excess of uric acid. Vesical catarrh from suppressed gonorrhea. Cystitis. Urine smells like ammonia or like horse’s urine.

Medorrhinum

A powerful and deep-acting medicine, often indicated for chronic ailments. Bed wetting, passing large quantities of pungent smelling urine or scanty or highly colored or copious pale urine with pungent odor. Painful tenesmus when urinating. Nocturnal enuresis. Renal colic. Urine flows very slowly.

Sepia Officianalis

Red, adhesive, sand in urine. Involuntary urination, during first sleep. Chronic cystitis, slow micturition, with bearing-down sensation above pubis.

Sulphur

Frequent micturition, especially at night. Enuresis, especially in scrofulous, untidy children. Burning in urethra during micturition, lasts long after. Mucus and pus in urine; urethra sore. Must hurry, sudden call to urinate. Great quantities of colorless urine.

Psorinum

Psorinum should be prescribed for bed wetting when all other medicines you know, fails. Bed wetting due to suppressed eczema, or eruptions or after acute severe illness. Discharge of prostatic fluid before micturition. Tenesmus urination and discharge of a few drops when he thinks he has done. Frequent micturition at night. Sticking inwardly from orifice of urethra. Burning during micturition with cutting. Urine has a red sediment and a pellicle of fat.

Calcarea Carbonicum

Too frequent emission of urine, even in the night. Bed wetting or enuresis. Deep-colored urine, without sediment, red like blood, or a brownish red, of an acrid, pungent, and fetid smell, with white and mealy sediment. Hematuria. Abundant discharge of mucus with the urine. Polypus of the bladder. Micturition, burning even without urinating.

Pulsatilla Nigra

Urine scanty; bloody; with mucus; reddish; pain before and during urination. Retention of urine, with redness and heat in bladder area (lower abdomen). Involuntary micturition; Enuresis/bedwetting. Involuntary emission of some drops of urine when coughing, walking, sitting down, expelling flatus (or during sleep). Enuresis of old people with distended colon. Profuse emission of watery urine, with weakness in loins and diarrhea, or scanty red or brown urine, sometimes with a violet-colored froth.

Contraction of urethra with a very small stream of urine. Pressure and constriction in bladder, with soreness (sensitiveness) in that region. Swelling near neck of bladder, with soreness when touched, intermittent stream of urine, and spasmodic pain in pelvis and thighs after urinating.

Verbascum Thapsus

Verbascum Thapsus has pronounced action on the inferior maxillary branch of the fifth pair of the cranial nerves; on the ear; and respiratory tract and bladder. Catarrhs, and colds, with periodical prosoplasia. Quiets nervous, and bronchial, and urinary irritation, and cough. Constant dribbling. Enuresis. Burning urination. Increase with pressure in bladder.

Causticum

Its action is mainly in chronic paralytic affections, indicated by the tearing, drawing pains in the muscular and fibrous tissues, with deformities, progressive loss of muscular strength, tendinous contractures. Involuntary urinate when coughing, sneezing etc. Expelled very slowly, and sometimes retained. Involuntary during first sleep at night; also, from slightest excitement. Retention after surgical operations. Loss of sensibility on passing urine.

Kreosote

Severe, old neuralgic affections. Excoriating, burning, and offensive discharges. Overgrown, poorly developed children. Post-climacteric diseases. Vanishing of thought; stupid, forgetful, peevish, irritable. Child wants everything but throws it away when given.

Kreosote is a medicine used to treat bedwetting where the child passes urine while in a deep sleep, and it is tough to waken the child. High frequency of urination during the day and presence of red or white sediments in the urine. Dreams of urinating. Enuresis in the first part of night. Must hurry when desire comes to urinate.

Cina

Cina is the source of the alkaloid Santonin. It is pre-eminently a worm medicine, it treats all the symptoms like helminthiasis both mental, nervous, and bodily. Grinding of teeth during sleep, shrieking, crying or being scared during sleep, an irritable or obstinate behavior, rubbing of nostrils are some other symptoms that indicate the need for this medicine.

P. S: This article is only for doctors having good knowledge about Homeopathy and allopathy, for learning purpose(s).

For proper consultation and treatment, please visit our clinic.

None of above-mentioned medicine(s) is/are the full/complete treatment, but just hints for treatment; every patient has his/her own constitutional medicine.

To order medicine by courier, please send your details at WhatsApp– +923119884588

Dr. Sayyad Qaisar Ahmed (MD {Ukraine}, DHMS), Abdominal Surgeries, Oncological surgeries, Gastroenterologist, Specialist Homeopathic Medicines.

  Senior research officer at Dnepropetrovsk state medical academy Ukraine.

Location:  Al-Haytham clinic, Umer Farooq Chowk Risalpur Sadder (0923631023, 03119884588), K.P.K, Pakistan.

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