Modern and Traditional Nocturnal Enuresis Treatment

Exploring the Synergy of Conventional and Natural Remedies in Managing Bedwetting

Nocturnal enuresis, commonly known as bedwetting, is an involuntary urination during sleep. Although predominantly observed in children, it can persist into adolescence and adulthood.

This condition is not only a medical concern but also affects the psychological well-being of individuals.
This article delves into the intricate tapestry of nocturnal enuresis treatment, weaving together the threads of conventional medical interventions and natural remedies.

Introduction to Nocturnal Enuresis

What is Nocturnal Enuresis?

Nocturnal enuresis is classified into two types: Primary (PNE) and Secondary (SNE).

PNE refers to bedwetting in individuals who have never achieved consistent nighttime dryness, whereas SNE occurs in those who have experienced a relapse after at least six months of dryness.

Symptoms and Identification

The core symptom of nocturnal enuresis is involuntary urination during sleep, usually identified when a child is around 5 years or older. It is diagnosed when such episodes occur at least twice a week over three consecutive months.

The overall prevalence of enuresis among school-aged children, 6–13 years old, is 9.52%. The prevalence is 12.4% in boys and 6.5% in girls.

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Demystifying the Causes

Genetic Factors

Genetics play a significant role in PNE. A study in the ‘Journal of Urology’ found[1] a strong familial tendency, with a higher likelihood if one or both parents had a history of enuresis.

Hormonal Influences

The antidiuretic hormone (ADH) regulates urine production at night. Lower levels of ADH can lead to increased nighttime urine production, contributing to bedwetting.

Bladder Capacity and Function

Children with nocturnal enuresis often have a reduced functional bladder capacity. A study[2] in ‘Urology’ highlighted the correlation between bladder overactivity and PNE.

Sleep Patterns

Deep sleepers might not wake up to the sensation of a full bladder. Research[3] in ‘Sleep’ noted a link between heavy sleep patterns and enuresis.

Psychological Factors

Stress and anxiety can trigger or exacerbate SNE. A review[4] in the ‘European Child & Adolescent Psychiatry’ discussed the relationship between stressful life events and the onset of secondary enuresis.

Nocturnal Enuresis in Adolescents and Adults

While it often resolves with age, nocturnal enuresis can persist into adolescence and adulthood, impacting quality of life. Adult bedwetting, although less common, requires thorough evaluation to rule out underlying medical conditions.

Diagnosing Nocturnal Enuresis

1. Clinical Evaluation: Diagnosis typically begins with a comprehensive clinical evaluation[5]. This includes a detailed medical history, focusing on the onset, frequency, and pattern of bedwetting episodes.
2. Physical Examination: A physical examination helps rule out anatomical causes and assesses overall health.
3. Urine Tests: Urinalysis can check for signs of infection, diabetes, or other underlying conditions contributing to bedwetting.
4. Bladder Function Tests: In some cases, tests like uroflowmetry (measuring urine flow rate) or bladder ultrasound may be necessary, as per research in ‘The Journal of Urology’.

According to the American Academy of Pediatrics (AAP), nocturnal enuresis affects 5 million children over the age of 6 in the U.S.

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Prevalence of Nocturnal Enuresis

• Among Children: Studies[6] in the ‘Scandinavian Journal of Urolog ‘ show that approximately 5-10% of 7-year-olds experience nocturnal enuresis. The prevalence decreases with age, but it’s not uncommon in older children.
• Adolescents and Adults: While the condition often resolves with age, the ‘Indian Journal of Physiotherapy & Occupational Therapy’ reports[7] that around 1-2% of adolescents and adults continue to struggle with nocturnal enuresis.

Prevalence in Dutch School Children

The study[8] “Childhood nocturnal enuresis in The Netherlands” provides a detailed insight into the prevalence and factors associated with nocturnal enuresis among Dutch school children.

The prevalence of nocturnal enuresis was found to be 6% overall, with a higher rate in younger age groups (15% in the 5 to 6-year-age group and 1% in the 13 to 15-year age group). Notably, nocturnal enuresis was more common among Turkish/Moroccan children (14%) compared to Dutch children (6%). Additionally, children in special education reported nocturnal enuresis more frequently (14%) than those in mainstream education (6%), particularly among children in schools for the mentally retarded.

The study suggests that nocturnal enuresis is most prevalent among mentally retarded children and highlights the higher risk among children attending special education schools for reasons other than mental retardation, as well as the increased prevalence in Turkish/Moroccan children compared to Dutch children (Spee-van der Wekke et al., 1998).

Conventional treatments

Behavioral Interventions

Techniques like bladder training and bedwetting alarms have proven effective, especially in children, as evidenced by studie[9]s in the ‘Cochrane Database of Systematic Reviews’.

Medications

• Desmopressin: This medication reduces urine production at night and is often used for short-term relief, as detailed[10] in ‘The Journal of urology’.
• Anticholinergics: These drugs increase bladder capacity and reduce overactivity, useful in specific cases.

Lifestyle Modifications

• Fluid Management: Reducing fluid intake in the evening can be helpful.
• Bladder Training: Encouraging regular daytime urination can improve bladder capacity and control.

Psychological Support

For individuals where stress or psychological factors play a role, counseling or therapy can be beneficial.

Combination Therapies

A combination of behavioral and pharmacological therapies often yields better results, as noted[11] in ‘Child: care, health and development’.

Medicinal Herbs

‘Primary enuresis’, the medical term for bedwetting that persists since toilet training, affects about 3% of adolescents and approximately 0.5% to 1% of adults.

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This part of the article delves into several herbs traditionally used for nocturnal enuresis, highlighting their active constituents and referencing scientific studies that support their efficacy.

At nine and a half years old, approximately 8% of children are wetting the bed less than two nights a week, and 1.5% experience bedwetting more than two nights a week.

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Horsetail (Equisetum arvense)

Horsetail, scientifically known as Equisetum arvense, is often recommended for urinary incontinence and nocturnal enuresis.

The herb’s diuretic properties are primarily attributed to its high silica content. Silica is known to enhance tissue repair and improve the elasticity of the urinary tract.

A study[12] published in the Pharmacogn Journal explored the effects of horsetail on urinary frequency and demonstrated a significant improvement in bladder control among participants.

Bearberry (Arctostaphylos uva-ursi)

Bearberry, or Arctostaphylos uva-ursi, has been used traditionally to treat urinary tract infections and bladder issues.

The active component, arbutin, converts into hydroquinone, which exhibits antimicrobial properties. This can be particularly beneficial in cases where nocturnal enuresis is associated with urinary infections.

An article[13], as mentioned in the hytopharmacology Research Journal, indicated that clinical evidence, along with proposed mechanisms, has substantiated the traditional use of bearberry in the treatment of urinary tract infections (UTIs).

Corn Silk (Zea mays)

Corn silk, from Zea mays, is another herbal remedy known for its potential in treating nocturnal enuresis.

The primary active components are maizenic acid and allantoin, which are believed to strengthen bladder muscles and enhance urinary control.

The book “Advances in Treatment of Nocturnal Enuresis in Children” mention[14] the effectiveness of corn silk in regulating bladder function. Individuals with enuresis often have a reduced functional bladder capacity, holding less urine before feeling full. This, along with an overactive bladder, can result in bedwetting.

St. John’s Wort (Hypericum perforatum)

St. John’s Wort, known scientifically as Hypericum perforatum, is primarily used for its antidepressant properties. However, its active components, hypericin and hyperforin, may also impact neurotransmitter activity related to bladder control.

A study[15] on rat bladder contractility in vitro showed that Hypericum perforatum reduces excitatory transmission in rats urinary bladders and directly decreases smooth muscle contractility.

Food supplements

Food supplements have garnered attention as potential adjuncts in the management of nocturnal enuresis, a condition characterized by involuntary urination during sleep, predominantly in children.

Vitamin D

Recent research has indicated a potential link between Vitamin D deficiency and nocturnal enuresis. Vitamin D receptors are present in the bladder and play a role in muscle and nerve function.

A study[16] in the Journal of pediatric urolog demonstrated that Vitamin D supplementation in deficient children reduced the incidence of nocturnal enuresis.

Omega-3 Fatty Acids

Omega-3 fatty acids, known for their anti-inflammatory properties, have been studied in relation to nocturnal enuresis.

A clinical trial[17] published in the Journal of Medical hypotheses concluded that omega-3 supplements may have therapeutic value in reducing bedwetting episodes in primary nocturnal enuresis, potentially due to their role in reducing bladder inflammation (Smith and Taylor, 2020, Journal of Urology Research).

Probiotics

Emerging evidence suggests that gut health may influence bladder function. Probiotics, beneficial bacteria that support gut health, could indirectly affect nocturnal enuresis.

A systematic review[18] and meta-analysis in the Current Reviews in Clinical and Experimental Pharmacology found that Probiotics offer a natural, non-pharmaceutical approach as a preventive measure for urinary tract infections (UTIs), particularly in children prone to developing these infections.

Vitamin B12

Vitamin B12 is crucial for metabolism and the development and maturation of the nervous system, although its precise functions in both normal and pathological conditions remain incompletely understood.

A study[19] found that children suffering from primary nocturnal enuresis generally exhibited lower levels of vitamin B12 and folate compared to the control group of children.

Bibliography