Nocturnal enuresis Nocturnal enuresis (bed wetting) is defined by the National Institute for Health and Care Excellence (NICE) guidelines as involuntary wetting during sleep without any inherent suggestion of frequency of bedwetting or pathophysiology. It is considered normal up to the age of 5 years. Children with nocturnal enuresis may have excessive nocturnal urine production, poor sleep […]

Homeopathic Management of Nocturnal Enuresis in a 15-Year-Old Boy

Patient Details: Age/Gender: 15-year-old male Patient ID: 46520 Branch: Life Force Homeopathy, Pimpri Registration Date: February 2022 Introduction Nocturnal enuresis (bedwetting) is defined by the National Institute for Health and Care Excellence (NICE) as the involuntary passage of urine during sleep. It is considered normal up to the age of 5 years. Children with nocturnal enuresis may have excessive nocturnal urine production, poor sleep arousal, and/or reduced bladder capacity, and may sometimes also exhibit daytime urinary urgency, frequency, or incontinence. Types of Nocturnal Enuresis: Primary Nocturnal Enuresis (PNE): Recurrent involuntary urination at night in children aged 5 years or older who have never achieved consistent night-time dryness. Without daytime symptoms: Enuresis only occurs at night. With daytime symptoms: Includes daytime urgency, frequency, or wetting. Secondary Nocturnal Enuresis: Occurs in children who were previously dry for at least six months but regress, requiring investigation to rule out underlying pathology. Etiology: Disorder of sleep arousal Bladder factors: low nocturnal capacity or overactive bladder Nocturnal polyuria: low overnight vasopressin, excessive dilute urine Case History The patient began experiencing nocturnal enuresis at age 7, triggered by extended play, anger outbursts, and parental reprimands. At the time of registration, he was wetting the bed 3–4 times per week, usually 1–2 times per night in the early morning. He had received homeopathic treatment four years prior with no significant improvement. Past Medical History: Right-hand fracture 4 years ago History of chickenpox and dengue Examination and Investigations Ultrasound Abdomen & Pelvis (July 2022): Normal Urine Routine: Occasional PC and EC; mild protein (trace) Vitamin D: Normal Vitamin B12: Low → Supplementation advised Treatment & Advice Homeopathic Medicine: Causticum-30, prescribed according to case need Lifestyle Advice: Encourage daytime fluid intake; limit fluids 1–2 hours before bedtime Toilet before sleeping; wake once at night if necessary Avoid bladder irritants (caffeine, acidic foods) in the evening Maintain a regular bathroom routine Provide emotional support; bedwetting is involuntary Use waterproof mattress covers and absorbent underwear Follow-Up & Progress Date Observation April 2022 Bedwetting decreased to 1–2 times/week; improved sleep June 2022 Slight worsening: 5 episodes/month; sleep better July 2022 Significant improvement in symptoms September 2022 Frequency of bedwetting reduced; symptoms better October 2022 Mild increase in episodes; medicine revised November 2022 Severity and frequency decreased compared to last follow-up December 2022 Overall improvement; stable recovery sustained Conclusion This case demonstrates that individualized homeopathic treatment, along with supportive lifestyle measures, can be a safe and effective approach for managing nocturnal enuresis. Improvement may involve addressing deep sleep patterns, emotional triggers, and bladder sensitivity.

Nocturnal enuresis

Nocturnal enuresis (bed wetting) is defined by the National Institute for Health and Care Excellence (NICE) guidelines as involuntary wetting during sleep without any inherent suggestion of frequency of bedwetting or pathophysiology. It is considered normal up to the age of 5 years. Children with nocturnal enuresis may have excessive nocturnal urine production, poor sleep arousal, and/or reduced bladder capacity. Children with nocturnal enuresis may also have daytime urinary urgency, frequency, or incontinence of urine.

Definition:

Primary nocturnal enuresis.

This is the recurrent involuntary passage of urine during sleep by a child aged 5 years or older, who has never achieved consistent night-time dryness. This may further be subdivided into:

1. Primary nocturnal enuresis without daytime symptoms: children who have enuresis only at night.
2. Primary nocturnal enuresis with daytime symptoms: those who also have daytime symptoms, such as urgency, frequency, or daytime wetting

Secondary nocturnal enuresis.

This is the involuntary passage of urine during sleep by a child who has previously been dry for at least six months. Primary enuresis most often represents developmental delay which resolves in time. In secondary enuresis, the patient regresses after a period of continence, which requires the exclusion of underlying pathology - eg, a urinary infection.

Three etiological factors are commonly involved:

1. A disorder of sleep arousal. The child is not awakened by the sensation of a full bladder.

2. Bladder factors. There may be a low nocturnal bladder capacity and/or an overactive bladder. Emptying reflexes are not inhibited during sleep

3.Nocturnal polyuria. Affected children have been found to have low overnight vasopressin levels and excessive production of dilute urine during the night.

This is a case of a 15-year-old boy. At the age of seven, the patient began experiencing episodes of nocturnal enuresis after exertion from extended play hours, an outburst of anger, and after parental reprimands. The patient was registered in February 2022 (Patient ID-46520) at the Life Force Homeopathy Pimpri branch. He was bedwetting three to four times a week, 1-2 times at night, usually in the early morning. Four years ago, he had been treated with homeopathy, but there were no noticeable changes in his bedwetting complaint.

Past history: He had a right hand fracture 4 years ago and had a history of chicken pox and dengue.

His case was studied in detail, and as per the case need, Dr. Rajesh Shah prescribed Causticum-30.

Advice was given to parents to encourage him to drink more fluids during the day and limit intake to 1-2 hours before bedtime. To ensure he uses the toilet before sleeping and, if needed, wake him once during the night for a bathroom visit. To avoid bladder irritants like caffeine and acidic foods in the evening. To establish a regular bathroom routine and provide emotional support, as bedwetting is involuntary and not the child’s fault. It was also suggested that using waterproof mattress covers and absorbent underwear can help manage accidents without stress.

Investigations:- 

July 2022 USG: Abdomen and pelvis: No abnormality was present

Urine Routine:-PC and EC Occasional, Mild Protein was trace

Vitamin D was normal and Vitamin B12 was low, so for the same, additional supplements were prescribed and guided.

First followup:-

In his first follow-up in April 2022, the frequency of urine was decreased 1-2 times a week, and his sleep was better.

Second followup

By the second follow-up, which was taken in June 2022, there was a slight worsening in the condition; he had wetted a bed 5 times a week last month, but sleep was better.

Third followup

In July 2022, when he gave his third follow-up, the symptoms were much better.

Fourth followup

In September 2022, the symptoms of nocturnal enuresis were better, and the frequency of urine was also reduced.

Fifth followup

By October 2022 the frequency of urine episodes was increased, he was wetting the bed more often, on inquiry the cause was not found. As per the case need the medicines were revised.

Sixth followup

In November 2022, the severity and frequency of nocturnal enuresis decreased as compared to the last follow-up.

Seventh followup

In his last follow-up dated December 2022, the patient had improvement overall and was stable; his recovery was sustained.

Conclusion:-

This case demonstrates homeopathic treatment can be a safe and effective option to address underlying causes like deep sleep, emotional factors, or bladder sensitivity in cases of nocturnal eneuresis