Waking up on a wet bed can be very distressing to any child, especially for children above 12 years of age. Even though this is not a fatal condition the psychosocial impact that this can have on a child and parent is unnerving. Through this article Dr. Dhnaya explains the types, causes and Ayurvedic treatments available for bedwetting.
It is understood that by the age of 5 yrs, 90-95 % children are nearly completely continent (able to retain urine and stools) during the day and 80-85% are continent (able to retain urine and stools) at night. Involuntary voiding of urine during sleep usually after the age of five years is considered as bedwetting. It may affect the child’s behavior and their emotional and social life. The problem is found more in boys than in girls. There is a tendency among children to hide the problem and this makes it worse. A low level of self esteem is noted in children with bedwetting. The extent of parental concern and child distress is an important factor in the treatment. 30th May 2017 was world bedwetting day and the motto this time was ‘time to take action’ in recognition that much more can be done to diagnose and treat those children who suffer from bedwetting.
It is of two types- primary (75-90%) and secondary(10-25%).
The primary means the child was never dry in his/ her lifetime.
Secondary means the child was dry at least for six months and the symptom reappeared after that.
- Delayed development of neurological balance that controls urination.
- Defective sleep arousal- The child does not waken when his or herbladder is full
- Genetic factors – if both the parents had bed wetting problems there is a 77 % likelihood of the problem to be appearing in children
- Constipation- A full rectum impinging on the bladder
- Overactive bladder or bladder with reduced capacity
- Sleep disorders or Sleep disordered due to enlarged adenoids
- Urinary tract infections
- Diseases like Diabetes mellitus or diabetes insipidus.
- Structural abnormality- Bedwetting associated with other symptoms like urgency to urinate, hesitancy, increased frequency and day time incontinence may be due to an abnormality in the urinary tract.
- Emotional problems:A stressful home life, new school, birth of sibling, or moving to a new home, physical or sexual abuse
Age, male gender, toilet training with threatening method, deep sleeper, sleep walking, school success, the general approach of the family to children, being introverted and shy – all these factors significantly increase the risk of betting.
Treatment is not needed for bedwetting in children below the age of 6. Causes, if any, should be found and treated accordingly. For e.g., if the underlying cause is diabetes mellitus, diabetes insipidus or some renal disorders, treatment for those diseases should be given. Parental care and emotional support is as important as treatment.
The most primary treatment for bedwetting is motivational therapy. This includes making charts to track the number of dry nights and rewarding the child for dry nights. Punishment and angry responses should be avoided. Conditioning therapy can also be tried in older children. It involves the use of an alarm attached to a moisture sensor in the underwear. It awakens the child and alerts them to void. Persistent use of the alarm for several months is necessary.
Krimi (any foreign organism inside human body) is considered as the main etiological reason of Shayyamootrata ( bedwetting) in Ayurveda. Vitiation of Apana Vata ( a type of Vata Dosha which governs the downward excretory process) is also an important etiological factor. So the primary line of treatment in Ayurveda involves Apana vatanulomana chikitsa (treatment involving the pacification of Apana Vata) and Krimighna chikitsa ( treatment involving destruction of Krumi). For this, treatments like virechana, medicines like Krimighna vatika, Krimishodini, Krimikuthar Ras, Krimimudgar Ras, Vidangarishta, Sanjeevani Gutika, Vidangaasava etc. can be used. Seeds of Palasha (Butea monosperma), Kutaja seeds( Holarrhena antidysenterica ), Vidanga (Embelia ribes), Nimba (Azadirachta indica) , Bhoonimba (Andrographis paniculata ) can be powdered and mixed inequal quantity with jaggery and can be given to the child. Drugs like Vidanga (Embelia ribes), Indrayava( Holarrhena antidysenterica ), Kampillaka (Mallotus philippensis), Dadima (Punica granatum), Musta (Cyperus rotundus), Bilwa (Aegle marmelos) can be used in combination or individually.
In case of urinary tract infection, drug like Chandraprabha Vati, Bruhatyadi Kashaya, Dashamool Kwath, Varuna (Crataeva nurvala), Shigru ( Moringa oleifera) etc. can be given. In case of constipation castor oil mixed with milk or soaked raisins can be given.
Mootra sangra haneeya Drugs (drugs which decrease urine output) are also used. Jambu (Syzygium cumini), Vangabhasma, Bahumootrantak Ras are some of the other drugs used in the treatment of Shayyamootrata in Ayurveda
Bimbi (Coccinia indica), Vishatinduka ( Strychnos nuxvomica), Kataka (Strychnos potatorum), Shilajatu, Shati (Heydichium spicatum), Haridra (Curcuma longa) Krishna tila (Sesamum indicum) , Amalaki (Phyllanthus emblica) , Ashwagandha (Withania somnifera) are also useful in this condition. Bimbi root juice and honey or bimbi and maricha (Piper nigrum) can be used for treating this condition.
The children who are motivated to remain dry are likely to be cured more easily than others. The physician usually has the role of facilitator and active participation by child is critical for the success of treatment. So more than a simple drug therapy the disease can be successfully overcome by a combination of various treatment modalities.
What parents can do?
- Don’t panic. Don’t criticize the child. Understand that it is a self- limiting condition
- Fluid intake should be restricted to 2 oz after 7 pm.
- Note the time at which bedwetting happens. Note down the pattern.
- Note whether the child is snoring or has urinary problems
- Make child to void at night time.
- Avoid extraneous sugar and caffeinated drinks like tea, coffee etc and soda after 4 pm
- Waking up the child few hours after they go to sleep and make them void
- Reward them for dry nights
BEDWETTING IS NOBODYS FAULT. IT CAN AND SHOULD BE TREATED
Dr. Dhanya. R
Department of Dravyaguna Vigyana ,
SNKD Trusts Nallasopara Ayurved Medical College,