Functional Enuresis

The condition may be nocturnal (bed-wetting), diurnal (occurring during waking hours), or both.

Nocturnal enuresis is referred to as primary if there has been no preceding period of urinary continence, and secondary if there has been a preceding period of urinary continence.

There is no absolute period of continence needed to become secondary enuresis, but 6 months is a commonly used time frame.

Most children achieve regular daytime and night-time continence by 3 or 4 years of age, and 5 years is generally taken as the youngest age for the diagnosis.

Nocturnal enuresis can cause great unhappiness and distress, particularly if the parents blame or punish the child, and if the condition restricts staying with friends or going on holiday.

Nocturnal enuresis occurs in about;

• 10 % of children at 5 years of age,
• 4 % at 8 years,
• 1 % at 14 years,
• 0.5 % in adulthood.

The condition is more frequent in boys. 

Daytime enuresis has a lower prevalence and is more frequent in girls.

Nocturnal enuresis usually presents with voiding of urine during sleep in a child in whom it is difficult to wake. It may be accompanied by bladder dysfunction during the day which is termed non monosymptomatic enuresis.

Day time enuresis also known as urinary incontinence may also be accompanied by bladder dysfunction.

The symptoms of bladder dysfunction include:

1. Urge incontinence:

In detail, The presence of an overwhelming urge to urinate, frequent urination, attempts to hold the urine and urinary tract infections.

2. Voiding postponement:

Delaying urination in certain situations such as school.

3. Stress incontinence:

Generally, Incontinence that occurs in situations when increased intra-abdominal pressure occurs such as coughing.

4. Giggling incontinence:

Basically, Incontinence that occurs when laughing.

Secondary incontinence usually occurs in the context of a new life event that is stressful such as abuse or parental divorce. 

The majority of cases of nocturnal primary enuresis are idiopathic; there is simply a delay in maturation of the nervous system controlling the bladder.

These children often have a family history of enuresis, as children who have either one or two parents who were enuretic have a 44 and 70 % chance, respectively, of being enuretic themselves.

There are a range of other causes of enuresis, but these are more commonly associated with secondary nocturnal or diurnal enuresis.

Common causes of nocturnal primary enuresis:

• Idiopathic developmental delay
• Genetics

Less common causes of enuresis (consider in secondary nocturnal or diurnal cases):

• Urinary tract infection

• Diabetes mellitus
• Abnormalities of the urinary tract (e.g. small bladder, vesicoureteric reflux)
• Structural abnormalities of the nervous system (e.g. spina bifida occulta)
• Chronic constipation
• Diuretics: e.g. caffeine, alcohol

• ADHD

• Learning disorders or syndromes of developmental delay
• Behavioural: being too engaged in play or ‘leaving it too late’
• Psychological: i.e. a response to bereavement, stress, abuse, or bullying
• Obstructive sleep apnoea
• Epilepsy 

Other Causes:

• Fluid intake at night.
• The bladder is irritated by the bowels.
• Inability to know if the bladder is filled.
• Urinary tract infection.
• Stress also anxiety.
• Hyperactivity in children.
• Lack of attention. 

The remedies contained in this preparation bring about an improvement in nervous and debilitated constitutions. They also have an affinity to the motor nerves controlling the bladder functions.

Calcarea phosphorica: Constitutionally indicated in the asthenic patient.

Pulsatilla: Incontinence of urine, particularly in girls.

Ferrum phosphoricum: Incontinence of urine, also during the day.

Kali phosphoricum: Nervous constitutions. General debility and weakness.

Sepia: Specific affinity to the bladder sphincter (insufficiency of). Nocturnal enuresis during first sleep. Close relationship to sexual sphere.

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What is Functional Enuresis ?

Functional Enuresis is the repeated involuntary voiding of urine, occurring after an age at which continence is usual and in the absence of any identified physical disorder.

Homeopathic Medicines used by Homeopathic Doctors in treatment of Functional Enuresis ?

• Calcarea phos
• Pulsatilla
• Ferrum phos
• Kali phos
• Sepia

What causes Functional Enuresis ?

• Idiopathic developmental delay
• Genetics
• Urinary tract infection
• Diabetes mellitus
• Abnormalities of the urinary tract
• Structural abnormalities of the nervous system
• Chronic constipation
• Diuretics: e.g. caffeine, alcohol

• ADHD

What are the symptoms of Functional Enuresis ?

• Urge incontinence
• Voiding postponement
• Stress incontinence
• Giggling incontinence

1. Psychiatry, Fourth Edition – Oxford Medical Publications -SRG-by John Geddes, Jonathan Price, Rebecca McKnight / Ch 32.

2. https://en.wikipedia.org/wiki/Enuresis