Most effective role of Ayurveda Therapy in treating a child patient of Nocturnal Enuresis (Bedwetting) is discussed.

Introduction

Nocturnal Enuresis often called as bedwetting or sleep wetting—is more common than daytime wetting in boys above age 5 years. There are many reasons for night time incontinence. Young people who experience night time wetting tend to be physically and emotionally normal. Most cases probably result from a mix of factors including slower physical development, an overproduction of urine at night, a lack of ability to recognize bladder filling when asleep and in some cases, anxiety. For many, there is a strong family history of bedwetting, suggesting an inherited factor.

History:

An 11 year old male patient of Nocturnal enuresis visited Carewell Clinic for Ayurveda treatment. He had complaints of nocturnal incontinence since childhood. He had taken lot of treatments (in U.S too) before but nothing had helped him. He had to forcibly withdraw from social gatherings due to prolonged habit of bedwetting. He seemed to be physically and emotionally normal but had a sense of embarrassment due to bedwetting habit.

Outlook:

Prolonged nocturnal enuresis can cause anxiety and affect psychologically especially in adolescence.

Investigations:

USG abdomen and pelvis, thyroid profile, BSL, urine routine were normal ruling out structural anomalies, hormonal issues and infections.

Family history: None

Case study:

Patient visited on 03 / 08 /2016 with complaints of Bedwetting everyday post midnight since childhood and lack of sensation of fullness of bladder especially at night.

Clinical observations:

Appetite: Normal

Digestion: Normal

Motions – 1-2 times a day. Normal without constipation etc

Urine – Normal during the day without any wetting and Bedwetting only at night

Tongue: Alpasaama

Pulse: Alpasaama, madhyambala (Vata predominance)

P/ A – Non specific

Psychological aspect: Sense of embarrassment and avoiding night out with friends.

Observation: Patient avoided drinking water in the evening due to fear of bedwetting

Ayurveda diagnosis: Shayyamutrata

Line of treatment:

1. Krumichikitsa(due to Balavaya)

2. Treatment for improving the bladder capacity

3) Improving development of body's alarms in the brain that signal a full bladder or emptying of the bladder

Treatment :

1. Vishatindukvati – 1-1-1 in vyanodaana kala ( ½ hr post meals ) – Vyadhipratyanikchikitsa

2. Capsules made from Chandraprabha ,Pravalpanchamruta, Tagar(Valerianawallichii), Jatamansi(Nardostachysjatamansi), Brahmi(Bacopamonnieri), Ashwagandha (Withaniasomnifera), Vidanga(Embeliaribes), Gokshuradi Guggulu (2-2-2 vyanodana kala)

3. Krumikuthar Rasa 1-1-1 (1-1-1 vyanodanakala )

The clinical observations during the follow up are as given below:

24/ 08 / 16

1. Patient showed very little improvement

2. Digestion : Normal, Pulse – Vatapradhan

             Urine: Bedwetting still present

3. Advice given – To drink adequate water as he had stopped drinking water at night.

            Treatment: Vishatindukvati was added in the medicine

            Dietary advice: To avoid curd, oily and spicy food, junk food.

            Exercise: Kiegel’s exercise to improve bladder control

21/ 09/ 16

Bedwetting had completely stopped. Patient was happier and more confident.

Digestion: Normal

Appetite: Normal

Pulse: Nirama, madhyambala

Urine: Normal without bedwetting.

Patient is advised to continue medicines for Apunarbhava (prevention of recurrence)

 Ayurvedic perspective in treating Nocturnal Enuresis : Medicines worked in Strengthening of the bladder, Improving the body and brain co-ordination for sending signals regarding fullness of bladder,To regulate output of urine during sleep and Improving mental immunity.This proves that Chandraprabha and Gokshuradi Guggulu helps in strengthening the bladder function and urinary system. Pravalpanchamrut helps in regulating the process of urine formation.Tagar, Brahmi, Ashwagandha, Jatamansi,Vishatinduk vati helps in regulating the body - brain coordination and the signal send by brain related to fullness of bladder and timely emptying of bladder. Krumikuthar Rasa helps in preventing helminthic infestations in children which could affect or enhance enuresis.

* Ayurveda consultant, Panchakarma expert, Carewell Clinic, Basil Ayurveda and Panchakarma Centre and Nationwide Clinic, Bangalore

References of medicines:

No.	Name of the formulation	References
1	Pravalpanchamruta	Ayurved Sarasangraha
2	Chandraprabha	Bhaishajyaratnawali
3	Gokshuradiguugulu	Sharangdharsamhita
4	Vishatindukvati	Rasatantrasara
5	Krumikuthar rasa	Rasachandanshu

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