Bed wetting that occurs in a child older than 4 or 5 years who has already developed bladder control is frequently related to stress. It could be jealousy of a new baby, anxiety about moving house, changing school, trouble with schoolwork, teachers, peers, upset over family discord or anything else that causes stress, over-excitement, insecurity or unhappiness. A child who wets the bed will need plenty of reassurance from parents rather than reprimanding for something they cannot help and probably find humiliating. Fear of others outside the family being aware of the problem and of the social isolation this could mean becomes a stress in itself, which can exacerbate the problem.
If a child has never developed proper bladder control, it may be that nerves and muscles governing bladder function are not yet mature enough. Once a child is over 4 years and still wetting the bed regularly there may be underlying causes that require addressing. These include structural abnormality, diabetes, chronic urinary infection, dietary deficiency (particularly of calcium and magnesium), overuse of refined foods and sugar, over-sensitivity to food additives or chemicals in drinking water or food allergy. Some children tend to wet the bed more if they get cold, so parents need to ensure they are well covered at night in bed and put extra night clothes on them if they habitually kick off the bedcovers in their sleep.
Treatment of bed wetting
• Infusions of horsetail (Equisetum arvense) St John’s wort (Hypericum perforation) or corn silk (Zea mays) can be given through the day, to soothe an irritated bladder and to encourage normal nervous control of the bladder.
• A recent Cochrane Review indicates that tricyclic antidepressants such as imipramine are effective in treating nocturnal enuresis, though have a far higher rate of relapse compared to alarm type treatments (Glazener et al 2003). St John’s Wort is an effective alternative to imipramine (Schulz 2002) and a well-established remedy for bed wetting and thus can offer a possible adjunct to treatment should behavioural and dietary measures not be effective.
• Plantain leaf tea or plantain leaf glycerite can be taken 2-3 times during the day as a general urinary tissue tonic.
• When bed wetting can be related to anxiety or stress, relaxing herbs like lemon balm, skullcap (Scutellaria laterifolia), vervain (Verbena off.) and wild oats (Avena sativa) can be added to the remedy.
• Hypericum oil can be massaged into the lower spine and abdomen when settling the child down for sleep.
• Chamomile oil can also be soothing; 2 drops of chamomile oil can be added to a teaspoon of St John’s Wort oil.
• Broad-spectrum mineral deficiencies may be involved in bed wetting, including zinc, selenium and copper. Calcium and magnesium are essential for proper nerve and muscle function and it is worth giving a child mineral and trace element supplements before bed. Sesame seeds are high in calcium and may prove helpful.
• On a psychological level children benefit from encouragement and being rewarded for each dry bed. Parental or peer pressure on the child may only serve to aggravate the problem. Giving children drinks at night should obviously be avoided.
Herbs are given to balance Vata, to strengthen the nervous system and the urinary tract.
• Shilajit is a popular remedy. For children younger than 5 years, quarter of a gram is given twice daily, mixed with milk on an empty stomach. For children up to age 15, half a gram is given twice daily. A much-used Ayurvedic formula containing shilajit is Chandraprabha. Children of about 5 years are given half a tablet in the morning and another half in the evening on an empty stomach with half a cup of milk. Children over 10 years of age can take one full tablet, twice daily with milk.
• Sesame seeds (1 tsp) are given to children to chew at night presumably for their calcium content but also because sesame is a major remedy used to balance Vata.
• A warm sesame oil massage at night followed by a warm bath can be effective in promoting good sleep and uninterrupted by enuresis.