Nocturnal enuresis, involuntary and repeated passage of urine while asleep with daytime continence, is a frequent disorder during childhood. In some cases, it may persist into adult life. Although the condition was formerly thought to be psychogenic, studies have revealed some peculiarities of bladder physiology in enuretic sufferers. The intravesicular pressure periodically rises to higher levels and the arousal time under such conditions is delayed. Additionally, the bladder of enuretics tends to be smaller.
Enuresis usually occurs during the first third of the night, especially during stage 4 of non-REM (NREM) sleep and is preceded by a burst of rhythmic delta waves. Therefore, it is sometimes classified as a form of parasomnia. Diseases of the urinary tract, diabetes mellitus or insipidus, epilepsy, sickle-cell anemia, pathology of the spinal cord, and cauda equine must be differentiated as causes.
Tricyclic antidepressants are known to reduce the frequency of enuresis; however, they can cause significant cardiovascular or anticholinergic side effects or weight gain. Psychotherapy, behavioural conditioning and bladder training have also been successful. Acupuncture is useful with the advantages of no side effects.
Case Report
A 24-year-old woman working in a factory had a history of stressful childhood, including beatings by her alcoholic father. She recalled her urine slightly escaping during the daytime in response to the climate of fear generated by him. Her menarche was at age 13, and thereafter she became enuretic. Now, she and her boyfriend were planning to get married. She had not revealed her problem to him and was determined to stop it.
When first seen, she reported bedwetting once or more each night. The frequency per night was based on her observation of the quantity of fluid found in the bed each morning. During the day she was continent, with some bladder urgency. She had undergone neurological and urological diagnostic procedures, which revealed no peculiarities. She had been treated with carbamazepine (oral anticonvulsant and antineuralgic) and emepronium (anticholinergic drug used for neurogenic bladder) with no effect. She often felt anxious, sometimes accompanied with hand tremors, and was reluctant to take antidepressant drugs.
Acupuncture treatment was given at specific points with seirin disposable needles. Points were stimulated in the dense wave mode. Acupuncture was done twice weekly for five months.
Results
From the first night, using the bedwetting alarm, she was awakened each time the slightest amount of urine was passed. After two weeks, she began to wake up spontaneously in response to bladder distension. By the sixth week, the awakenings were 8:2 in favour of spontaneous versus alarm arousal. After five months, her awakenings were solely spontaneous. In one year, she was symptom-free.
(This study was done by Maja Roje Novak, Bauerova 21, 10000 Zagreb, Croatia) The author is Head of the Department of Acupuncture, Sir Ganga Ram Hospital, Delhi