CHILDRENS BLADDER

Goswami B K

 

Perhaps with the only exception of enuresis there is no urinary disease which is found exclusively in children or which has a course of treatment different from that applicable to adults. Thus we find that the cause and treatment of all other renal conditions in children are the same as for the grown-ups and hence they do not deserve any special mention here. Enuresis could have been inserted as a concomitant of “Sleep”. But in our Materia Medica there is a number of medicines having renal symptoms particularly found in children alone. To enunciate those peculiarities we feel the need of opening a separate chapter where enuresis too will find its proper place. In this chapter we shall deal as well with other common urinary troubles of children but shall simply touch them and shall not go very deep.

As mentioned above bed-wetting is the most common urinary complaint in children and it is more amenable to our potentized drugs than to any other therapy. Thus this is one of the numerous complaints in the treatment of which homoeopathy has an upper hand.

Involuntary micturition of elderly children during sleep is known as enuresis or more commonly as bed-wetting and when it occurs during night it is called nocturnal enuresis. Sometimes this habit continues upto the age of adolescence and in some case, though rare, even adults are its victims. At about the age of three the children become big enough to understand that this is a nasty habit which they should correct, and this is also the age when they acquire a control over the bladder. Continuation of the habit any longer surely needs a proper medical treatment. Punishment or reproach will prove the worst that the parents can do to correct the habit.

Some of the probable causes of enuresis are: – (1) irritation of any kind, it may be reflex irritation from worms or from pungent foods, (2) indurated adenoids, (3) constipation, (4) tight fore-skin, (5) paresis of sphincter and (6) atony of bladder. A stone in the bladder or some nervous diseases may also be at the back of this condition. Some say that if the child sleeps on sides he does not lose the control but lying on the back is not certainly one of its causes. In any case the cause of the disease should be ascertained and given due consideration.

It has been observed that more girls than boys are its victims. In homoeopathic treatment of enuresis no auxiliary measure is necessary although abstention from taking anything liquid after sunset and waking up the child once to empty the bladder one hour after he falls asleep will facilitate thee treatment considerably. While under homoeopathic treatment one should not indulge in pungent, spicy or rich foods, this is general restriction for all patients, no matter what are the names of their complaints, and this restriction is more necessary in the case of enuresis.

Now for the treatment we should consider the constitutional remedies first as this condition is generally nothing but a symptom of some constitutional defect. Sulphur, Calcarea carb. and Tuberculinum are the remedies that almost every constitution requires in the childhood and they happen to be of super excellent benefit or enuresis. They follow well in the order they have been named. The 200th centesimal potency at intervals of a week will modify the constitution of almost every child.

Sulphur kids are warm-blooded with some eruptions on their skin; unhealthy skin. They cannot keep their feet covered during sleep and kicks off the covering. The child is very pleased with his position and possessions. In the absence of a clear-cut indication for any other drug Dr. Jahr recommends this drug in the 30th potency for a week and claims to have obtained success with very few exceptions.

Calcarea carb is the remedy for chilly kids with fair complexion, large head, open fontanelles and big abdomen. At thee first sight they will appear surprisingly healthy with a tendency to obesity, but on close examination you will find it is pseudo-plethora as those are not muscles but fat. These kids lack in childish buoyancy and would stay in any one position for a pretty long time as exertion of any kind exhaust them.

They perspire easily, especially on the head and feet, and more during sleep. Sluggishness runs all through this medicine, these children are slow to move, slow to comprehend, slow in learning to walk and to talk, slow to cut the teeth, slow to have the fontanelles filled up and they have slow formation of bone. They suffer from constipation which is, perhaps, due to their sluggish bowels.

Tuberculinum will be required when the above medicines fail though indicated and particularly if there is a history of TB in the family (inherited sycosis – Med.). These children are very susceptible to cold. We recommend it in the 200th potency not more frequently than once a week.

Cina will be indicated if there are worms. It has bulimy, dilated pupils, irritative mood, picking of nose, and during sleep grinding of teeth. Whatsoever may be the name of the disease in the treatment of children the writer always gives this remedy a consideration and believes it is worth while.

Belladonna is the remedy for plethoric children with fine complexion and light hairs, starting and twitching of limbs during sleep. According to Dr. Jahr this is the remedy for plethoric boys when Sulphur cannot stop this nasty habit.

It has been found that in the majority of these cases the incontinence occurs in the first part of the night which means that these children lose the control in their first sleep. If the mothers awake them within two hours of their sleep to empty the bladder they will remain dry for the rest of the night. Sepia, Kreosotum and Causticum are the principal remedies for this type of bed-wetting and their indications are as under:-.

Sepia children are constipated and nervous. They are indifferent to their clothes, dolls and play-things. They become afraid and nervous when told that another child of the same age will come to the house to make friendship. These children will not lose the control if they are lifted up in the first sleep to urinate. Milk does not agree, it causes constipation. Dr. Jahr advises this remedy for nervous girls when Sulphur does not act.

Causticum: the child requiring this remedy will have incontinence or urine more in winter nights than in summer months when the habit may even disappear. It has delicate skin, chronic tonsil complaint and incontinence of urine on sneezing and coughing. The urging for urination comes so suddenly that the urine escapes before the child can run to the bathroom. The Causticum child stands up to pass stools. The elderly ones will describe to have been dreaming that they were urinating in the proper place (Sep., Kreos).

Kreosotum is the remedy when it is very difficult to awake thee child (Bell.). Teeth decay shortly after their appearance.

Benzoic acid is another remedy that may be called for in the treatment of enuresis in the first sleep. Its guiding symptom is a very strong, pungent odour of urine. It smells like horse urine and is always high coloured.

In the third group let us take up the medicines suitable for chronic form of the trouble and when the urine escapes at any part of the sleep, it may be day or night.

Equisetum will be suitable when the child wets the bed every night, no matter whether he drinks water after sunset or not and whether he is roused from sleep to urinate or not. It is his very habit and no other cause can be found. The urine is pale and watery. Perhaps girls will need this remedy more often than boys. It has also nightmares and night terrors.

Chloral will be useful when the enuresis occurs in the latter part of the night. Like the preceding remedy it has the symptom of wetting the bed even if the child does not take water in the night and is lifted from sleep to urinate.

Ferrum metallicum will be indicated for anaemic children who flush often on slightest excitements.

The special features of some other possible remedies are given below:-

Phosphoric acid:- Great indifference to surroundings. The urine leaves a milk-white mark when dries up (Cina, Cal-c.). The child dreams of urination.

Silica child urinates too often when nervous. It is useful after Belladonna.

Pulsatilla is suitable for timid and touchy girls who weep very easily. It has also involuntary dribbling when coughing. Thirstlessness with dry mouth it its characteristic peculiarity.

Plantago may be suitable for those children who suffer from toothache and earache every now and then.

Rhus tox. is another remedy suitable for rheumatic subjects. These children cannot stay long in any position and move constantly which relieve their pains. The urine is turbid, high colored and scanty. These children lie on their back during sleep which is also profound.

Hyoscyamus child is very unreasonable in his talks and behaviour. To smile or to repeat the last word of your questions before he answers is a very strong indication of this drug. Twitching of muscles during sleep is very prominent in this remedy. The child starts up in sleep.

Lycopodium will be the remedy if sediments like brick-dusts are found on the diaper. The child, on waking from sleep, becomes very cross and kicks at them who happen to be on his bed.

Five drops of tincture Lycopodium in a little water is claimed to have worked like a specific.

Nux vomica will be suitable for those who are in the habit of taking patent medicines, too much tea or spicy foods. The child is peevish and constipated. The urine dribbles due to paresis of bladder.

Magnesia phos. has nocturnal enuresis from nervous irritation. The urine is pale and copious. Try 3x or 6x trituration.

Argentum nitricum children are afraid to go to a crowded place and of strangers. It will benefit more if the child is very fond of sugar and sweet things which do not suit him and bring diarrhoea.

Gelsemium has copious pale, watery urine. The child urinates too frequently if he has to go out. Nervous children who are afraid of strangers and crowds. The Gels. kid is a chilly subject and gets frequent attacks of spasmodic sneezing. Thirst is never prominent in Gels. patients.

Note:- Sepia is the most frequently indicated remedy for enuresis in first sleep, next comes Causticum and then Kreosote.

For spasmodic enuresis think of Arg. nit. first and Gelsemium next.

For dreaming of urination consider Caust., Sep., Kreos., and Phos-ac. The first two merit greater than the other two.

When the child wets the bed every day consider Ferr-met., Bell., Caust and Equisetum in the order they have been named.

The next common urinary complaint for which the parents bring their wards to us is painful micturition. For this trouble Borax is the most frequently indicated remedy (for adults-Canth.) and fear of falling down leads to its application. The child cries before urination. Lycopodium is indicated if deposits of urates are found on the childs diaper. Sarsaparilla also has strangury associated with deposits of sands on the childs diaper. Under this drug the child cries before and during micturition.

Marasmus of children, summer boils and a history of eruptions after vaccination will further guide to its choice. All these three drugs have painful urging for urination and the child cries until the flow is established. But in Sarsaparilla alone the cry i.e. the pain continues until the flow is concluded. Nux vomica is another medicine for painful urging and its leading features have already been described under enuresis.

Another renal trouble of children is ischuria although it is not so common as the preceding two complaints. If this condition is brought from an exposure to cold, particularly dry cold, then Aconite will be sufficient. It has fever, restlessness, unquenchable thirst and dry skin. The child has the urging but nothing comes out. Gelsemium is another remedy having dysuria from an exposure to cold but the condition develops slowly and not soon after the exposure as in Acon. The fever of Gelsemium is also milder and drowsiness is always its predominant symptom. It lacks thirst and restlessness of Aconite.

Dulcamara will be indicated if the retention is from an exposure to damp cold weather. All these three remedies are also suitable for a paralytic condition of the bladder or of the sphincter and so is Causticum which may be tried if any of the previous ones fails to reach so deep. Apis mel. is the remedy if there is oedematous swelling of eyelids, more particularly the lower.

It has sudden piercing pain in the ureter as will be indicated by sudden shrieks of the child. The child sits to urinate but only a little dark colored urine comes out drop by drop. Opium will be required when a soporous sleep predominates. It is also suitable for retention of urine after fright. Benzoic acid will be useful if the urine has very strong odor. Other possible medicines are Bell., Copaiva, Nux-v., Puls., etc.

For ineffectual urging think of Aconite first and then Lycopodium. Apis may also be required in some cases for this condition.

Remember:-.

Petroselinum is the first medicine for sudden urging for urination and next comes Kreos. or Sepia. Phos-ac and Sulph also have this symptom.

Petroselinum is the first medicine for sudden urging for urination and next comes Kreos. or Sepia. Phos-ac and Sulph also have this symptom.

Petroselinum has another peculiar symptom, the child gets the urging suddenly and if he is not allowed to empty the bladder immediately a severe pain ensues which makes him jump about up and down.

Aconite has a similar peculiarity. Though the urging is not sudden like the former but each time the boy feels the urging he will grasp the genital and cry. For painful urging there are several medicines but to hold the genital every time before urination can be found only in this remedy.

Under Mercurius sol also we find that the child frequently puts his hand on the genital, perhaps it is due to some irritation or a pricking sensation in the urethra, may be a mere feeling of uneasiness there. Whatsoever may be the reason this symptom is an indication of Mercurius and Mercurius will correct this habit.

For calculi think of Benz-ac., Calc-c., Canth., Lyco., and Sepia. But for brick dust sediments in urine Lycopodium is the best remedy.

For copious or increased urination think of Arg-n., Kreos., Merc., Nat m., Nat-s., Phos-ac., Puls., and Sulph.

And when the quantity of urine is diminished consider Apis, Equis, Graph, Hell., Merc-sol., Nat-s., Op., and Sep.

Natrum mur. has both copious flow of urine with inordinate thirst. But it has two great peculiarities. The quantity of urine voided is greater than the quantity of water taken and great thirst inspite of increased ptyalism.

Apis mel. is just the reverse of the preceding two remedies. Both thirst and urine are greatly diminished, sometimes totality absent, under this drug.

Sarsaparilla has a strange symptom worth remembering. Adults requiring this drug has no pain before or during urination but the pain comes only on the conclusion of the flow; but in the case of children it produces the opposite symptom; the pain arises before the urination, remains as long as the flow continues, and ceases only with the cessation of the flow.

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