Patient's question:
I need traditional Chinese medicine treatment. Are there any good traditional Chinese medicine formulas for this?Doctor's answer:
Urinary incontinence and the nervous regulation system—namely the cerebral cortex, brainstem, and primary micturition centers in the spinal cord, as well as the autonomic nerves that innervate the bladder and urethra, such as the vagus nerve, hypogastric nerve, pelvic nerve, and sacral nerve. Due to delayed functional development of the brain and brainstem, weakened control over the spinal cord's primary micturition center, or obstructive lesions in the spinal cord or neural pathways, the control of the bladder and urethra becomes impaired, leading to enuresis.(2) Urinary incontinence and the bladder—due to delayed functional development of the bladder, it cannot safely exercise autonomous control, resulting in uninhibited contractions during the storage phase, leading to a small bladder capacity, high sensitivity, and poor compliance. The perception of bladder filling and contraction is impaired, with stimulation intensity below the sleep-wake threshold in the cerebral cortex. Abnormal functioning of bladder pressure receptors fails to provide warning signals, causing enuresis before the individual awakens.
(3) Urinary incontinence and the urethra—incomplete closure of the urethral function, i.e., unstable urethra causing enuresis; urethral malformations such as congenital stenosis.
(4) Urinary incontinence and sleep-wake dysfunction—delayed development or dysfunction of sleep-wake function is a major factor or cause of enuresis. The dysfunction may result from impaired perception of bladder filling and contraction or excessive fatigue leading to deep sleep, or from incomplete bladder function or delayed development.
(5) Urinary incontinence and reduced antidiuretic hormone (ADH) secretion—normal ADH secretion is lower during the day than at night (1:2.5), with urine volume inversely correlated with ADH levels (daytime to nighttime urine ratio of approximately 3–4:1). In some enuretic children, insufficient nighttime ADH secretion (1:1.4) leads to increased nighttime urine production, producing diluted urine, exacerbating bladder burden, and causing enuresis.
(6) Urinary incontinence and genetics—about 30–40% of enuretic patients have a family history, with studies suggesting polygenic inheritance. The probability varies by ethnicity and region. The incidence rate is 77% among children of enuretic parents, 44% among children of one enuretic parent, and only 15% among children with no enuretic parents.
(7) Urinary incontinence and psychological, mental, and behavioral abnormalities—sudden psychological stress, such as fear, shock, rage, sadness, severe mental depression, and behavioral abnormalities, as well as disorientation, can all cause enuresis. These factors may also become persistent or chronic enuresis in children and adults.
(8) Urinary incontinence and diseases—diseases causing enuresis originate from multiple systems, including organic, inflammatory, metabolic, and traumatic causes. Common neurological diseases include epilepsy, encephalopathy, brain tumors, cerebrovascular diseases, multiple sclerosis, spinal cord inflammation or tumors, bleeding, meningocele, and lumbar/sacral spina bifida. Urological diseases include malformations (urethral stenosis, meatal stenosis, hypospadias, urethral valves, bladder neck obstruction, and phimosis in males), inflammation (nephritis, pyelonephritis, cystitis, urethritis, balanitis), stones, and kidney damage. Other diseases include chronic diarrhea, abdominal pain, persistent respiratory or pulmonary diseases, ectopic posterior pituitary, hypophyseal, or renal diabetes insipidus, diabetes, severe anemia, hypercalcemia, hypokalemia, and habits such as masturbation or inertia. Other conditions include sleep apnea and allergies.
(9) Urinary incontinence and zang-fu organ function—Traditional Chinese Medicine (TCM) believes that enuresis is related to the underdevelopment of zang-fu organ function, such as delayed bladder development and weakness, particularly in the spleen, kidneys, and lungs. The kidneys are the root of human life, known as the "foundation of congenital essence," storing essence, governing development, reproduction, marrow production, and brain connection. The kidneys are paired with the bladder, and sufficient kidney yang warms the bladder, promotes qi movement and fluid transformation, ensuring proper bladder retention and opening. Deficient kidney yang leads to declining life gate fire, excessive yin, resulting in "exhaustion of the lower burner causing incontinence." Deficient kidney qi may cause cardiac-kidney fire intersection, leading to cardiac dryness and irritability. Kidney qi deficiency also weakens bones, impairing marrow production and brain function, resulting in slow growth or obesity without strength, low intelligence, and clumsiness.
Spleen deficiency enuresis—The spleen is the "foundation of acquired essence" and the source of qi and blood. Robust spleen yang can regulate water metabolism, promote clarity and eliminate turbidity. Deficient spleen yang reduces gastric motility, prolongs gastric emptying time, lowers gastric secretion, and decreases amylase production, leading to poor appetite, impaired digestion, and insufficient qi and blood production to nourish the congenital essence, causing kidney and bladder weakness and enuresis.
Lung deficiency enuresis—The lungs govern qi and are the source of upper water. They have the functions of dispersing and descending. Lung qi deficiency impairs these functions, causing fluid to flood and the bladder to lose control. Lung fire inflammation may scorch yin fluids, preventing fluids from descending, leading to lower burner heat, dry stools, bladder dampness, short urine output, and retained phlegm dampness, causing enuresis during deep sleep when the individual is unresponsive.
Liver channel damp-heat enuresis—Liver channel damp-heat or internal fire forcing the bladder to lose control.
(10) Besides genetic factors and spina bifida or occult spinal dysraphism, the most important factor or cause of enuresis in children is unscientific urination training by parents. Unscientific training includes:
1. Over-calling or catheterizing the child during non-bladder filling periods.
2. Not calling or catheterizing during bladder filling periods, such as prolonged use of diapers or pads.
3. Scolding or punishing the child after bedwetting.
Scientific urination training remains a crucial measure in treating pediatric enuresis.
Clinical Guidance: Based on the above classification, Western medications should be selected according to syndrome differentiation:
1. Imipramine—Not recommended for frequent use in children due to underdeveloped brain nerves.
2. Oxybutynin ()—Reduces bladder pressure, increases capacity, and reduces involuntary bladder contractions. Oral 2.5–5 mg before bed is suitable for nocturnal enuresis.
3. Ephedrine—Oral 25 mg before bed increases bladder neck and posterior urethral contraction while stimulating the central nervous system. Suitable for mixed enuresis.
4. Desmopressin ()—A synthetic antidiuretic hormone. Oral 0.2–0.4 mg before bed is suitable for nocturnal polyuria.
Combining amitriptyline, desmopressin, and oxybutynin is currently considered an effective triple therapy for refractory mixed enuresis, with a 3-month course. Advantages include efficacy close to the SNM method, but disadvantages include varying degrees of side effects and recurrence after discontinuation.
These medications are prescription drugs. Imipramine and amitriptyline are antidepressants, and the dosages listed are for adults. Children should be dosed per kilogram of body weight.