Patient's question:
I need traditional Chinese medicine treatment. Are there any good herbal formulas for treating this?Doctor's answer:
Urinary incontinence and the nervous regulation system—i.e., the cerebral cortex, brainstem, and primary micturition centers of 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 development of brain and brainstem functions, weakened control over the spinal cord's primary micturition center, or obstructions in the spinal cord and various nerve pathways, the control of the bladder and urethra becomes impaired, leading to enuresis.(2) Urinary incontinence and the bladder—Due to delayed development of bladder function, the bladder 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 for the cerebral cortex. Abnormal function of bladder baroreceptors, which fail to provide warning signals, also contributes to enuresis before the individual awakens.
(3) Urinary incontinence and the urethra—Incomplete closure of the urethral function, caused by unstable urethra, leads to enuresis. Urethral malformations, such as congenital stenosis, are also contributing factors.
(4) Urinary incontinence and sleep-wake dysfunction—Delayed development or dysfunction of sleep-wake function is a major or one of the primary causes of enuresis. The dysfunction may result from impaired perception of bladder filling and contraction or excessive fatigue leading to deep sleep. It can also be caused by incomplete bladder function or delayed development.
(5) Urinary incontinence and reduced secretion of antidiuretic hormone (ADH)—In normal individuals, ADH secretion is lower during the day than at night (1:2.5), and urine volume varies inversely with ADH levels (daytime-to-nighttime urine volume ratio of approximately 3–4:1). Some enuretic children have insufficient nighttime ADH secretion (1:1.4), leading to increased nighttime urine volume, dilute urine, and increased bladder burden, resulting in enuresis.
(6) Urinary incontinence and genetics—Approximately 30–40% of enuretic patients have a family history, with research suggesting polygenic inheritance. The probability of occurrence varies by race and region. The incidence rate is 77% among children of enuretic parents, 44% among children of one enuretic parent, and only 15% among children of parents without enuresis.
(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—Enuresis can be caused by diseases from multiple systems, including organic, inflammatory, metabolic, and traumatic conditions. 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 conditions, 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, weak function, and deficiencies in the spleen, kidneys, and lungs. The kidneys are the root of life and are known as the "primordial foundation," storing essence, governing development, reproduction, marrow production, and brain function. The kidneys are paired with the bladder, and sufficient kidney yang warms the bladder, promotes qi movement and water transformation, ensuring proper bladder retention and opening. Deficiency of kidney yang leads to declining "mingmen fire," excessive yin, resulting in "exhaustion of the lower burner" and enuresis. Kidney qi deficiency may cause heart-kidney fire intersection, leading to heart dryness, irritability, or bone weakness. Insufficient kidney qi impairs marrow production, affecting brain health, growth, and intelligence.
Spleen deficiency enuresis: The spleen is the "" (postnatal foundation) and the source of qi and blood. A healthy spleen yang can regulate water metabolism, promote clarity, and eliminate turbidity. Spleen yang deficiency 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 to nourish the kidneys and bladder, resulting in enuresis.
Lung deficiency enuresis: The lungs govern qi and are the source of upper water metabolism, with functions of dispersing and descending. Lung qi deficiency impairs these functions, causing fluid to flood the bladder and lead to enuresis. Lung fire rising may scorch yin fluids, preventing fluids from descending, leading to lower burner heat, constipation, bladder dampness, short-term urination, and enuresis due to retained phlegm-dampness, deep sleep, and unresponsiveness to calls.
Liver channel damp-heat enuresis: Liver channel damp-heat or internal fire forcing the bladder to empty uncontrollably.
(10) In addition to genetic factors and spina bifida or occult spinal dysraphism, the most important factor or cause of enuresis in children is the lack of scientific urination training by parents. Unscientific urination training includes:
1. Over-calling or catheterizing the child when the bladder is not full.
2. Not calling or catheterizing the child when the bladder is full, such as prolonged use of diapers or.
3. Scolding or punishing the child after bedwetting.
Scientific urination training remains a crucial measure in treating pediatric enuresis.
Treatment recommendations: Based on clinical classification, Western medications can be selected as follows:
1. Imipramine: Not recommended for frequent use in children due to underdeveloped central nervous system.
2. Oxybutynin (): Lowers bladder pressure, increases capacity, reduces involuntary bladder contractions. Oral 2.5–5 mg before bed is suitable for diurnal 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 enuresis.
Combining amitriptyline, desmopressin, and oxybutynin is currently considered an effective triplet therapy for refractory mixed enuresis. A 3-month course has an efficacy similar to SNM therapy but may cause side effects and relapse after discontinuation.
These medications are prescription drugs. Imipramine and amitriptyline are antidepressants, and the dosages listed are for adults. Children should be dosed based on body weight.