Pediatric Enuresis (Bedwetting)
Overview
Pediatric enuresis refers to involuntary bedwetting during sleep in children over 5 years old, occurring at least twice weekly for more than 3 months. In TCM, it is mainly caused by kidney qi deficiency with cold of the lower yuan, leading to loss of bladder control; or spleen-lung qi deficiency failing to govern the lower; or damp-heat in the liver meridian rushing down to the bladder. The disease is located in the bladder and closely related to the kidney, spleen, lung, and liver. Organic diseases such as spina bifida, urinary tract infection, and diabetes must be ruled out.
Pattern differentiation (clinical patterns)
Kidney Qi Deficiency
Bedwetting during sleep with copious clear urine, pale complexion, fatigue and weakness, aversion to cold with cold limbs, soreness and weakness of the lower back and knees, pale tongue with white coating, and a deep weak pulse.
Warm and supplement kidney qi; consolidate the bladder and stop enuresis.
Spleen-Lung Qi Deficiency
Bedwetting during sleep with frequent scanty urine, sallow complexion, fatigue and weakness, poor appetite, loose stools, susceptibility to colds, pale tongue with thin white coating, and a fine weak pulse.
Supplement and benefit the spleen and lung; raise and consolidate.
Damp-Heat in the Liver Meridian
Bedwetting during sleep with yellow malodorous urine, irritable and quick-tempered, flushed face and red lips, thirst with desire to drink, red tongue with yellow greasy coating, and a wiry slippery rapid pulse.
Clear the liver and drain heat; resolve dampness and stop enuresis.
Connections
Daily care & prevention
Establish regular voiding habits, restrict fluids 2 hours before bedtime, and wake the child for scheduled voiding at night. Avoid excessive scolding and provide psychological encouragement. Keep the lower back, abdomen, and feet warm; moxibustion at Guanyuan (CV4) and Shenshu (BL23) may be applied. Diet should be warm and nourishing, avoiding raw, cold, and spicy irritants.
When to seek medical care
If accompanied by fever, painful urination, frequent or urgent urination, or daytime incontinence, polydipsia, polyuria with weight loss, or skin abnormalities over the lumbosacral region with lower limb weakness, seek medical attention promptly to rule out urinary tract infection, diabetes, spina bifida, and other organic diseases.