Efficacy of Causticum 200C on Children with Primary Enuresis- A Study


Dr Jyoshna Shivaprasad MD (Hom), Dr Revan B.L MD (Hom)

Abstract:

Context: Primary Enuresis is the incontinence of urine presenting beyond the bladder control age in childhood, showing negative psychological effects in children.

Aims: To study the efficacy of Causticum 200C in the treatment of Primary enuresis.

Materials and Methods: This prospective clinical study was conducted in 30 patients who were clinically diagnosed with Primary enuresis to know the efficacy of Causticum 200C over a period of 12 months attending the outpatient department of Father Muller Homoeopathic Medical College Hospital, Mangalore, Karnataka, India.

Results: From the 30 patients, 26 children showed complete relief of symptoms at the end of 12 weeks. The maximum number of patients belonged to the age group of 8-10 years, with the female preponderance and nocturnal presentation being more common.

Conclusion: Therapy with Homoeopathic remedy Causticum 200c was found to be safe and effective in the treatment of Primary Enuresis in children.

Keywords: Primary Enuresis, Children, Homoeopathic remedy, Causticum 200c

Introduction:
Primary enuresis( bedwetting) is a socially stigmatizing and stressful condition which affects around 15% to 20% of five-year olds and up to 2% of young adults.

Although there is a high rate of spontaneous remission, the social, emotional and psychological costs to the children can be great.  Enuresis or bedwetting is an extremely common paediatric problem after 5 years of age. It is often neglected and has become a potential cause of distress to the child as well as the parents. The Diurnal enuresis is seen in 5.5% of children aged 5 to 12 years and Nocturnal enuresis in 15% of children aged 5 years and 2% of those aged 15 years and more.

Some children empty the bladder involuntarily and wet the bed at an age beyond which sphincter control is normally developed when bedwetting occurs frequently it is said to be Enuresis.

Clinically two forms are recognized such as the Primary (persistent) enuresis where in the child has never been dry at night. It is usually the result of erratic bladder training either by parents who are over anxious for prompt control or those who are not reasonably close to child’s need or any chronic psychological stress not related to bladder training and Secondary (regressive) enuresis is characterized by control of bladder that later gets disturbed by stressful environmental events like conflict, death in the family, arrival of sibling or shifting to a new house. It is usually intermittent and transitory. The common cause of this is either psychological stress or organic factors like UTI, Diabetes mellitus, Worm infestation or anatomical defects.

In Primary enuresis the Homoeopathic remedy, Causticum 200C supersedes other remedies wherein it is intended to cure the patient. It not only stops bedwetting but also provides the patient, the potentials to thrive in unfavourable environment without being sensitized to it.

Materials and Methods:
In this prospective study conducted over a period of 12 months from May 2014 to May 2015, 30 patients with Primary enuresis attending the Outpatient Department of Paediatrics, Father Muller Homoeopathic Medical College Hospital, Mangalore, Karnataka, India were included. Patients or their guardians were provided with standard information regarding the study and written informed consent was obtained. The cases were analyzed and prescribed the remedy Causticum in 200C potency, 4 globules once a week till the changes were observed along with general management. Success of the treatment was judged by adopting a Enuresis questionnaire and a scoring with 0 being complete remission & 1 for no improvement in symptoms. Therapy was discontinued in patients once they showed improvement. Follow-ups were conducted on weekly basis to look for changes in the symptoms. The data were analyzed in the form of frequency, tables, and graphs.

Results:
All the 30 patients completed the study. Females (63.3%) outnumbered the males (36.6%) [Figure 1]. Age group of the affected patients ranged from 5 years to 15 years with the maximum number of cases being of those who were between 8 and 10years [Figure 2].The incidence of children belonging to different socioeconomic groups were, low socio economic ( 53.3%), middle socio economic (30% )and upper economic groups(16.6%) [Figure 3]. 26 (86.6%) children out of 30 [Figure 4] achieved complete remission of enuresis at the end of 12 weeks.4 children didn’t respond to the treatment and maintained status quo.

Discussion:
The study concludes with recommendations for further research. The findings from this study indicate that Primary enuresis among children between the 8- 10 year old age group are more prevalent as the research indicates. The results from the study participants indicated that 86.6% of the respondents presently were dealt with bedwetting behaviour. Conclusions from the study indicate a higher percentage of bed-wetting females (63.3%) and males (36.6%) in the 5 to 15 year old age group.

Nocturnal enuresis can take a toll on a child’s self-esteem and is a frustrating problem to parents. Feelings of the parents may range from worried to frustrated, sad to angry, and even tired. Children may be able to sense these feelings in parents. The response of treatment was quite good.

Limitations of the study include volunteer, or response bias as a possible influence on the validity of the results. As such, there was no way to guarantee equal size, age and gender groups. This added a limitation to the study, and could have been detrimental to the results.  Keep the sample group large. In doing so, the researcher will have a good representation of the population. As can be seen by the literature review and study findings, Enuresis is prevalent among children between 8-10 years of age. Parents should not become overwhelmed with feelings of frustration or failure due to their child’s bed-wetting. Although it is prevalent, bed-wetting is seldom a topic of conversation among parents due to the private nature of the topic and perhaps to spare the feelings of the child.

Conclusion:
The study concludes that Homoeopathic remedy Causticum 200C is very effective in Primary enuresis especially in children among 5-15 yrs of age (P value 1.60888E-14). It is an attempt to highlight the effectiveness of homoeopathic treatment with drug Causticum 200C in Primary enuresis. A thorough examination of the child by the family physician should be done to rule out any medical issues and if necessary professional counselling should be sought to help the child overcome their bed-wetting behaviour along with homoeopathic treatment.

Financial Support and Sponsorship
Father Muller Research Centre, Kankanady, Mangalore

Conflicts of Interest
There are no conflicts of interest.

Ethical approval:
Approval of institutional ethics Committee of Father Muller Charitable Institutions was obtained before initiation of the project and the procedures followed were in accordance with the ethical standards provided by Indian council of medical research, New Delhi. Informed consent was obtained from each individual before the screening of the patients. The clinical trial is registered in the ClinicalTrials.gov protocol registration system (registration number NCT02154152).

Acknowledgement:
The authors convey thanks to Prof. Dr Shivaprasad K, Principal & HOD, Organon of Medicine and Hom. Philosophy, Fr Muller Homoeopathic Medical College & Hospital and Prof. Dr Sanjeev Rai, Chief of Medical Services, Father Muller Charitable Institutions, Mangalore. Special thanks to the Rev. Fr Vincent Vinod Saldanha, Administrator, Fr Muller Homoeopathic Medical College & Hospital for his support.

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Principal Investigator, Professor, PG Guide & HOD, Department of Paediatrics & Hom. Therapeutics,  Father Muller Homoeopathic Medical College and Hospital.

Address for correspondence: Dr Jyoshna Shivaprasad
Father Muller Homoeopathic Medical College and Hospital, Deralakatte, Mangalore
Mobile: 9342231894, Email: jyoshnashiv@gmail.com

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