Enuresis of Children from the Perspective of Iranian Traditional Medicine.

Enuresis is a pathologic and bothersome condition, which occurs frequently during childhood (1). Despite the numerous studies that have been conducted to clarify the cause of enuresis, only some of the risk factors for the disease have been found, because “enuresis” is a multifactorial disorder (2). Continence is the result of intact function of bladder to reserve urine during reservation phase and powerful contraction of external sphincter’s muscle on bladder’s neck in this phase. Any disturbance to these two structures (bladder and external sphincter) which cause them to not do their roles properly during reservation phase leads to urinary incontinence. According to Iranian Traditional Medicine (ITM) which is a medical system based on temperament (3), developed by Iranian scholars such as Rhazes, Haly Abbas and Avicenna (4), the leading cause of enuresis is “sterkha” means loosening of external sphincter’s muscular tone. Loose muscle cannot contract on bladder’s neck strongly so cannot prevent the involuntary outflow of urine. “Sterkha” is due to moisture in the muscle fibers of external sphincter (5). As a wool sweater loose when is wet! According to ITM perspective children are prone to enuresis for two reasons. 1) Their temperament is wetter than adult. 2) Their sleep is deeper than adults. Such deep sleep prevents them from waking to pass urine voluntarily. Deeper sleep is due to high humidity of brain in children than in adults. Upon ITM, when children grow up, the humidity in their temper becomes less. Resolution of enuresis after childhood in most cases can be evidence for the claim (1). Other cause of enuresis is bladder weakness due to dystemperament. Coldness, which is more bothersome than other dystemperaments, decreases the intrinsic natural power of bladder to hold urine during sleep. Sometimes, in addition to the detrusor muscle weakness due to coldness and asthenia and “sterkha”of external sphincter’s muscle fibers due to moisture, sharp quality of urine is also the cause of enuresis. This type of urine has its own signs including full color, penetrating odor and irritation (5, 6). According to what was mentioned, enuresis treatment is strengthening the bladder and the external sphincter by heating the bladder and removing moisture from the external sphincter (7). In addition to conservative management including