Dormanesh B¹. , Bayhaghi M.H.²

1. Professor of Pediatric Nephrology, AJA University of Medical Sciences, Tehran, Iran
2. MD, researcher, Tehran, Iran

Abstract

Background:

Nocturnal Enuresis (NE) refers to nighttime intermittent involuntary incontinence in a childaged five years or more (at which staying dry at night can be reasonably expected.) without any other urinary tract symptoms.

It is a is a multifactorial pathologic disease and although conditioning modalities and also some pharmacologicalinterventions are the main therapeutic strategies, parents who have a child with NE, usually suffer from this issue and take a refuge to alternative medicines to manage this disorder.

According to Iranian Traditional Medicine (ITM) and were first developed by Iranian scientists such as Rhazes, Haly Abbas and Avicenna, Nocturnal Enuresis (NE) is justifiable with a medical system based on child stemperament.

I believe we can use folk beliefs in the treatment of Enuresis, if they are not disruptive for our treatment and also not inconsistent with our religious commands (Islamic orders). So, in this study I decided to search in Medieval Persia resources and make sure we can prescribe or advise people for these traditional remedies beside other treatments.

Methods:

First of all, I searched Iranian Traditional Medicine (ITM) resources and for each of herbal remedies I looked for its mechanism. If I found a didn’t find a strong scientific support for any of them, and it was just used as a folk belief, I refused them.

In my experience, I realized Iranians especially villagers and illiterate people and also sometimes even educated persons, use Sweetbread roast for Enuresis treatment in children and I witnessed that eating sweetbread at least one time per week for 3months was effective even without medication.

In Islam eating Sweetbread is unlawful and is not a halal meat, so the next step was requesting for this opinion from 10of religious leaders (Mufti).So first I ask if it’s allowed usage for prepubertal child( boy or girl) as a treatment and if we can prescribe it as a substance in a form of a drug by extract it .

Results:

Avicenna (980‑1037 AD), the famous Iranian scientist, in his book “The Canon of Medicine” wrote that the most important cause of enuresis was “sterkha” which means loosening of external sphincter’s muscular tone due to moisture in the muscle fibers, especially on the bladder’s neck, which are important in preventing the involuntary outflowof urine. According to ITM perspective resources, children may have enuresis due to one or more of bellow reasons(table1).

1.Their temperament is wetter than adult. So anticholinergic herbal remedies, such as Alpinia galangal (Kholanjan), Quercus ilex (Baloot), Nigella sativa (Shooniz) can be effective.

2.Their sleep is deeper than adults. They believe in these children; deeper sleep is due to high humidity of their brain in compare to adults and while they grow up, the humidity in their temper becomes less. So, some herbal remedies such as Chewing on a cinnamon bark even powdered cinnamon bark once a day would be helpful due to heating bladder.

3. Immunity immaturity is another reason and in this view apple cider vinegar and Amla (boost of Vitamin C and antioxidants) can be helpful.
4. Coldness, which is the most bothersome of dismemberments, decreases the intrinsic natural power of bladder to hold urine during sleep. In this term, strengthening the bladder and heating the bladder and removing moisture from the external sphincter by oral plants Myrtus communis (Mourd) or by rubbing a hot nature oil (olive oil) into the bladder area can be effective.

strengthening the bladder and also as an astringent, tonic bladder, semi cooked sweetbread (non halal meat)can be effective.

Table 1 – Plants used by TPM practitioners to treat nocturnal enuresis

Scientific name	Traditional name	Plant Family	Used Part	Related Function	Pharmacologic action
Alpinia galangal	Kholanjan	Lamiaceae	root	Astringent/ heatingkidney	anticholinergic
Quercus ilex	Baloot	Fagaceae	fruit	Astringent/ siccative	anticholinergic
Nigella sativa	Shooniz	Fumariaceae	seed	Heating bladder/ siccative	Anticholinergic/muscle relaxant
Cinnamomum verum	cinnamon	Lamiaceae	dried bark strips	siccative	Lowering Blood Glucose & Cholesterol
Amla	Indian gooseberry	phyllathaceae	fruit	siccative	antioxidant
Olea europaea	olive	oleaceae	Fruit/oil	Heating bladder	–
Myrtus communis	Mourd	Myrtaceae	Seed /oil	Astringent/ bladdertonic	Antispasmodic/ anticholinergic

 

At the second step, about permission of sweetbread usage in prepubertal child results from 10 of religious leaders (Mufti) (table2) and at all it was as bellow:

40% for of them did not allow taking it. But 30% of them believed we can prescript it if it is necessity and rely on the necessary amount. 20% of religious leaders (Mufti) allowed it because they believe, it is not a religious duty for prepubertal children. Finally, Grand Ayatollah Shobeiri Zanjani knows it as opposite of caution.

 

Table 2- Sweetbread consumption forprepubertal child enuresis inIslam

(from the viewpoint of Iranian religious leaders)

	Sutra (religious rule)	Religious leader(Mufti)
1	Sweetbread eating is prohibited	Grand Ayatollah Golpayegani Grand Ayatollah Sobhani Grand Ayatollah Noori Hamedani Grand Ayatollah Sistani Shabestari
2	Sweetbread can be used as necessity and just as necessary amount	Grand Ayatollah Behjat Grand Ayatollah Moosavi Ardabili Grand Ayatollah Makarem Shirazi
3	Sweetbread eating has opposite caution	Grand Ayatollah Shobeiri Zanjani
4	Sweetbread eating is allowed	Grand Ayatollah Rohani Grand Ayatollah Saneie

 

 

Finally ,I asked if we can use sweetbread as a substance in a form of a drug by extract it( table3). In this way,almost all of the religious leaders permitted it , but just if it is necessity and rely on the necessary amount and 30% of them emphasized that it can use just as a form of suppository or injected drug and not oral .

Table 3- Sweetbread extract(drug) for prepubertal child enuresis in Islam

(from the viewpoint of Iranian religious leaders)

	Sutra (religious rule)	Religious leader(Mufti)
1	if the drug is unique or if in comparison to other similar drugs it has many benefits, prescription is allowed, but just if it is necessity and rely on the necessary amount	Grand Ayatollah Makarem Shirazi Grand Ayatollah Shobeiri Zanjani Grand Ayatollah Behjat
2	It is permitted	Grand Ayatollah Noori hamedani Grand Ayatollah Sobhani
3	if the drug is unique, prescription is allowed, but just if it is necessity and rely on the necessary amount and only in the form of suppository or injection drug	Grand Ayatollah Golpayegani Grand Ayatollah Sistani Shabestari Grand Ayatollah Rohani
4	It is permitted, in the lack of transubstantiation and in a form of a drug	Grand Ayatollah Saneie
5	there is no way to use it unless it is the only way for treatment.	Grand Ayatollah Moosavi Ardabili

 

Conclusion:

Enuresis in children is a multi-factorial disease and usually needs prolonged treatment, so it is better to use folk beliefs, beside our specific medical and conditioning treatment, if they are effective. On the other hand, in Islam we have a lot of religious leaders (Mufti) and we can use efficient folk beliefs in their treatment, but just if it is not inconsistent with their mufti commands.