Reviewed: Sharifi H, Minaie MB, Qasemzadeh MJ, Ataei N, Gharehbeglou M, Heydari M. Topical use of Matricaria recutita L (chamomile) oil in the treatment of monosymptomatic enuresis in children: a double-blind randomized controlled trial [published online September 30, 2015]. J Evid Based Complementary Altern Med. doi: 10.1177/2156587215608989.
Monosymptomatic enuresis is defined as urinary incontinence in children who have no other lower urinary tract symptoms and no history of bladder dysfunction. Pharmacological treatment includes drugs such as tricyclic antidepressants, anticholinergics (drugs that inhibit the action of the neurotransmitter acetylcholine), and desmopressin (an antidiuretic drug), which can often have adverse effects. Because of this, complementary and alternative medicines are being investigated to treat enuresis in children. Chamomile (Matricaria recutita, Asteraceae) flowers are used in traditional Persian medicine to treat children with enuresis.
The goal of this double-blind, placebo-controlled, randomized clinical trial was to evaluate the efficacy and safety of a traditional preparation of chamomile oil in children with monosymptomatic nocturnal or daytime enuresis.
The authors evaluated, for eligibility, 125 patients attending the Pediatric Clinic of Golpaygani Hospital at Qom Azad University in Qom, Iran, between March 2014 and August 2014. The patients had been diagnosed with monosymptomatic nocturnal (patients aged seven and older) or daytime (patients aged four and older) enuresis. Eighty patients were chosen and all completed the study.
Chamomile flowers were purchased from a local herb shop and verified by a botanist at the Herbarium Center of the University’s School of Pharmacy. Following traditional preparation methods, the dried chamomile flowers were ground, macerated in water for 24 hours, and decocted for 30 minutes. The resulting extract was boiled in sweet almond (Prunus dulcis, Rosaceae) oil until water was evaporated. Sweet almond oil was used as the placebo for the study. The patients’ parents were instructed to apply six drops of the chamomile-infused oil (n = 40) or the placebo (n = 40) topically on the perineal and suprapubic area of the children once nightly.
Patients were evaluated at baseline and after two, four, and six weeks of treatment. The data of one patient in the chamomile group and three in the placebo group (who consumed drugs that were not included in the study protocol) were analyzed in their respective groups according to the intention-to-treat analysis protocol. The chamomile group included 24 (60%) boys and 16 (40%) girls; in the placebo group were 29 (72.5%) boys and 11 (27.5%) girls. The mean age of the chamomile group was 9.52 ± 1.88 years, and the mean age of the control group was 9.90 ± 2.51 years.
In the chamomile group, the mean frequency of enuresis decreased significantly at two, four, and six weeks (P < 0.001 for all time points) compared with baseline. Compared with the control group, the changes in the chamomile group were significantly greater at two (P < 0.001), four (P = 0.03), and six (P < 0.001) weeks. No significant correlation was seen between age and frequency of nocturnal enuresis after six weeks, and no significant differences were seen in outcome between girls and boys.
Although five parents complained about the greasy nature of the chamomile oil, no adverse effects were reported.
In this study, the mean frequency of enuresis in the chamomile group was significantly lower than in the placebo group at all measured time points. The authors attribute the observed effects to the spasmolytic and anticholinergic activities of chamomile’s active constituents, and conclude that chamomile should be considered as a potential complementary treatment option for children with monosymptomatic enuresis. Admitted limitations of the study include the short duration of follow-up, absence of a standard treatment group as a reference control, and the lack of examination of the recurrence rate after discontinuing the treatment.