How Can A Chiropractor Help With Bed Wetting?

The majority of children and adults with this problem, known as nocturnal enuresis, tend to be withdrawn and possess very low self-esteem. This negative effect touches many aspects of their lives. They generally make few friends and do not do well in school. A bedwetter will decline offers to sleep over at a friends house or go on camping trips. The very real fear of being "discovered" by their peers would be too devastating to risk the attempt. Their academic performance may suffer as a direct result of the stress, tension, and lack of self confidence associated with this condition. All of this negativity can and will affect a child's psychological development.

Many studies and surveys have been conducted producing the following profile:

The average bedwetter is between 4 and 14 years old About 15% of children wet the bed after the age of 3 Two out of three bedwetters are boys It is common for the child to wet within 2 1/2 hours of going to sleep A bedwetter will do so 1-4 times a night, 5-7 nights a week Bedwetting may be inherited Normally, bedwetting ceases by puberty In most cases, bed-wetting is considered as just an unfortunate childhood problem, and no outside treatment is sought. The parents are frequently prepared to simply wait until the child grows out of it, and in most cases these problems go untreated.

The traditional chiropractic approach to treating the child who is a bed-wetter is to adjust the spine, usually in the area of the lumbar spine or sacrum. A review of the anatomy and physiology of the bladder may help us understand why these areas are chosen as the prime target.

The bladder

Emptying of the urinary bladder is controlled by the detrusor and trigone muscles. The nerve supply to these muscles is via the sacral parasympathetic nerves from S2 to S4.

Appropriate bladder function is also controlled by the urogenital diaphragm which derives its nerve supply from the L2 spinal nerve.

Development of the Sacrum The sacrum (or tailbone) develops as five separate segments. These segments remain separated until a child reaches puberty, at which time fusion of one sacral segment to another commences. Eventually, the sacrum will be one single bone with all five segments fused together, but this does not occur until the mid-20s.

Because the sacrum consists of separate segments during the early years of life, it is possible that misalignment of these segments can cause nerve irritation or facilitation. This nerve facilitation, especially to the area of the bladder, may be the cause of the inappropriate bladder function associated with bed-wetting.

As we have seen, the developing sacrum in the early childhood years remains highly mobile, existing as separate spinal segments. During this period, the sacrum can be subjected to repeated trauma from childhood falls and the early attempts at walking. This early trauma to the sacrum may be the major reason why bed-wetting in some patients ceases after the spine is adjusted.

Is the Spine the Cause of all Enuresis?

Adjustment of the sacral segments in the bed-wetter has an anecdotal history of effectiveness throughout the years. Recent studies, however, would appear to disagree with such claims. One such study from Australia concluded that spinal adjusting offered little help for enuresis, while another study suggested that good results could be obtained. This apparent disagreement may suggest nothing more than bed-wetting is due to several causes, one of which is spine related. Children with a spinal cause respond while those with other causes of bed-wetting do not.

The conclusion would therefore appear to be to have all children who are bed-wetters evaluated for the possibility of spinal problems as the underlying cause.

Interesting Studies

The following studies are provided by International Chiropractic Pediatric Association

Results of the present study strongly suggest the effectiveness of chiropractic treatment for primary nocturnal enuresis. Twenty-five percent of the treatment-group children had 50% or more reduction in the wet night frequency from baseline to post-treatment while none among the control group had such reduction. The post-treatment mean wet night frequency of 7.6 nights/ 2 wk for the treatment group was significantly less than its baseline mean wet night frequency of 9.1 nights/2 wk. For the control group, there was practically no change (12.1 to 12.2 nights/2 wk) in the mean wet night frequency from the baseline to the post-treatment.

Improvement was obtained after the first adjustment and remained stable. The treatment effect, i.e. change from bed wetting to non bed-wetting, in children that had never been dry was large and relatively immediate.

Examination found fixation in L3 and both SI joints, following the restoration of SI function the patient’s mother reported the patient was now aware of bladder distention approximately 30 minutes before it was necessary to void. A slight loss of bladder sensitivity occurred 4 months after the release from treatment and responded immediately to manipulation.

In 171 children suffering with enuresis, The average number of bed wettings per week was 7, while at the end of the study the average number of bed wettings per week was reduced to 4. Additionally, 1% of patients were considered "dry" at the beginning of the study, while 15.5% were considered "dry" at the end of the study.

A controlled clinical trial of 46 primary enuretic children was over a period of 14 weeks to assist in evaluating the influence of chiropractic care. Subjects were between five and 13 years of age. There were 31 in the treatment group, which received a spinal evaluation and/or adjustment at a minimum of every ten days. The remaining 15 subjects were control which came in with the same frequency but received a "sham" adjustment over an equal period of time. Chiropractic care was rendered for ten weeks, preceded and followed by a 14-day non-treatment baseline. The mean post-treatment frequency of wet nights for the treatment group was significantly less than its pre-treatment frequency; while there was practically no difference between mean pre- and post-frequency for the control group. Subjects receiving chiropractic care averaged a 17.9% reduction in wet nights for the control over the same period of time.

The patient's enuresis resolved with the use of manipulation. This happened in a manner that could not be attributed to time or placebo effect.