Bed-wetting (nocturnal enuresis) is a common concern for many parents, and it’s an uncomfortable and inconvenient nuisance for both parent and child.

It’s normal for children to make “mistakes” while they’re learning any new skill. But at what point is wetting the bed considered abnormal? And is there anything that your chiropractor can do to help?

According to the Canadian Pediatric Society, primary nocturnal enuresis is the involuntary discharge of urine (bed-wetting) by children old enough to be expected to have bladder control - typically by the age of five. Secondary enuresis occurs when a child who has exhibited proper bladder control (for at least six months) begins again to wet the bed.1

We don’t know the cause of nocturnal enuresis. Some suggest we should look to the more pathologic causes of this disorder - a neurogenic bladder, genetic abnormalities, or other congenital issues. Other professionals, such as your chiropractor, suggest that we look to the spine for the possible cause. The anatomy and physiology of the bladder holds some clues as to why this may be the case.

How the Bladder Works

The bladder is a sac-like structure that is lined with a muscle called the detrusor. The flexibility of this muscle allows for the container to stretch when it’s being filled, and the contraction of this muscle functions to void the bladder.

The bladder empties into a tube-like structure (the urethra) connecting it to the outside world. Two sphincter muscles in the urethra keep the bladder from emptying continuously. One is the intrinsic sphincter and is located where the bladder meets the urethra. At the other end of the urethra, sits the second muscle called the extrinsic sphincter.

The function of the bladder is an impressive example of nerve-muscle coordination. As the bladder fills, stretch receptors send nerve signals to the brain, signaling that it’s time to empty the bladder. The brain interprets these signals and sends the appropriate nerve impulses back down the spine, causing certain muscles to contract while others relax. The amazing thing is that this coordination happens automatically, without a person’s need to think about it.

Luckily for us, we do have some control over this process, or we would never venture far from a bathroom! 

Our control comes in the form of the extrinsic sphincter muscle. If we feel the urge to urinate, but decide that it’s inappropriate at that time, our brain will send nerve signals causing the extrinsic sphincter to contract. As a result, we stop the flow of urine from the bladder.  Innervation of the bladder and intrinsic sphincter muscles come from two main areas of the spine – the upper lumbar and sacral portions. The nerve supply to the extrinsic sphincter is provided by the pudendal nerve, which also originates from the sacral segments.

The Chiropractic Influence on Bladder Function

Chiropractic as a profession focuses on the identification and correction of vertebral subluxations. These can be defined as misaligned and/or restricted vertebrae that can interrupt the proper flow of nerve information as it passes through the spinal cord and neighboring nerve roots. Any tissue or organ system can be affected by subluxations, as nerve supply is essential for coordinated organ function.

Given the number of times that we see our kids fall on their bums when learning to walk, run, jump and play, it’s reasonable to assume they can develop subluxations in the area of their sacrum and lower back. If these subluxations occur in an area that can irritate the nerves supplying the bladder and its associated muscles, chiropractic adjustments may be the answer.

Adjustments of these sacral and lumbar segments in children who suffer from abnormally prolonged bed-wetting has often resulted in a complete resolution of enuresis.^2-4  Other times, multiple adjustments are needed, and although improvements are noted, a complete cure is not established.4-8

If we keep in mind the multitude of factors that can contribute to bladder dysfunction, we can understand how not all children may respond favorably to chiropractic adjustments alone. However, with a significant number of children reporting a reduction of their bed-wetting episodes following chiropractic adjustments, it’s definitely worth it to have your child assessed by your chiropractor. There is a good chance that chiropractic adjustments will help. If your child is going to respond to chiropractic, your child’s problem should improve within a few visits.

Dr. Christian Guenette

www.back2health.ca

References and Sources:

1. Canadian Pediatric Society. Management of primary nocturnal enuresis. Paediatric Child Health. 2005; 10(10): 611-4.

2. Blomerth PR. Functional nocturnal enuresis. J Manipulative Physiol Ther 1994; 17: 335-8.

3. Bachman TR, Lantz CA. Managementof pediatric asthma and enuresis with probable traumatic etiology. Proceed-ings of the National Conference on Chiropractic and Pediatrics (ICA). 1991: 14-22.

4. Marko RB. Bed-wetting; two case studies. Chiropractic Pediatrics 1994; 1(1).

5. Gemmell HA, Jacobson BH. Chiropractic management of enuresis: time series descriptive design.J Manipulative Physiol Ther 1989; 12(5): 386-389.

6. Borregard PE. Neurogenic bladder and spina bifida occulta: a case report.J Manipulative Physiol Ther 1987;10(3): 122-123.

7. Reed WR, Beavers S, Reddy SK, Kern G. Chiropractic management of primary nocturnal enuresis.J Manipulative Physiol Ther 1994;17(9): 596-600.

8. LeBoeuf, et al. Chiropractic Care of Children with Nocturnal Enuresis.J Manipulative Physiol Ther 1991; 14(2): 110-115.