Enuresis : Chiropractic Biophysics Patient Resources

What Is Enuresis?

Enuresis ("en-yur-ee-sis"), or “nocturnal (nighttime) enuresis” is a term used to describe bed-wetting during sleep. Wetting the bed prior to the age 6 is not uncommon. Bed-wetting is not a behavioral problem. It is not due to the child being too lazy or disinterested in getting out of bed to use the bathroom.

Who Does Enuresis Affect?

It is not uncommon for children to wet the bed up to age 6; bladder function is developed at varying ages so there is a slight variation to this. Although bed wetting is frustrating for the parents, it can be more frustrating for the young child when constant efforts are made and disappointing remarks are muttered to the child when the accidents happen.

· Boys are traditionally known to wet the bed later than girls. Research has shown that, “The overall 12-month prevalence of enuresis was 4.45%. The prevalence in boys (6.21%) was significantly greater than that in girls (2.51%).”¹

· It has also been shown that enuresis is associated with ADHD (Attention Deficit Hyperactivity Disorder).¹

What Causes Enuresis?

Prolongedbed wetting occurs for various reasons, including:

· Slower than normal development of the neurological mechanisms used to control emptying of the bladder at night. Any disruption of this neurological control can cause problems with enuresis.

· It is also known that bed wetting can also be genetic in nature, as it can historically run in families.

· Chiropractors believe that irritation to the nervous system from abnormal spinal alignment may contribute to generalized dysfunction in the body. This dysfunction may result in bed wetting (enuresis) in some cases. See Figure 2.

· Subluxation is the term that Chiropractors use to describe different types of abnormal spinal alignment. See Figure 2.

Figure 2. The brain by way of the Central Nervous System is the master control system of the body.

Information from the brain travels down the spinal cord and out through spinal nerves.
The brain makes decisions, in part, based on information it receives from the spinal nerves (and the rest of the body).
If the brain receives bad input from a Subluxated Spine (abnormally aligned) then output signals maybe interfered with.

Examination Procedures for the Diagnosis of Enuresis

Enuresis can be diagnosed based upon the patient history. In order to find out if chiropractic care may help the resolution of enuresis, your chiropractor may use a variety of diagnostic procedures. These procedures help to identify whether there is subluxation (abnormal spinal alignment) that could be causing interference with the nervous system. This interference could have an affect on the central nervous system control of bladder function. Diagnostic procedures include:

· Posture analysis,

· Palpation of the spine and surrounding tissues,

· Motion analysis of the spine and body,

· Emg equipment to assess the function of the muscles,

· X-rays,

· And several other procedures.

Common Chiropractic & Other Conservative Treatments

As stated previously, abnormally slow development or abnormal function of the nervous system can be a cause of prolonged enuresis. The spinal cord and nerve roots are important components of the central nervous system and are housed in the spine. Abnormal spinal structure, called subluxation, can cause dysfunction of the nervous system.

Chiropractic care, and specifically, Chiropractic BioPhysics^® (CBP^®) care attempts to improve the function of the body and nervous system by restoring normal structure to the spine through the use of Mirror Image^® (opposite positioning) procedures. See Figure 3 for a pediatric Mirror Image^® adjustment example.

· Mirror Image^® exercises,

· Mirror Image^® spinal/posture traction,

· Mirror Image^® and spinal/posture adjustments.

· Chiropractors also recommend dietary changes for children as well as behavior modification strategies.

Figure 3. Chiropractic BioPhysics^® Mirror Image^® Adjustment for the pelvis and legs in a pediatric case with internal rotation of the hips, legs, and feet. To 3 top row photos show a child of walking age where the feet and legs are ‘internally rotated’. This rotation is abnormal is causing the child difficult walking.

The body part (the legs and feet in this case) is placed into a corrective position,
A gentle instrument adjustment is used on areas of the spine or hips that are dysfunctional or,
A gentle Chiropractic table adjustment is used.

Common Medical & Alternative Interventions

Medications for enuresis typically include:

· DDAVP (i.e. ADH or Desmopressin), Oxybutynin chloride (an anticholinergic) and Imipramine (Tofranil)—a tricyclic antidepressant with anticholinergic properties.

· Success rates are relatively low and relapse rates are higher than desired.

· Hypnosis is an additional intervention used in the management of enuresis.²

· Moisture Alarms are audible alarms that go off when there is moisture present. These are conditioning devices that have been shown to have higher success rates and less relapses than medication.³

Chiropractic Care May Have a Positive Influence on Enuresis

Chiropractic adjustments and rehabilitation procedures offer a safe and effective means of an initial course of treatment for pediatric patients suffering from enuresis. Several research studies and review articles have shown the potential benefits of chiropractic care for improving enuresis in children. These studies range from randomized trials to case reports.^2,4,5-12 Significantly, Chiropractic BioPhysics^®(CBP^®) Technique care has promising ability to improve enuresis in children suffering from this condition.

References

1. Shreeram S, He JP, Kalaydjian A, Brothers S, Merikangas KR. Prevalence of enuresis and its association with attention-deficit/hyperactivity disorder among U.S. children: results from a nationally representative study. J Am Acad Child Adolesc Psychiatry. 2009 Jan;48(1):35-41.

2. Glazener CM, Evans JH, Cheuk DK. Complementary and miscellaneous interventions for nocturnal enuresis in children. Cochrane Database Syst Rev. 2005 Apr 18;(2):CD005230.

3. Glazener CM, Evans JH, Peto RE. Alarm interventions for nocturnal enuresis in children. Cochrane Database Syst Rev. 2005 Apr 18;(2):CD002911.

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

5. Leboeuf C, Brown P, Herman A, Leembruggen K, Walton D, Crisp TC. Chiropractic care of children with nocturnal enuresis: a prospective outcome study. J Manipulative Physiol Ther. 1991 Feb;14(2):110-5.

6. Bachman, Trent R; Lantz, Charles A. Management Of Pediatric Asthma And Enuresis With Probable Traumatic Etiology. International Chiropractic Association International Review Of Chiropractic 1995; Jan/Feb:37-40.

7. Gemmell, Hugh A. Chiropractic Management Of Enuresis: Time-Series Descriptive Design. Journal Of Manipulative And Physiologic Therapeutics 1989; 12:386-389.

8. Haselden, P; Tepe, R; Zhang, J. Chiropractic Adjustments Reduced Urinary Incontinence. Journal Of Chiropractic Education 2006; 20:113-113.

9. Langley, Cheryl. Epileptic Seizures, Nocturnal Enuresis, Add. Chiropractic Pediatrics 1994;1:22-22.

10. Marko, Richard B DC. Bedwetting: Two Case Studies. Chiropractic Pediatrics 1994; 1:21-22.

11. Sweeny, Aine DC. Resolution of Enuresis With Chiropractic Adjustments In Romania
Two Case Reports. International Chiropractic Association Review 1997; :70-74.

12. Zhang, J. MD, PhD; HAselden, P. DC; Tepe, R. PhD. A Case Series Of Reduced Urinary Tract Incontinence In Elderly Patients Following Chiropractic Manipulation. Journal Of Chiropractic Medicine 2006; 5:88-91.

Disclaimer

The primary purpose of this list of and general discussion of health conditions is to inform the public of the possibility that use of Chiropractic care may be associated with positive improvements in a variety of health conditions for patients actively undergoing Chiropractic care. Many of these symptoms require co-management and/or referrals to other health care specialists. This information is not intended, nor should it be used, to diagnose or treat any individual’s unique health condition.