Bedwetting is a problem we know well. Technically called “nocturnal enuresis”, it occurs when a child is old enough for the bladder to be neurologically and physically developed to the point the child can remain dry at night. But according to the data, about 8% of children suffer from bedwetting past this point. The prevalence is thought to be higher in boys (10.7%) than in girls (5.4%) though the reason for this is unclear. This can be further broken down according to age, with as many as 15% of seven-year-olds affected by the condition. But even in adolescence, some 2% of individuals are affected. [1, 2]
Anecdotal evidence and case report data has shown that bedwetting improving or resolving under chiropractic care isn’t uncommon, but mechanisms behind this improvement remain unconfirmed. A recent study published in the Asia Pacific Chiropractic Journal looked at nocturnal enuresis in three children who shared similar physical presentations. The case series presented some novel considerations for clinicians caring for those who suffer from the condition.
But before we get to the particulars of the case, some interesting findings were pointed out by the author. Studies into nocturnal enuresis show [2]:
- That the condition can have psychological impacts – a fact which should be unsurprising.
- While some kids will “outgrow” the condition (properly called “spontaneous remission”), it can have a lasting effect on self-esteem.
- Some cases have been associated with circadian rhythm issues, especially with arginine-vasopressin.
- Others have been associated with airway compromise, dental growth, or developmental issues.
- There appears to be an interrelationship between ADHD and nocturnal enuresis in that it appears to persist for longer in ADHD sufferers.
The author aptly noted that it is important to consider all possible underlying pathologies in order to them out prior to commencing care. These should include bladder dysfunction, infection, neurological conditions, anatomical abnormalities and polyuria. All this being the case, three cases with remarkable similarities presented to a chiropractic clinic and symptoms reduced concomitant with chiropractic care.
The Cases in the Series
The case series involved a seven-year-old girl, a seven-year-old boy and a ten-year-old boy. While the individual birth circumstances, environmental stressors and individual allergic presentations differed from child to child, the chiropractor noticed “they had very similar postural, muscle, neurological, physiological and SOT [Sacro-Occipital Technique] findings.
The full examination findings are detailed in the original case report (referenced below – 2). However, they included [2]:
- Decreased right psoas and left lower core (transverse abdominus) muscle strength relative to the contralateral side with weakness and 4/5
- Signs of a persisting positive Spinal Galant reflex (which causes babies to curve their hip outwards if they are stroked in the lower back region next to the spine.
- Large right thoracic translations
- Subluxations found at C2, T11/T12, L3, L4 and sacrum
- Findings consistent with Kidney Ptosis (where the kidney shifts more than two vertebral bodies during a position change from side lying to upright)
All three began a care plan comprising two visits per week for three weeks. All three were adjusted using SOT techniques, and pre-blocking techniques including kidney ptosis and psoas correction. All had their subluxations adjusted as indicated. Home care recommendations including increasing vitamin C and managing stress.
At the three week re-examination, all three children were now within normal limits, with significantly improved posture, absent spinal galant reflex, and a significant reduction in bedwetting.
It should be noted that, in addition to the SOT technique, the chiropractor also used Chiropractic Manipulative Reflex Technique, which is “based on the premise that chronic somatovisceral and viscerosomatic aberrant reflexes will adversely affect the function of the nervous system and perturb the vertebral subluxation complex.” [2] Simply put, reflexes to and from the brain, when they go awry, will impact subluxation. Put even more simply, structure dictates function, and the return of proper structure (as indicated by a reduction in subluxation and improvements in posture) may have preceded the improvement in function.
It’s a concept that requires further investigation before we can make strong claims about it. Until such a time as a study like this is done though, keep an eye out for similar findings in your bedwetting patients. You never do know…
References:
Bakhtiar, K., Pournia, Y., Ebrahimzadeh, F., Farhadi, A., Shafizadeh, F., & Hosseinabadi, R. (2014). Prevalence of nocturnal enuresis and its associated factors in primary school and preschool children of khorramabad in 2013. International journal of pediatrics, 2014, 120686. https://doi.org/10.1155/2014/120686
Walker R. Sacro Occipital Technique (SOT) Chiropractic and Nocturnal Enuresis in Children: A report of three cases. Asia-Pac Chiropr J. 2023;4.1. URL apcj.net/papers-issue-4-1/#WalkerEnuresisx3
