Bedwetting or Nocturnal Enuresis

May 1, 2013 by
Filed under: Case of the month, Cases, Spinewave Bulletin, Symptoms 

bedwetting nocturnal enuresis chiropractorNocturnal enuresis means uncontrolled urination at night after the age of 5 years.

This article highlights brain-based reasons for bedwetting, outside of pathological conditions such spina bifida, kidney disease or urethral obstructions. It’s for the parents who have already tried alarm clocks, reduced fluid intake before bed time, done reward charts, watched their child go to the toilet before bed or may have even considered medication.

There are 2 types of nocturnal enuresis: 1. The child who has never been dry for more than a few months at a time (primary nocturnal enuresis); and 2. The child who has been completely dry for more than 6 months and then starts to wet the bed again (secondary nocturnal enuresis).

In the context of brain-based bedwetting, the mechanisms for either would be similar, and would generally respond favourably to chiropractic care.

The 3 commonalities in a child with brain-based bedwetting are as follows:

  1. A child who is sensitive in nature or has experienced recent emotional events.
  2. A child with poor sleep rhythms – disturbed, restless, or very deep sleep.
  3. A child displaying retained primitive reflexes (see below).

Sleep disruptions in children are usually a normal symptom of central nervous system development but enuresis might be sign of immaturity of the sleep mechanism. Sleep is coordinated by the brain, its emotional centres, the circadian cycle and hypothalamus, the brainstem and autonomic nervous system. It’s a complex overlay of multiple controls, which is why there is never one straight forward answer.

The autonomic nervous system is the arm of the brainstem that controls all natural functions without one’s conscious control. The sympathetic nervous system is essentially the fight/flight response and the parasympathetic nervous system controls feelings of relaxation. Both branches of the autonomic nervous system must be in balance for the bladder to function efficiently.

The ability to voluntarily inhibit urination develops by the age of 2–3 years, as higher levels of control in the brain develop (about the time of potty training). The urge to urinate is controlled by the sympathetic nervous system and the actual act of urinating is controlled by the parasympathetic nervous system. This is called the micturition reflex, illustrated in the video below.

Studies have shown that there is hyperactivity of the parasympathetic nervous system in bedwetters1,2, meaning they are more likely to void the bladder. This is essentially what brain-based chiropractic care is aimed at: Firstly, balancing the two arms of the autonomic nervous system (sympathetic and parasympathetic) and, secondly, coordinating better reflexes from the brain and brainstem.

Sometimes through emotional upset or sub-optimal nervous system development, children might retain certain newborn reflexes they were supposed to lose in the first year of life. Retention of these reflexes does not mean the child has a brain pathology, it simply means the brainstem has more control over certain functions, like voiding the bladder, than it should. This is because reflexes are looped from the bladder to the brainstem and back down again. The brain monitors this whole process, but if the child is emotionally upset or enters a deep, deep sleep for too long, then normal control of the brainstem is altered. The autonomic nervous system will exhibit sympathetic failure (leading to high parasympathetic tone). One will see newborn or primitive reflexes start to emerge again, control of the bladder will be disturbed, and the child will continue to wet the bed.

Other symptoms one might notice with retained primitive reflexes and bedwetting are: being really fidgety, having difficulty concentrating or remembering things in the short term, or as a baby having difficulty with rolling.

Brain waves and circadian cycle overlay the autonomic nervous system, and if a child tends to be in long periods of stage 4 sleep, exhibiting long lasting rhythmic slow waves, then he or she is more likely to wet the bed3.

Stage 4 is a deep sleep that usually only lasts for approximately 30 minutes. Bed wetting and sleepwalking are most likely to occur at the end of stage 4 sleep. As the reflexes and autonomic nervous system are improved with the right tools, the child should also enter more appropriate sleep cycles.

Adjusting the spine in specific places, coupled with special brain exercises, can help with emotional control, sleep rhythms, and retained primitive reflexes.

sleep-cycle-bedwetting-chiropractic

“I am a nine year old boy. I used to wet my bed every night. It made me feel bad. I couldn’t go on sleepovers. Dr Neil helped fix the light switches in my spine. Now I don’t wet my bed anymore. Dr Neil is helpful and kind. I feel happy.”

My son has had an ongoing problem with bedwetting. For the last three years, I’ve been getting him out of bed at around 10pm or 11pm at night to go to the toilet, but this only works about half the time. We also tried a bedwetting alarm without success. I never made a fuss of it, thinking he would grow out of it and that it was related to him being such an unusually heavy sleeper. However, now he is nine years old, he is really troubled by it. He is aware that his younger brother and his friends don’t have the same problem and as he said “pull-ups aren’t cool when you are 9”.

He is very reluctant to go to friends’ houses for sleepovers and was getting very worried about a school camp later in the year. After doing some research on the internet, I stumbled across some interesting links between bedwetting and chiropractic treatment. I also read a case study by another of Dr Neil Bossenger’s patients. My son and I discussed it and agreed chiropractic might be an interesting thing to try so we scheduled an appointment with Neil.

From the first phone call, I found Neil and his assistant Pip to be very approachable and friendly. They also have a great understanding of customer service, from the “welcome” note they had waiting for us on our first visit, to Pip’s stash of lollipops that get raided at the end of each visit! I really appreciate how Neil has gone out of his way to make my son feel relaxed, informed and an active participant in his treatment process.

Neil emphasised from the outset that he takes a holistic approach. Now near the end of the programme, we are amazed at the difference across many aspects. My son is not wetting the bed anymore which is great, but in addition to that, he now has a more natural sleep pattern and wakes up looking refreshed and relaxed instead of being constantly tired. His focus and concentration at school has improved too. Most importantly, his whole outlook on life has changed. Instead of being a boy with the heavy burden of an embarrassing secret, he is now lighthearted, confident, outgoing and feeling like he is control of his life – it’s such a pleasure to see.

I am immensely grateful to Neil and Pip and am busy recommending them to everyone I know!

© Dr Neil Bossenger 2013

References:

  1. Yakinci, C., et al. Autonomic nervous system functions in children with nocturnal enuresis. Brain Dev. 1997. Vol.19(7):485-7. Turkey.
  2. Fujiwara. J., et al. Evaluation of the autonomic nervous system function in children with primary monosymptomatic nocturnal enuresis-power spectrum analysis of heart rate variability using 24-hour Holter electrocardiograms. Scand J Urol Nephrol. 2001. Vol.35(5):350-6. Japan.
  3. Inoue M., et al. Rhythmic slow wave observed on nocturnal sleep encephalogram in children with idiopathic nocturnal enuresis. Sleep. 1987. Vol.10(6):570-9. Japan.

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