Bedwetting (aka enuresis) is an embarrassing and difficult problem for a child. His self-esteem may suffer. Sleepovers can be torture, and even thinking about going away to Grandma’s or to summer camp can create a tremendous burden for the child who wets the bed. Bedwetting is also a distressing problem for parents concerned about their child’s well-being.
What Causes Bedwetting?
It is important to understand that bedwetting is not bad behavior. It is not intentional, and it is not the child’s fault. If you have a child who west the bed, please remember that this child deserves your thoughtful attempts to help resolve this problem.
Bedwetting is the most common childhood urinary complaint affecting are an estimated 5 to 7 million children. Boys are twice as likely to be affected than girls. The typical child who wets the bed has a small or immature bladder. Because he is unable to hold urine through the night, he consistently has “wet” nights.
There are also children who once had bladder control but have lost it. This type of bedwetting is likely to be related to either emotional or organic problems. Emotional causes include stressful or scary situations, such as a move to a new house, the birth of a new baby in the family, or parental separation. Such stresses may cause a child to regress to an earlier pattern of behavior. Bedwetting due to stress is usually temporary. Organic problems include urinary tract infections, which can irritate the urethra and bladder and interfere with normal functioning; obstructive lesions of the urinary tract, and spinal disorder that interfere with sensations and voluntary control of the bladder. Children with diabetes or sickle-cell disease may have difficulty concentrating their urine and typically urinate larger amounts, sometimes to the point of wetting the bed at night. A food allergy or sensitivity can also cause bedwetting because problem foods can irritate the bladder. These problems must be diagnosed and treated by a medical professional.
Will My Child Outgrow Bedwetting?
The most important consideration with regard to bedwetting is to understand your child’s normal growth and development so that your expectations are realistic. As your child’s body grows, his bladder becomes able to hold more and more urine. Only when a child’s bladder can hold about a cup and half of urine does sleeping through the night without wetting the bed becomes physically possible.
Another requirement is the development of neuromuscular control necessary to control voiding. Because this typically occurs at around four to five years of age, it is unreasonable to expect a child younger than this to sleep through every night without wetting the bed. Moreover, every child’s growth and development is unique. Full bladder control may not occur until five or six years of age. In fact, bedwetting at night is not considered to constitute an official medical condition (nocturnal enuresis) when it occurs in children younger than five.
How Does Your Nerve System Affect Bedwetting?
Your bladder is controlled by a combination of:
The Brain – has an overall inhibitory effect over the brainstem (pons) and therefore maintaining dryness. During urination, the brain releases its inhibitory control over the brainstem (pons).
The Brainstem – is the center for the urinary process (pontine micturition center).
Parasympathetic nerves from S2-S4 – These nerves exit the base of your spine and allow your bladder wall to contract and your bladder neck to relax to pass urine. They allow your internal urethral sphincter to relax, allowing urine to pass out of the bladder. Both of these occur innately and are beyond your control. They also supply your external urethral sphincter which you can control, giving you the choice to urinate or not.
Sympathetic nerve from T11-L2 – These nerves exit your mid to lower spine and cause the bladder to relax and the bladder neck to contract, so you can hold on to urine. They control the internal urethral sphincter’s tightening, assisting to hold stored urine in the bladder – both of these occur innately.
Conventional Treatment Options for Bedwetting
Wait and see approach. Most kids will eventually grow out of wetting but it may take up to 14 years.
Medical treatment. Use of medication to slow urine production at night (ie. Imipramine). Although this is not a cure it can be helpful when kids are sleeping at friends or at camp. The use of medication is usually only considered after other therapies have been trialed for at least 3 months and do have side effects. Consult your doctor.
Bedwetting alarm. This occurs by training the bladder and brain to communicate more efficiently. This process usually takes between 6-8 weeks.
How it works: A sensor is placed in the child’s underpants. Once a drop of urine touches the sensor it transmits a signal to the alarm ( wirelessly) and the alarm wakes the child. Over the next 6-8 weeks, the child learns to react quicker to the alarm until eventually waking before the alarm starts.
Behavioral therapy. This may include reward charts, hypnosis, and relaxation therapy, as well as Kegel’s exercises, which help to train the bladder muscle.
Chiropractic Care and Bedwetting
The urination process occurs through the control of a combination of reflexes (inhibitory and excitatory) involving the bladder, brain, brainstem, and nerves exiting the spine (T12-L2 and S2-4). Any interference with these messages may delay the communication occurring between the bladder and the brain. NeuroStructural Chiropractors propose spinal shifts cause nerve irritation which may affect the communication between the bladder and the brain. Correcting these spinal shifts using chiropractic corrections, aim to re-establish optimal nerve communication and function between the bladder and brain.
More research is necessary, however, some small studies have shown some improvement in bedwetting following chiropractic care.
