Chiropractic Management of Bedwetting in Children

Childhood bedwetting can be a very stressful time for everyone involved. For the parents it can be very tiring getting woken up in the middle of the night by a child who has wet the bed, and constantly having to wash the soiled sheets. It can also be very stressful for the parents not knowing how long your child will be dealing with this issue for. For the child, wetting the bed can cause a lot of stress and anxiety. They are likely dealing with the embarrassment of wetting the bed, and they may be scared to spend the night away from home, and can miss out on experiences such as staying the night at a friend’s or grandparents house, or going away on school camp. Bedwetting during the night is also called nocturnal enuresis, and this article will discuss what can cause nocturnal enuresis, how chiropractic can help with it, and other ways to help your child to stop wetting the bed. 

Something you may not know is that nocturnal enuresis can be caused by something called a subluxation. If you haven’t had much experience with chiropractic you may not know what a subluxation is. A subluxation is when a spinal joint loses its proper position or movement. This misalignment can cause interference to the nervous system, which runs directly through the spine. Your nervous system is what controls and co-ordinates all of the other systems within your body. If a misaligned spinal segment is placing stress on the nervous system, it is not able to function at its full potential, and this can lead to numerous issues. The most common issue that people come into a chiropractor for is pain, but it is the cause of many other issues as well, one of those being nocturnal enuresis. 

The spinal cord runs directly through your spine, and there are many nerves that then branch off of this and connect to all the different parts of the body. Several of these nerves, in different regions of the spine, branch off and connect to the bladder, and to the sphincter muscle that opens and closes the bladder. One of the nerves that is involved in nocturnal enuresis is called the phrenic nerve. The phrenic nerve is the nerve that connects to the diaphragm, which is your breathing muscle. This nerve comes from 3 different segments of the spine in the neck, C3, C4, and C5. The phrenic nerve controls something called the phrenic reflex. The phrenic reflex is what happens when carbon dioxide levels in the blood get too high. This causes smooth muscle tissues to relax. The sphincter muscle that controls the opening and closing of the bladder is made up of smooth muscle fibres, so when this reflex is triggered, the sphincter muscles relax and cause the bladder to void, causing your child to wake in a wet bed. This reflex is usually under-developed in children, and children tend to breathe very slowly throughout the night, causing a rise in their carbon dioxide levels, and causing this reflex to be triggered. This is a normal thing to happen in infants, as the phrenic reflex is not fully developed yet, but as your child grows older this reflex matures, and your child should be able to sleep through the night and retain their urine. This reflex develops slower in boys, which is why boys tend to be bed wetters more often than girls. While a slow development of this reflex can be sometimes due to hereditary factors, it can also be due to a subluxation, which as mentioned before, can prevent the nervous system from being able to work at its best. 

There are other nerves down in the lower back and the pelvis that can also play a role in nocturnal enuresis. There are 3 nerves that are responsible for carrying signals from the bladder up to the brain to let it know that the bladder is full. They then carry signals from the brain to the sphincter muscle to let it know when to open and void the bladder. These nerves include the hypogastric nerve which originates in the mid back at levels T10-L2, the pudendal nerve which originates in the lower back at levels L4-S4, and the pelvic nerve which originates in the sacral region at levels S2-S4. In adults all of the sacral segments are fused, but these don’t fully fuse until 25 years of age. This means that these segments are freely moveable in children, making them more susceptible to misalignments, especially when children are regularly falling down on to their behind. 

If any of these spinal segments become subluxated, they can place stress on the nerves talked about above, and can cause dysfunction of these nerves, leading to nocturnal enuresis. Chiropractors are able to help by restoring the proper motion and position to these spinal joints, through chiropractic adjustments. These adjustments are extremely gentle and safe for children. The best way to find out if your child’s bedwetting is due to subluxation, is to go and see a chiropractor and get your child adjusted. You may be pleasantly surprised with the results that just a few adjustments can make!

Here are some other things you can do with a child who is struggling with wetting the bed:

1. During the day, have your child mentally note when they need to go to the toilet, then try to hold and wait until the second strong urge to go to the toilet. This helps to train the neural pathways that alert your child that their bladder is full. 
2. When going to the toilet, have them stop and start the flow 3 or 4 times while going. This helps to train the muscular control of the sphincter that opens and closes the bladder. 
3. Limit the amount of water your child drinks in the couple of hours leading up to bedtime. 
4. About half an hour before bedtime get your child to go to the bathroom, and then again right before they get into bed. 

If you would like some more information, here are a couple of case studies of children with nocturnal enuresis, and how chiropractic care helped them:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4812021/

http://chiropractorwellington.com/wp-content/uploads/2018/02/2012-1197_asd.pdf

https://livingvitallife.com/wp-content/uploads/2018/01/Resolution-of-Childhood-Nocturnal-Enuresis-Following-Subluxation-Based-Chiropractic-Care.pdf