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Posted on 10-03-2017

Nocturnal Enuresis/Bed wetting

The cause of bed wetting is not really known or well understood.  There are many ideas about possible or likely causes.

The child cannot yet hold urine for the entire night.

The child sleeps so soundly that they don’t wake when bladder is full.

The child produces a large amount of urine during the evening and night hours.

The child has poor daytime toilet habits. Many children habitually ignore the urge to urinate and put off urinating as long as they possibly can.

Structural or anatomical abnormality: An abnormality in the organs, muscles, or nerves involved in urination can cause incontinence or other urinary problems that could show up as bedwetting.

Emotional problems: A stressful home life, as in a home where the parents are in conflict, sometimes causes children to wet the bed. Major changes, such as starting school, a new baby, or moving to a new home, are other stresses that can also cause bedwetting.

Neurological problems: Abnormalities in the nervous system, or injury or disease of the nervous system, can upset the delicate neurological balance that controls urination.

Children with a spinal or neurological cause respond well to chiropractic while those with other causes of bed-wetting don’t always.

To understand this, let’s take a look at the anatomy and physiology.  Emptying of the urinary bladder is controlled by the detrusor and trigone muscles. The nerve supply to these muscles is via the sacral parasympathetic nerves from S2 to S4 which exit the cord at the level of the sacrum.

Another nerve reflex called the phrenic reflex may also be involved in bedwetting.  As we sleep, our respiration slows down gradually such that we get less oxygen and more carbon dioxide building up in our blood stream. When this level reaches a threshold, our brain activates the phrenic nerve, which goes to the diaphragm and causes you to take a sigh or deep breath. This phenomenon is often observed in people during a deep sleep. In children this reflex is not as well developed (particularly in boys) and so there can be a greater delay in its activation. The increased levels of carbon dioxide in the blood causes smooth muscles (such as the muscles that are found in organs and blood vessels) to relax which can lead to a relaxation of the bladder sphincter resulting in bedwetting. This higher level of carbon dioxide in the blood also causes a very deep and heavy sleep state, which parents often find frustrating as they cannot wake the child to go to the bathroom.

The phrenic nerve exits the spine in the neck at the levels of C3, C4 and C5 and passes down the thorax into the diaphragm.

Subluxations/spinal misalignments, at any of these spinal or sacral levels will irritate the nerves interfering with the transmission of signals or nerve impulses to these structures which can lead to dysfunction.

It is worth it for a child with bed-wetting to have their spine evaluated by a chiropractor to determine if spinal problems are the underlying cause.

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