Nocturnal Enuresis - Bed Wetting

Tri-7 Wk9 Day 426 - Tuesday

Enuresis is involuntary urination. When it occurs at night we call it nocturnal enuresis and, if done during the day, is called diurinal enuresis. The prevalence of enuresis is as follows

• 30% of 4 year olds
• 15% of 5 year olds
• 7% of 8 year olds
• about 3% for 12 year olds (2-4%)
• 2-4% for adults

Within the last week there was a report on the radio about a child holding a sign that said "I'm 10 years old and I wet my bed" Presumably, this was an attempt by the parents to help curb their child's bed wetting but, I might suggest this is probably ineffective and could potential do more harm than good. If you're a parent reading this and are dealing with enuresis and think punishments are the way to go then consider this question. What makes you think your kid is choosing to wet the bed? Hopefully, most people will come to the conclusion that their offspring is not intentionally choosing to wet the bed and will realize that, for the most part, it's something out of their control.

Dr. Zaleski was one of the first physicians who started conservative care for the condition of nocturnal enuresis. He learned from studies that most patients with enuresis tended to have some type of allergy. Dr. Z checked the bladder walls of eneuritic patients and found immunoblobins inherent with allergic conditions.

Dr. Brenaman followed up Dr. Zaleski's studies and followed several hundred children for a 20 year period and found that a full 2/3 of the study population had food allergies linked to their enuresis. Of those 2/3rds a full 60% of them had an allergy to a single food - cow's milk.

One test I've learned of that can help detect this allergy is called the Chvostek's reflex (or sign) which involves tapping the patient's zygomatic arch (bone close to the eyes) and looking for an excessive blink response.

Cases, as previously discussed, would be considered secondary types of causes for enuresis. With secondary types of enuresis, the word from Logan seems to be that chiropractic care may be of great benefit. One teacher from a previous semester commented that there is more documented research dealing with enuresis and chiropractic than for any other ailment.

Primary cases of enuresis would include factors such as developmental delay, genetics, sleep disorders, anatomical variations and ADH levels. With primary causes, it is prudent to consult a medical doctor while using a chiropractor in a complementary fashion.

Today's picture is of a positive Chvostek's sign (CS) as demonstrated on an infant. CS is a classical sign of hypocalcemia.

One final note, statistics regarding enuresis for children less than 4 years old isn't given because studies are generally not done of individuals who are aged 3 or less because the bed wetting is just too common of an occurrence. Even with children approaching 10 years of age you're still likely to find 5 kids out of 100 who are dealing with enuresis. Physiologically speaking, it's not a big deal. Rewards or punishments are definitely contraindicated as means of dealing with the situation. If you want a plan in working with your youngster then consider the following points;

1. Have a routine, maintain a regular bedtime schedule and no fluid intake in the last hour before bedtime.
2. Make sure your child goes to the bathroom just before going to bed along with brushing their teeth or anything else you may deem significant.
3. eliminate milk and citrus foods for two weeks - cereal is easy but consider pancakes, French toast, waffles or eggs.
4. have the child's spine and SI joints evaluated by a qualified chiropractor.

Two weeks may be too short of a time period to notice significant results but you should still probably be able to notice an improvement especially if the milk or citrus foods were the cause. If positive results are obtained then you can start by adding back one of the foods at a time to help see which was the culprit.