Nocturnal Enuresis

Manipulation Resolves Enuresis

OBJECTIVE: To discuss a patient with primary nocturnal enuresis whose symptoms resolved following manipulation.

CLINICAL FEATURES: An 8-yr-old boy with a history of primary functional nocturnal enuresis was under care at this office. The patient's clinical examination was benign. He had several areas of lumbar segmental dysfunction. The patient's medical history was unremarkable except for childhood asthma.

INTERVENTION AND OUTCOME: The patient's lumbar spine was manipulated once, and at a 1 month follow-up there was complete resolution of enuresis. The patient had several recurrences of bed-wetting, all of which were associated with minor injury to the lower back. The patient responded positively to subsequent manipulation.

CONCLUSION: This patient's enuresis resolved with the use of manipulation. This happened in a manner that could not be attributed to time or placebo effect.

Blomerth PR. Functional nocturnal enuresis. J Manipulative Physiol Ther 17 (5): 335-338 (1994)

Chiropractic Treatment of Primary Nocturnal Enuresis is Effective

OBJECTIVE: To evaluate chiropractic management of primary nocturnal enuresis in children.

DESIGN: A controlled clinical trial for 10 wk preceded by and followed by a 2-wk nontreatment period.

SETTING: Chiropractic clinic of the Palmer Institute of Graduate Studies and Research.

PARTICIPANTS: Forty-six nocturnal enuretic children (31 treatment and 15 control group), from a group of 57 children initially included in the study, participated in the trial.

INTERVENTION: High velocity, short lever adjustments of the spine consistent with the Palmer Package Techniques; or a sham adjustment using an Activator at a nontension setting administered to the examiner's underlying contact point. Two 5th-year chiropractic students under the supervision of two clinic faculty performed the adjustments.

MAIN OUTCOME MEASURES: Frequency of wet nights.

RESULTS: The post-treatment mean wet night frequency of 7.6 nights/2 wk for the treatment group was significantly less than its baseline mean wet night frequency of 9.1 nights/2 wk (p = 0.05). For the control group, there was practically no change (12.1 to 12.2 nights/2 wk) in the mean wet night frequency from the baseline to the post-treatment. The mean pre- to post-treatment change in the wet night frequency for the treatment group compared with the control group did not reach statistical significance (p = 0.067). Twenty-five percent of the treatment-group children had 50% or more reduction in the wet night frequency from baseline to post-treatment while none among the control group had such reduction.

CONCLUSIONS: Results of the present study strongly suggest the effectiveness of chiropractic treatment for primary nocturnal enuresis. A larger study of longer duration with a 6-month follow-up is therefore warranted.

Reed WR; Beavers S; Reddy SK; Kern G; Chiropractic management of primary nocturnal enuresis J Manipulative Physiol Ther 1994; 17(9): 596-600

Spinal Manipulattion Effective in Treating Primary Nocturnal Enuresis

OBJECTIVE: A comprehensive review of the literature concerning the etiology, diagnosis, and the natural history of primary nocturnal enuresis is presented. Contemporary treatment options are discussed in light of the documented annual remission rate of this disorder.

DATA SOURCE: Articles reviewed were obtained by conducting a computer-aided search of papers indexed in Medline and the Index to Chiropractic Literature from 1989 to 1993. In addition, the Chiropractic Research Abstracts Collection and bibliographies from pertinent articles were manually searched.

DATA SYNTHESIS: Primary nocturnal enuresis affects some 200,000 children and their families throughout Canada. Twenty percent of children wet the bed at age 5, 10% at age 10, and only about 1% at age 15. The documented natural history of the disorder reveals that for those affected, 10% to 20% exhibit spontaneous resolution per year. Contemporary treatment options center on three factors that play primary roles in the etiology of this condition: functional bladder capacity, patient conditioning and the circadian rhythm of nocturnal ADH secretion.

CONCLUSIONS: The success of each therapeutic option must, in part, be attributed to the natural history of enuresis, as well as any educational or placebo aspects of treatment. Conditioning therapy utilizing the urine pad alarm may be the most reasonable initial mode of intervention. Spinal manipulative therapy has been shown to possess an efficacy comparable to the natural history.

Kreitz BG, Aker PD. Nocturnal enuresis: treatment implications for the chiropractor. J Manipulative Physiol Ther 1994 Sep;17(7):465-473

Spinal Manipulation Reduces Frequency of Wet Nights

A controlled clinical trial of 46 primary enuretic children was over a period of 14 weeks to assist in evaluating the influence of chiropractic care. Subjects were between five and 13 years of age. There were 31 in the treatment group which received a spinal evaluation and/or adjustment at a minimum of every ten days. The remaining 15 subjects were control which came in with the same frequency but received a "sham" adjustment over an equal period of time. Chiropractic care was rendered for ten weeks, preceded and followed by a 14-day non-treatment baseline. The mean post-treatment frequency of wet nights for the treatment group was significantly less than its pre-treatment frequency; while there was practically no difference between mean pre- and post-frequency for the control group. Subjects receiving chiropractic care averaged a 17.9% reduction in wet nights for the control over the same period of time.

Reed WR; Beavers S; Reddy SK; Kern G; Chiropractic management of primary nocturnal enuretic children. Proceedings Of The National Conference On Chiropractic & Pediatrics. 1993 Oct. pp 64-82.

Spinal Manipulation Reduces Frequency of Wet Nights

In 171 children suffering with enuresis, The average number of bed wettings per week was 7, while at the end of the study the average number of bed wettings per week was reduced to 4. Additionally, 1% of patients were considered "dry" at the beginning of the study, while 15.5% were considered "dry" at the end of the study.

Functional nocturnal enuresis is a common problem which causes a great deal of stress to the suffering children and their families. Some chiropractors advocate chiropractic care as a mode of therapy for this complaint. One hundred and seventy-one enuretic children, aged 4 to 15, were treated with chiropractic adjustments, and their number of wet nights was monitored by their parents. The median number of wet nights per week was 7.0 at the onset of the study. After 2 wk without any therapy, the number of wet nights had decreased to 5.6 (p = .01) and by the end of the treatment this figure was 4.0 (p less than .0001). Following the course of treatment, 15.5% of subjects wet a maximum of 2 nights per fortnight, or, where data for the last 2 wk of therapy were unavailable, a maximum of 1 night/wk. This result is less favorable than the therapeutic success of other common types of therapy, which have reported "cure" rates well above 50%. The only variable which predicted treatment outcome was the initial estimate of bed-wetting; the more severe the condition at the onset, the less likely was the child to improve by the end of the study. In the absence of a control group there appears to be no validity in the claim that chiropractic is a treatment of choice for functional nocturnal enuresis.

Leboeuf C; Brown P; Herman A; Leembruggen K; Walton D; Crisp TC; Chiropractic Care of Children With Nocturnal Enuresis: A Prospective Outcome Study. J Manipulative Physiol Ther 1991; 14(2):110-5

Additional references

Limes, D.H., "Chiropractic In The 21st Century, The Past, The Present And Future" J Austr Chiro Assoc., 1989 19(2):49-54