Nocturnal Enuresis (Nighttime Bedwetting) - What Parents Can Do To Help Their Child
Soggy sheets and pajamas — and an embarrassed child — is an all too familiar scene for families struggling with bedwetting. While bedwetting isn't a sign of failed toilet training (developing nighttime bladder control is a normal part of a child's development), prolonged bedwetting past the age of 5 can have a big impact on a child’s sleep quality and therefore, growth and development. For a parent, it can be very tough to see your child struggle with bedwetting challenges because they can create additional issues for your little one like guilt and embarrassment (which can lead to low self-esteem) and loss of opportunities for social activities like sleepovers and camp.
And if your child seemed to have mastered nighttime bladder control but now, has all of a sudden started having trouble with bedwetting again, it can be equally distressing for you as parents as it is for your child.
Because there can be a stigma associated with bedwetting, some parents and children delay seeking help. The goal of this article is to let you parents know there’s help out there. Let’s start with how bedwetting affects children, if your child is struggling with it, potential causes and what you as parents can do to help your child.
BEDWETTING, AKA NOCTURNAL ENURESIS OR NIGHTTIME INCONTINENCE
Bedwetting, also called enuresis, nocturnal enuresis or nighttime incontinence, affects 5 million children older than age 6 in the United States. Enuresis is characterized as involuntary urination while asleep after the age at which staying dry at night can be reasonably expected.
If your child is experiencing any of the following, they may be struggling with nocturnal enuresis:
Your child still wets the bed after age 5
Your child starts to wet the bed after > 6 months of being dry at night
Has recurrent urine leakage in bed > 2 nights/week for >3 weeks in children ≥ 5 years old
Beyond the psychological and social implications of persistent or recurrent bedwetting, there are physical complications as well. Some children suffer from rashes on their bottom and genital area if they aren’t aware they are sleeping in wet underwear.
And if the root cause is left unaddressed, bedwetting can persist into adulthood. This can be socially disruptive and cause emotional distress like anxiety and depression. It can also create an obstacle in forming meaningful relationships as an adult.
TYPES OF NOCTURNAL ENURESIS
There are 2 types of enuresis: primary enuresis and secondary enuresis.
Primary Enuresis
When a child isn’t able to stay dry through the night, this is primary enuresis. This occurs when the child has never fully mastered toilet training.
Secondary Enuresis
If your child seems to have already developed bladder control and mastered potty training but has had a recurrence in bedwetting, this is considered secondary enuresis. If your child has been able to stay dry at night for 6 months or longer but has started having trouble again at an older age, this is a sign of secondary enuresis.
EFFECTS OF NOCTURNAL ENURESIS
Because poor sleep quality, periodic movement during sleep and inadequate sleep are common challenges for children with bedwetting, the American Psychiatric Association classifies it as a sleep disorder. It is common knowledge that quality sleep is necessary for proper brain development, growth and physical development for children. Sleep disruptions play a major impact on a child’s growth, development, school performance as well as mood. With sleep being so important during adolescence, lack of proper sleep and rest can lead to more stressed out and anxious children.
As with any childhood struggle, nocturnal enuresis can be stressful for parents as it’s difficult to understand why it is happening. The emotional impact on both the child and parent should not be underestimated.
CAUSES OF NOCTURNAL ENURESIS - WHY IS MY CHILD STRUGGLING WITH BEDWETTING?
It can be difficult to know what exactly is causing your child’s struggles, some common factors that may be playing a role are:
Stress and anxiety
The Brain’s inability to recognize a full bladder
Diabetes
Hormone imbalances
Physical Trauma (like big falls or even birth trauma)
Emotional Trauma
As pediatric chiropractors, our specialty is neurology and neurodevelopment, so we investigate and look at things from a different angle than most traditional medical doctors and pediatricians. Because enuresis is not a diagnosis but a symptom of something deeper, we look to the system of what controls the endocrine system and what communicates with the detrusor muscles in the bladder itself – the central nervous system. The tone of the central nervous system is the primary determinant of the tone of the muscular and soft tissue systems. Additionally, proper balance of hormones that play a central role in the feeling of needing to void the bladder is controlled and coordinated by the central nervous system.
Whether it be traditional medicine or more holistic and integrative, most of the healthcare world will always look to things like physiology and chemistry first. However, we all know that with true health and development, everything begins with the health and function of the nervous system. World-renowned cellular biologist and researcher Dr. Bruce Lipton puts it this way: “The function of the nervous system is to perceive the environment and coordinate the behavior of all other cells.”
If we take that understanding of the nervous system’s vital role in controlling and coordinating everything, we can apply it to this conversation around your child’s bedwetting struggles. For years we’ve found the struggles our littlest patients are dealing with is the story of one primary thing – subluxation.
EXPLORING THE CONNECTION BETWEEN SUBLUXATION AND BEDWETTING
The way we explain subluxation to parents is that the first two (2) components, misalignment and fixation of the vertebra, are more biomechanical and musculoskeletal in nature. And then, the third component of subluxation is where the neuromuscular and overall neurological component comes into play. You can read more about subluxation and its effects but essentially, it goes so far beyond just looking at spinal joints and partial dislocations. Those who understand the role of subluxation in health look deeper into the neurological disruptions and dysfunction (dysautonomia) and get right to work restoring and improving those components with each and every chiropractic adjustment.
Subluxation is the most overlooked cause of various health issues that can be helped and cared for by a neurologically-focused chiropractor. One of the surest signs a patient’s condition is primarily linked to subluxation is when all medical tests and treatments come up empty, and despite seeing a long list of doctors and specialists, parents still do not have the answers and action steps they seek!
This is why we at Sprout Family Chiropractic measure the health and function of the nervous system using INSiGHT neuro-scans. Whether your child has struggled with persistent bedwetting or recurrent bedwetting, a consultation and examination with one of our pediatric chiropractors is an absolute must for this condition. Again and again, we find moderate to severe tension, subluxation, and dysautonomia. You can see an example of this tension and neurological interference on the INSiGHT Scan below.
You can see clearly how much stress and dysfunction has built up in this patient’s upper cervical spine (right under the hormone control center, the hypothalamus) as seen by the “counter-torque” tension pattern where C1 (atlas) is misaligned in one direction and C2/C3 (axis). What’s more, is there’s additional built up stress and dysfunction in the thoracolumbar and sacral regions, exactly where the nerves to the urogenital organs come out of. To learn more about these incredible INSiGHT neuro-scans that help determine if subluxation is at play for your child, check out this article here.
COMMON STRATEGIES FOR BEDWETTING HELP
There are many lifestyle changes than can absolutely help with bedwetting:
Restricting fluids within 2 hours of bedtime
Avoid high-sugar or caffeinated drinks during the evening
Build voiding into the bedtime routine by encouraging your child to go right before they hop in to bed
Many of these can help with your child’s ability to stay dry. Parents may have tried setting a mid-night alarm to wake their child to use the bathroom at midnight. While effective, this strategy is still disruptive for both the parent and the child when it comes to getting quality sleep. Some parents have had to use moisture alarms, also called “bedwetting alarms,” which are over-the-counter pads that are connected to a battery-operated alarm. Many children who use these last strategies find them to still be restrictive in terms of what social activities they can participate in.
If you’ve found these options haven’t worked for your child, it is likely a specialist or their primary care provider may have recommended prescription medication (i.e. desmopressin) as a short-term solution. The mechanism of action of this medication is that it acts as a synthetic version of the hormone arginine vasopressin antidiuretic hormone. It causes the body to retain water, so the bladder does not get too full overnight. Its overall success rate is between 30%-70% but 50% of the “success” stories reported relapse after stopping use of the medication. As with all medications, possible side effects should be considered by parents including: irritability, restlessness, nausea, vomiting and headaches.
LONG-TERM, DRUG-FREE SOLUTIONS FOR HELPING YOUR CHILD
You’ve tried everything and are still at a loss for what to do to help your child overcome nighttime bedwetting. You know in your mom or dad gut there’s a more long-term, drug-free solution that actually gets to the root cause of why your child is struggling. If this is you, we’re here to help. Our doctors are experts in drug-free, natural health solutions for babies and kids and can provide you with the Hope, Answers, and Help you’ve been searching for. You can easily schedule a consultation and exam for your child here to see how we can help.
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ARTICLE SOURCES
Chan IHY, Wong KKY. Common urological problems in children: primary nocturnal enuresis. Hong Kong Med J. 2019 Aug;25(4):305-11. doi: 10.12809/hkmj197916. Epub 2019 Aug 5. PMID: 31395789.
https://www.hopkinsmedicine.org/health/conditions-and-diseases/bedwetting-enuresis
https://www.mayoclinic.org/diseases-conditions/bed-wetting/symptoms-causes/syc-20366685