Nocturnal Enuresis is the medical term for bed wetting, for which there are several causes. If a young child urinates in their sleep, it is embarrassing and stressful for them. Sleeping at a friend’s house, camping or traveling with the family all contribute to the psychological distress of the child and the parent responsible for changing linens and washing clothes.
What Causes Bed Wetting?
Setting aside Psychosocial factors which include emotional trauma, or developmental delays, there are a couple of biomechanical causes which are often correctable. There is a reflex in the human body called the phrenic reflex. This is a spinal reflex that relates to the phrenic nerve. The phrenic nerve originates from the neck and innervates (controls) the diaphragm, our primary breathing muscle. This reflex is not developed at birth and takes time and as the child grows so does this reflex.
When an infant or child sleeps, they usually sleep very deeply (growing, developing and playing are exhausting!). Often as the infant sleeps, respiration continually slows down. With younger infants, it may even seem like they stop breathing for a period, but will soon take a deep breath and restart the cycle. As the breathing slows, carbon dioxide (CO2) will increase within the lungs and body. Once CO2 reaches a certain level, this stimulates the phrenic reflex and normal breathing patterns return.
If this reflex isn’t developed or isn’t functioning properly, CO2 continues to increases to a point where the automatic muscles in the body (called smooth muscles), like the heart, lungs and postural muscles and sphincters begin to relax. As I mentioned, Smooth muscles operate without conscious control, like the valve at the end of the urinary bladder. If it relaxes enough, it will not retain fluid. This is called CO2 intoxication and most bed wetting children and is what causes the child to sleep so deeply (Many parents can attest how difficult it is to wake up a child to go to the bathroom).
A child plays to exhaustion, sleeps hard with ever slowing respiration and increasing CO2 due to immature phrenic reflex, the valve/sphincter relaxes and involuntary urination occurs. There are also cases where the low back (lumbaosacral) segments are slightly misaligned or not articulating properly. This can cause impingement to the nerves that control bowel or bladder function. Although in my clinical experience, this is rarer than the aforementioned.
How Can You Help This?
In some cases, underdevelopment of the reflex is present and will take time to develop. If there are psychosocial concerns or hereditary factors those will need to be taken into consideration as well. As I have shared, the phrenic nerve comes out from in-between the 3rd-5th cervical vertebrae. A painless, fun and interactive examination with the child will help conclude if there is joint malalignment or dysfunction contributing to impingement or irritation of the nerves exiting the neck.
I also make sure to discuss the importance of limiting fluids before bed, prevent complete exhaustion by offering naps or quiet times throughout the day and by limiting diuretics or bladder irritants. Excess sugar acts as a diuretic. Acidic foods can sometimes irritate the lining of the bladder or urethra and caffeine can do the same.
It is not unusual for this to resolve after one adjustment (see the ICPA-International Chiropractic Pediatric Association if you are unsure of the safety or validity of chiropractic with prenatal, infant and children’s care). I have personally seen it take up to 7 adjustments but that is rare and would not consider that standard practice.
Children respond much faster than adults to chiropractic care as their bodies are more receptive to change and stimulus introduced to their system. Remaining supportive of your young one is very important. They see the frustration and stress that their problem brings and will internalize it which could lead to more problems in resolving it in the long run.