Enuresis

What is enuresis?

Inability of a child to establish proper bladder control resulting in either daytime or nocturnal involuntary urination

By what age should children be able to establish proper bladder control?

4-5 years old

What is primary enuresis?

Occurs in a child over 5 years of age, who has never been able to establish proper bladder control

What is secondary enuresis?

Diagnosis for a child who has been able to establish proper bladder control, but who has since lapsed back to wetting the bed

What muscles empty the bladder?

Detrusor and trigone muscles

What is the nerve supply of the detrusor and trigone muscles?

Sacral parasympathetic nerves from S2 to S4

What is the nerve supply of the urogenital diaphragm?

L2 spinal nerve

What is the etiology from primary enuresis?

Familial (more common in males), medications, link to emotional disturbances, anxiety, ADHD, mechanical causes in the spine

What is the etiology of secondary enuresis?

Related to stress, trauma, or psychological crisis

What is the reason why bed-wetting ceases in some patients after the spine is adjusted?

The developing sacrum in early childhood remains highly mobile, existing as separate spine segments

What is the management of enuresis?

Medication, CMT, counseling