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Nocturnal enuresis: treatment implications for the chiropractor
1Canadian Memorial Chiropractic College, Toronto, Ontario.
Journal of Manipulative and Physiological Therapeutics
|September 1, 1994
Summary
Primary nocturnal enuresis affects many children, with spontaneous resolution occurring in 10-20% annually. Conditioning therapy with a urine alarm is a recommended initial treatment for bedwetting.
Area of Science:
- Pediatrics
- Urology
- Sleep Medicine
Background:
- Primary nocturnal enuresis (PNE) impacts a significant pediatric population, affecting approximately 200,000 children in Canada.
- The prevalence of PNE decreases with age, with 20% at age 5, 10% at age 10, and 1% at age 15 experiencing bedwetting.
Purpose of the Study:
- To review the etiology, diagnosis, and natural history of PNE.
- To discuss contemporary treatment options in relation to the annual remission rate.
Main Methods:
- A comprehensive literature review was conducted using Medline and the Index to Chiropractic Literature (1989-1993).
- Manual searches of the Chiropractic Research Abstracts Collection and bibliographies of relevant articles were also performed.
Main Results:
- The natural history of PNE indicates a spontaneous resolution rate of 10% to 20% per year.
- Key etiological factors include functional bladder capacity, patient conditioning, and the circadian rhythm of nocturnal antidiuretic hormone (ADH) secretion.
Conclusions:
- Treatment efficacy is influenced by the natural history of enuresis and potential placebo effects.
- Conditioning therapy with a urine pad alarm is suggested as a primary intervention.
- Spinal manipulative therapy demonstrates comparable efficacy to the natural course of the disorder.