Bedwetting in children

Bedwetting in children

wtbdA common children’s condition we see at the clinic is bedwetting (nocturnal enuresis). It is normal for children below the ages of 4 or 5 to lack control of their bladder, however, if this continues after the age of 5, it could signify a problem. Primary enuresis is described as bedwetting in a child beyond 5 years old who has never been able to establish good bladder control. Secondary enuresis is described as a bedwetting relapse in a child who was previously toilet trained.

 

There are several alternative medicine therapies that have published reports on treatments for bedwetting. These include:

 

  • Dietary modification
  • Craniosacral therapy
  • Acupuncture

 

Dietary Modification

Many parents will be advised to keep a food diary when their child first comes to the clinic for treatment. This is so that the day to day biochemical composition of their diet can be assessed. In cases of bedwetting, we often find there is a sensitivity to one or more chemicals- including both natural and synthetic substances. The most common food chemicals found to affect to bladder function are:

 

  • Dairy
  • Salicylates
  • Propionates and other food additives

 

Dairy sensitivity is often accompanied by other symptoms such as eczema; abdominal bloating / cramps; bowel problems such as foul smelling gas and diarrhoea; and upper respiratory issues such as chronic sinusitis, tonsillitis, middle ear infections and glue ear. Eliminating dairy from the diet will help in these areas as well as in the bedwetting- though typically the bedwetting will take 1-2 months to show changes. In some milder cases replacing milk with A2 milk products may suffice to improve the condition.

 

 

Salicylate sensitivity is a relatively common condition in both children and adults. Please visit our separate blog article for more detailed discussion of Salicylate sensitivity. Salicylates are chemicals produced in fruits and some salfrtsvegetables that act as a sort of natural pesticide which kills the larvae of fruit flies and other insects when they attack the immature fruit. They are typically more concentrated near the skin, and decrease in concentration as the fruit/vegetable ripens. Unfortunately in our society, fruits and vegetables are often picked unripe in order to be transported, stored and artificially ripened through gassing which leads them to contain higher amounts of salicylates than would be the case if they were picked ripe. Plants that are bred to be disease resistant have higher levels of salicylates than heirloom varieties.

 

Foods that are high in salicylates are as follows:

  • Citrus
  • Grapes
  • Strawberries
  • tomatoes / tomato sauce
  • broccoli
  • olives / olive oil
  • almond milk
  • berries
  • tea, spices
  • mint flavouring (including toothpaste)

 

The safest practice when exploring salicylate sensitivity is to remove all fruit except for pears and bananas from the diet, and restricting other foods high in salicylates which includes most processed foods, medications and drinks other than water. Salicylates are often commonly fond in many fragrances, air sprays, skin creams, detergents, shampoos and soaps. Salicylates are also common in pain relief medications (aspirin), liniments and arthritis creams.

 

Salicylate sensitivities commonly display other symptoms but these may not be present in every case:

  • asthma
  • headaches
  • behavioural disorders such as ADHD
  • skin rashes, hives

 

 

Propionates (Propionic Acid)

brdCommonly listed as E280, E281, E282, E283

These additives are most commonly added to breads as a preservative to inhibit mould growth, and the permitted levels of propionates in Australia are among the highest in the world. The effects are cumulative, which means that even tiny amounts will build up in the system over time, resulting in many different symptoms possibly in addition to bedwetting – most commonly:

 

 

 

  • hyperactivity
  • learning impairment
  • irritability
  • restless sleep
  • migraine
  • gut aches
  • runny or stuffy nose
  • skin rashes
  • unexplained tiredness
  • nosebleeds

 

Many breads (including fancy/boutique breads), as well as wraps, crumpets etc. all commonly contain propionates. Recently propionates are making their way into the cheese making industry, through sprays and bacterial bi-products manufactured and labelled as “cultured wheat”, cultured dextrose, cultured whey or whey powder (only in baked goods) in an attempt to falsely market their products as “natural”.

 

To avoid added propionates and cultured propionates avoid any additive with in the 200 range, as well as the above mentioned cultured propionates. Bake your own bread at home, or purchase it in bakeries such as Bakers Delight, after asking for confirmation from the baker.brdaddtves

 

It can take up to 3 weeks to see a change in symptoms once you eliminate propionates, dairy and salicylates, which can then be re-introduced through a test challenge over the course of a week where the foods are reintroduced in larger amounts and the child observed for deterioration.

 

 

Craniosacral Therapy

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The bladder is a large muscular pouch that holds urine discharged from the kidneys. When stretch receptors are activated, the bladder relaxes its otherwise tight sphincter muscle and urine flows out. The bladder is controlled by nerves emerging from the sacrum, which in children is made up of 5 mobile bones that don’t fuse together until well after puberty. Because the sacrum forms the base of the spine, it bears a substantial amount of weight and distributes this into the legs. The knocks, falls and bumps that are so common in childhood may easily irritate or injure the nerves that emerge from this area and result in interruption of normal control of the bladder. Improving the position and stability of the pelvis in children through cranio-sacral therapy or visceral manipulation may be worth exploring in cases of bedwetting. These therapies are always modified for children to make them as gentle as possible.

 

Another nerve reflex called the phrenic reflex may also be involved in bedwetting. As we sleep, our respiration slows down gradually such that we get less oxygen and more carbon dioxide building up in our blood stream. When this level reaches a threshold, our brain activates the phrenic nerve, which goes to the diaphragm and causes you to take a sigh or deep breath. This phenomenon is often observed in people during a deep sleep. In children this reflex is not as well developed (particularly in boys) and so there can be a greater delay in its activation. The increased levels of carbon dioxide in the blood causes smooth muscles (such as the muscles that are found in organs and blood vessels) to relax which can lead to a relaxation of the bladder sphincter resulting in bedwetting. This higher level of carbon dioxide in the blood also causes a very deep and heavy sleep state, which parents often find frustrating as they cannot wake the child to go to the bathroom.

 

The phrenic nerve exits the spine in the neck at the levels of C3,C4 and C5 and passes down the thorax into the diaphragm, so where there are neck problems or poor posture affecting the neck, this area may be worth examining.

 

 

Acupuncture

acupbdwttTraditional Chinese Medicine operates on a completely different paradigm to modern western medicine, though there are some surprising similarities with European Folk medicine traditions. In general, acupuncture theory understands the role of the kidneys in producing urine and so acupuncture points aimed at improving the kidney meridians as well as the Connecting vessel meridian (in front of the bladder) are commonly stimulated with needles, pressure points or electronic instruments to effect a change in function of these organs. In addition, the sacral region is often also stimulated, in order to influence the nerves that exit in much the same principle as manual therapies would.

 

Thus in our clinic we have a very multi-faceted approach to the problem of bedwetting, where several systems of healing are explored in order to give parents a greater chance of success in curing their child of this frustrating and emotionally stressful condition. Of course, the evidence for alternative therapies in the form of large scale clinical trials is lacking so patients are always encouraged to be conservative, to speak with their doctor about their options, but to be open minded to other approaches, particularly if the only other options involve pharmaceutical drugs that may have irreversible or harmful long term effects.

 

If your child suffers from bedwetting and you need more information on alternative options, speak to your doctor or feel free to call the clinic on (02) 9822-0588

 

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