As many parents know, bed-wetting in young children is a frustrating problem. In a nearby town, at least two of the three chiropractors claim they can resolve bed-wetting issues. Are there any merit to these claims?
Bed-wetting is a perfect place for sham cures to thrive. It is a non-life-threatening and largely self-limiting concern, where it is plausible a placebo could be quite effective.
The Cochrane Collaboration examine and assess the evidence for medical treatments. Sure enough, they found a number of alternative
s to health treatments had been tried, including chiropractic.
- Huang T, Shu X, Huang YS, Cheuk DKL. Complementary and miscellaneous interventions for nocturnal enuresis in children. Cochrane Database of Systematic Reviews 2011, Issue 12. Art. No.: CD005230. DOI: 10.1002/14651858.CD005230.pub2
They looked at three small trials for chiropractic treatment of bed-wetting:
One of three RCTs identified on chiropractic therapy provided weak evidence for its effectiveness (Reed 1994). The group given active chiropractic adjustment were more likely to improve and had less frequent enuresis post-treatment. However, children in the active treatment group had less severe enuresis at baseline, leading to doubts about adequacy of randomisation and comparability of enuresis severity between the groups, which might bias the results. Another trial (Leboeuf 1991), was too small and the duration too short to provide useful information. In another trial (Feng 2008), pinching massage seemed to be as good as desmopressin during treatment, but it was a single small trial with no follow up, and needs to be verified in further trials.
There was weak evidence to support the use of hypnosis, psychotherapy, acupuncture, chiropractic and medicinal herbs but it was provided in each case by single small trials, some of dubious methodological rigour.
Combined with the weakness of the evidence for, one of the studies described adverse effects, including:
headache, stiff neck and lumbar spine pain with chiropractic (Leboeuf 1991);
Don't despair for your children. There are some other remedies with more substantial evidentiary support. Desmopressin and Tricyclics work in the short-term. Alarm interventions combined with dry bed training work in the longer term.
Further reading: Chiropractic: a bogus* treatment for bedwetting?
No conclusive evidence from study. Therefore it all depends on your priors ;) May 30, 2012 at 13:10
@Chad: If there were better studies, I would expect Cochrane to find them in their systematic search. Nonetheless, your commented spurred me to add another sentence, which described the adverse effects. If we have poor evidence for a treatment and evidence for adverse effects and other treatments with good evidence for success, it becomes unethical to prescribe the unknown treatment until/unless more good evidence is gathered. May 30, 2012 at 13:34
@Christian: As above, there was evidence for adverse effects, which may change your mind from the priors (depending, of course, whether you have grown to expect chiropractic to have adverse effects.) May 30, 2012 at 13:35
2I would doubt very much there is a placebo effect. Children who wet the bed will have a spontaneous cure rate of 15% per year with absolutely no treatment. Bed wetting is almost always just slower than normal development.– Sam I AmMay 30, 2012 at 13:52
@SamIAm, I don't want to over-state my evidence that bed-wetting is responsive to placebo; it isn't that strong. Outside of a controlled experiment, the 15%p.a. spontaneous complete cure rate is likely to be attributed to the chiropractic, but also reductions in frequency will be too. (The Reed study only showed an average drop of 1.8 wet days per week, compared to a baseline of 5.6 wet days per week). I suggest, without evidence, that the overall chance of reduction over the treatment period is likely larger than 15%p.a. This ignores further psychological benefits of the placebo. May 30, 2012 at 14:11