Complementary, Holistic, and Integrative Medicine: Nocturnal Enuresis

Abstract

1. Denise Adams, BSc* 2. Sunita Vohra, MD, MSc* 1. *Complementary and Alternative Research and Education (CARE) Program, Department of Pediatrics, Faculty of Medicine, University of Alberta, Edmonton, Alberta, Canada. On behalf of the American Academy of Pediatrics Section on Complementary and Integrative Medicine Nocturnal enuresis (NE) is characterized by the involuntary discharge of urine at night in those 5 years of age or older. Primary NE (PNE) is diagnosed in an individual who has never achieved nighttime dryness; in secondary NE (SNE), incontinence follows a dry period of at least 6 months. In either, the enuresis must not be due exclusively to a medical condition or diuretic therapy. Prevalence is estimated at 5% to 10% among 5-year-olds, 3% to 5% among 10-year-olds, and 1% among those 15 years of age and older. Between 5% and 10% of cases resolve annually without treatment. (1) The causes of PNE and SNE remain unclear, although physical, neurologic, and psychological factors; genetics; sleep structure; and other medical conditions have been implicated. (2) Treatment for NE includes pharmacologic and nonpharmacologic options, and many families are interested in complementary and integrative approaches. This review assesses the efficacy and safety of acupuncture/acupressure, hypnosis, and biofeedback in treating NE. Originally developed as a health-care tool in China thousands of years ago, the stimulation of specific points on the body (called acupoints) may be carried out by a variety of techniques, including insertion of thin needles (acupuncture), surface pressure (acupressure), electricity (electro-acupuncture), and laser (laser acupuncture). The effect of acupuncture on PNE was assessed through two recent systematic reviews. (3)(4) The Cochrane review summarized the results of three randomized controlled trials (RCTs). (5)(6)(7) In the first study, 111 patients ages 5 to 15 years were assigned randomly to two different forms of acupuncture. (5) In the treatment group, a needle was embedded under the skin and left in place; in the control group, a needle was placed on the skin surface for 30 minutes each day. The number of treatment courses (of 6 days …