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An Osteopathic Approach to Secondary Enuresis and Encopresis: Recovering Autonomic Stability

Journal: The AAO Journal Date: 2022/06, 32(2):Pages: 8-9. doi: Subito , type of study: case report

Free full text   (https://meridian.allenpress.com/aaoj/article/32/2/8/482676/LBORC-NUFA-Poster-Abstracts-2022-Residents)

Keywords:

case report [514]
encopresis [1]
enuresis [10]
children [228]
pediatrics [375]
OMT [2951]
osteopathic manipulative treatment [2973]

Abstract:

Introduction/Background: Anticipated bladder control at night is expected by five years of age. If intermittent urinary incontinence while asleep continues, at least two times per week for three months, it is then classified as enuresis. This burden is experienced by an estimated 6 million children in the United States. The pathophysiology of enuresis is multifactorial, though an underlying component is believed to be consistently contributory: autonomic instability. The L1-L3 sympathetic storage reflex and the sacral plexus parasympathetic voiding reflex must function properly for daily continence. Encopresis is defined as involuntary bowel movements in inappropriate places at least once a month for three months or more in children four years and older. Case: M, a nonverbal 8-year-old male with Down’s syndrome, presented to osteopathic manipulative medicine clinic with secondary enuresis and encopresis. It was hypothesized that the COVID-19 pandemic complicated by school closure had disorganized the patient’s learned voiding schedule. The primary goal of this case was to re-establish continence with utilization of osteopathic techniques focused on optimizing spinal mechanics and autonomic function while utilizing the biomechanical, neurologic, metabolic, and psychosocial osteopathic models of treatment. Techniques consisted of V-Spread, Sub-occipital Inhibition, Rib FPR, Sacral Ligamentous BLT, and Ischiorectal Fossa Release. Results: M had a large bowel movement following recent visits, and with reduced incidence of nocturnal enuresis and encopresis with increased daytime toileting. Discussion: The findings from our case study support other low-level evidence that OMT can be useful in the management of enuresis and encopresis, by possibly moderating autonomic function and would recommend further follow-up with a prospective study. Limitations were complicated by social determinants of health; primary parent, multiple long car-rides, confounded by restarting school schedule with previous routine.


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