A 5.5-year-old child with nocturnal enuresis was found to have a sacral fissure.

Patient's question:

A 5.5-year-old child has nocturnal enuresis, requiring adults to wake them up for urination as they cannot wake up on their own. There is no improvement in the condition, and the child is very worried about it. Recently, it was discovered that the child has a sacral crypt fracture. Is there a definite connection? Is it necessary to undergo uroflow rate testing (which would be very painful)? The child is otherwise healthy, with normal bowel movements. During the day, there is slightly increased urinary urgency and frequency. The child consumes a lot of fruits or dairy products and has slightly picky eating habits, not liking vegetables. Some research has been conducted, and some training methods have been tried, such as stopping urination midstream for a few seconds, encouraging the child to hold back urine, and waking them up during nighttime urination. However, due to poor consistency, no improvement has been observed. Herbal remedies have also been taken without any effect. Sincerely seeking...

Doctor's answer:

Hello, there is a certain relationship, motor development
Parent's question
Congenital sacral dysraphism
Congenital sacral dysraphism
Expert's answer
Sacral dysraphism is a type of congenital hidden spinal dysraphism, where there is a fissure in the sacral vertebrae. This fissure is caused by the failure of the two sides of the sacral vertebrae to fuse at the midline during the embryonic period, and it belongs to a neural tube defect. The cauda equina nerves, which run within the sacral vertebrae, along with the dura mater, protrude through this fissure outward, leading to adhesions and fixation over time. As children grow rapidly and their spines grow quickly, the spinal cord and cauda equina nerves, due to adhesions and fixation, are stretched, tightened, and ischemic, causing a series of symptoms such as urinary urgency, urinary frequency, urinary incontinence, constipation, fecal incontinence, calf muscle atrophy, high arch feet, hammer toes, inward-pointing feet, limping, and even paralysis, which are collectively referred to as "tethered cord syndrome" in medicine. Early surgery is necessary to separate the cauda equina adhesions, cut the filum terminale, and release the sacral cord to prevent the occurrence of "tethered cord syndrome."