MAY 11, 2017
According to the International Children’s Continence Society (ICCS) 5-7 million children in America are bed-wetters. Despite this statistic, it is common for a child to assume he or she is the only one experiencing this problem. This can lead to negative feelings such as guilt, isolation and anxiety for both the child and his or her family. Parents often become frustrated and wonder if their child is actually trying, or if he or she is just being lazy. It is important for anyone dealing with this challenging situation to understand nobody wants to be wet, bed-wetting is more common than most people realize and most importantly, it is treatable.
Voluntary control of bowel and bladder function is typically achieved between 3 and 5 years of age, and is dependent upon the development of each individual’s neuromuscular system. Notice this is a wide range, and does not fit in with the expectation of many pre-schools, which require toilet training for admission to their 3 or 4 year old programs. It is estimated that 10% of 5-7 year olds wet the bed, which means 2-3 students in most young elementary school classrooms are likely bed-wetters. During each year of growth after this, 15% of children will spontaneously “outgrow” bed-wetting. While this is great news for some, it also means that without intervention, 1-3% of 18 year olds are still wetting the bed.
So, what causes bed wetting, and how can it be treated? Bed-wetting, also known as enuresis, can be caused by a number of factors. Some common contributing culprits include: constipation, abnormal daytime urinary frequency, abnormalities in the brain or spinal cord, structural abnormalities of the urinary system, weak and / or overly loose or tense muscles in the pelvic region, diet, psychological factors, endocrine disorders or other medical conditions. It is essential to determine what is causing bed-wetting in order to treat it. In most cases, addressing issues during the day-that you may not even realize are issues-will lead to dry beds, confident kids and proud parents.
For example, constipation is a major contributor to both daytime and nighttime urinary incontinence. Often, parents are aware that their child is constipated due to a longstanding history of painful and hard bowel movements. However, in many cases, children are having regular bowel movements, but failing to fully empty. This can lead to an overstretched rectum that crowds the bladder, making it difficult to empty on demand and increasing the risk of leakage with relaxation. Constipation is generally initially addressed by enema and / or laxative use, but long term management requires other interventions. Diet and exercise modifications, changes in positioning on the toilet, routine bowel movement schedules, learning to relax the muscles of the pelvic floor and effective techniques for bearing down are all important components of long term constipation management. In some cases, use of other tools including: massage techniques, taping, relaxation / breathing techniques and electrical stimulation are also effective.
Sometimes children avoid urinating during the day due to fear of public restrooms, limited time, bullying in school restrooms or just being distracted by daily activities. This can lead to an overstretched bladder, causing difficulty with emptying. In other cases children are emptying too frequently, limiting the ability of the bladder and the pelvic floor muscles to learn how to hold in urine as they were designed to do. In either of these situations, learning healthy daytime habits can help lead to night time dryness. Developing an awareness of the muscles that allow for bowel and bladder emptying and learning how to better control them is an essential part of this process.
Pelvic floor physical therapy is a specialization within the field of physical therapy that focuses on improving the awareness of how to coordinate and control the muscles of the pelvic floor. Learning to effectively contract and relax these muscles is an essential part of developing and maintaining continence. It is also a skill that many people of all ages take for granted, as it generally occurs fairly automatically. But unfortunately, for many, this is not the case. In these instances, it is crucial to seek the skills of a qualified professional with expertise in the complex anatomy of the pelvic floor and experience in techniques to effectively train or re-train these muscles. It is equally important to work with a practitioner who is comfortable working directly with both the child and his or her parents to instill confidence and celebrate success along the way.