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Bedwetting 101: How PT Can Help!

Bedwetting is a significant issue in our children today, affecting 15% of girls and 22% of boys worldwide. The age at which a child achieves nighttime dryness can vary widely and is dependent on a host of factors. Most children will gain nighttime dryness between the ages of 4 and 6, or 10-12 months after they are initially daytime potty trained. Around this age, a child’s body will begin to produce anti-diuretic hormone, a hormone that slows production of urine while we are asleep. Many medical professionals agree that consistent nighttime wetting after the age of 6 years old is cause to seek additional information and treatment. After this age, there is only a 15% chance that bedwetting will spontaneously achieve nighttime dryness or ‘outgrow’ bedwetting. 

When discussing bedwetting (enuresis), we divide it into two categories: primary or secondary. Primary enuresis is bedwetting when a child has never achieved consistent nighttime dryness. 

If a child is wetting overnight beyond age 6, any anatomical abnormalities of the urologic and neurologic systems should be ruled out. Absent of known urologic or neurologic diagnoses, the following causes rank at the top of the list:

Constipation:

Constipation is the leading cause of prolonged bedwetting in children. A full, overstretched rectum presses on and irritates the bladder nerves. This can cause bladder spasms and overactivity, resulting in pee leaks, especially at night when a child is asleep. Until the rectum is cleaned out and shrinks back to a normal size, a child is likely to continue wetting the bed.  

Genetics:

Genes can play a huge role in bedwetting. A child with one parent who wet the bed into middle-late childhood is 50% likely to do the same. That figure raises to 75% if both parents experienced prolonged bedwetting. Researchers are looking into specific chromosomal abnormalities that can predispose a child to bedwetting. Anti-diuretic hormone production, bladder overactivity, and being prone to constipation are all other factors that are influenced by genetics that can also cause prolonged bedwetting.

Sleep obstruction:

If a child has difficulty sleeping or has confirmed obstructive sleep apnea, bedwetting is more likely. This can interfere with anti-diuretic hormone production and sleep-wake cycles, making it difficult for the body to slow urine production overnight.  

Secondary enuresis is bedwetting that returns after a child has been consistently dry at night for at least 6 months. Secondary enuresis, a return of consistent bedwetting, can be caused by new onset constipation, but may also be a sign of an underlying medical issue, such as type 1 diabetes or tethered spinal cord, among others. Return of bedwetting should be discussed with a child’s pediatrician as soon as possible.   

Physical therapists with pelvic floor specific training can help with bedwetting in a majority of cases! 60-70% of children who wet the bed have pelvic floor muscle insufficiency, meaning the muscles of the pelvic floor lack the strength and endurance to maintain continence throughout the night. A variety of exercises and use of animated biofeedback can help a child become more aware of where these muscles are, how to use them, and increase strength/endurance. Pelvic floor PT’s can help with improving daytime bladder habits, ensuring that a child’s bladder can be fully emptied before going to bed. They can also address constipation using a variety of techniques including abdominal massage, core strengthening, defecation training, and improving coordination of pelvic floor and core muscles. In cases where genetics play a role, therapists can help families complete a ‘dry-morning program’ or ‘dry-bed training’ after constipation and pelvic floor muscle strength has been addressed. There are many options when it comes to these protocols that do not require the use of an alarm system which can disrupt a child’s sleep. 

If your child struggles with bedwetting, pelvic floor physical therapy may be beneficial. Call our office (502)-633-1007 for a free 15 min screening with a pelvic floor physical therapist to see if PT may be right for your child. 

– Lauren Hirsch, PT, DPT