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Bedwetting and Pelvic Floor Physical Therapy

What is nocturnal enuresis and when is it a problem?

Nocturnal enuresis is a fancy term for bedwetting. (Nocturnal meaning nighttime, and enuresis meaning involuntary leakage of urine). Typically, a child will achieve nighttime dryness 6 months-1 year following daytime potty training OR by age 6. Many professionals consider bedwetting beyond the age of 6 or 7 to be ‘prolonged’ and require further investigation. However, it is often a personal/family decision as to when bedwetting is a problem. If your child is becoming embarrassed or distressed by nighttime wetting, or if it is impacting their quality of sleep, it may be time to talk to your child’s pediatrician about addressing the situation.

What are the most common causes of prolonged bedwetting?

#1) Constipation- The most common cause of bedwetting is constipation. When your child’s lower colon and rectum become full of hard stool, this takes up space and pushes on the bladder. If your child has less than 4 bowel movements per week, has frequent hard/painful bowel movements, passes large stools that may clog the toilet, or has frequent abdominal pain, your child may be constipated. An abdominal x-ray ordered by an MD can assess the presence of stool backed up in your child’s colon/rectum.

#2) Genetics- Children are more likely to experience prolonged bedwetting if they have immediate family members who also experienced prolonged bedwetting. If one parent experienced prolonged bedwetting, the child has a 40% chance of doing the same, and a 77% chance if both parents experienced this. In this instance, there is usually an underproduction of antidiuretic hormone and medication may be necessary.

#3) Obstructive sleep apnea/sleep disorders- If your child snores or has confirmed obstructive sleep apnea, their sleep cycle may be so disrupted that their bodies don’t know when to stop producing urine. This often results in a low level of antidiuretic hormone as well, so medication or referral to an ENT to address the snoring/apnea may be appropriate.

#4) Neuropsychiatric disorders, such as ADHD- Children with ADHD are 3 x’s more likely than children without ADHD to experience persistent nighttime wetting. This is due to the same deficits in inhibition also responsible for nighttime wetting. This could be due to lack of arousal and inability to inhibit bladder reflexes that should be happening at night to withhold urine.  

How can a physical therapist help with bedwetting?

Physical therapists can be helpful no matter the cause of bedwetting. In children with constipation, there are many manual/massage techniques, positioning recommendations, low level E-stim modalities (if appropriate) and pelvic floor coordination exercises that can be implemented to get stool moving through the colon quicker. These would typically be done in conjunction with some over the counter medication or supplements recommended by your child’s pediatrician. In children with a genetic, sleep-related, or other medical cause, there may be an element of pelvic floor dysfunction present. This would prevent the child from fully emptying their bladder during the daytime and contributing to leakage overnight. In addition, a physical therapist trained in pediatric pelvic floor therapy will be able to advise on fluid intake, dietary adjustments, or bowel/bladder routine changes. These tips may improve your child’s bowel and bladder health overall.

Lauren Hirsch, PT. Clarksville, IN