Physical Therapy Can Stop Bedwetting!

pediatric bladder physical therapy

Did you know that physical therapy can stop your child’s bedwetting?

We are expert bladder and bowel pelvic physical therapists right here in Grand Rapids, Michigan and we can help you and your child stop bedwetting.

At Purple Mountain Physical Therapy, here in Grand Rapids, Michigan, we specialize in pelvic health physical therapy and this includes pediatric pelvic health.  We know that kiddos and parents often feel stress when it comes to sleep-overs, the daily changing of sheets, the embarrassment your child may experience, the shame that a child might express.  We are here to help you and your family stop bedwetting by delivering you high quality physical therapy that works!  We want you and your child to have less stress around bedwetting by offering research backed and compassionate pelvic health physical therapy that improves your child’s bladder and bowel control, both daytime and nightime.

Is Bedwetting Normal?

Bedwetting is common and is reported in 16-20% of children up to age 6. After age 6, children do begin to age out of bedwetting, but in some cases issues can persist for years; even into adulthood.  Is there anything that can be done to stop bedwetting?  Yes!  Pediatric bladder & bowel physical therapy can help.

Common does not mean normal.

A typically developing urinary system should hit certain milestones:

~3 months: voiding occurs hourly and is not controlled

1-2 years old: awareness of bladder sensation and control of bladder begins

3 years old: voluntary control of periurethral striated muscles. This means that at this age the child’s muscle tissue and nervous system is ready for continence (toilet training).

4 years old: daytime and nighttime dryness achieved.

Bedwetting beyond age 4 is never normal. If you want to stop bedwetting, you should work with a physical therapist to help your child. In fact, the guidelines dictate this should be provided to your child!

We suggest if your child has this, that you look for a pediatric pelvic health physical therapist who can help you identify contributions to your child’s bedwetting.  We will assess and treat your child holistically to identify what are things that can be addressed to improve the bedwetting.  For example, parents are often surprised, for example, that bedwetting can indicate that your child is suffering from chronic constipation. And if we can improve your child’s bowel habits, then their nighttime wetting can improve.  Because physical therapy can stop bedwetting, our parents usually report to us that the entire household is less stressed!

The International Children’s Continence Society (ICCS) recommends active treatment for bedwetting beyond age 6.

“Treatment is not only justified but mandatory.”  – ICCS Standardization document 2010

The psychological stress that bedwetting causes in a child is well documented.  Beyond age 6, children are reaching the age where they feel different from their peers if they are bedwetting and bedwetting may impact their comfort participating in age appropriate activities, like sleepovers! Bedwetting places unnecessary stress on a child and there is safe effective physical therapy treatment available to help stop bedwetting.

Let’s Repeat The Guideline, in case we haven’t been clear:  Treatment is mandatory for pediatric bedwetting!  And here we are ready to help you and your child stop bedwetting!

Is bedwetting hereditary?

Research does support that a parent who wet the bed is more likely to have a child who wets the bed.  However, we also have research to support that constipation may be the common cause for both the parent and child who both experience pediatric bedwetting.   We know that what is passed on is likely a tendency toward constipation and a bladder that is sensitive to a stretched rectum.

The most common cause of bedwetting is constipation.

A full rectum will squish the bladder and can limit bladder capacity. This can cause the bladder to empty involuntarily when the child is sleeping at night or during the day.

If you, as a parent, wet the bed until 6, 8, 12 years or older, it does not mean that your child will have to do the same! Treating the underlying constipation can cure bedwetting.  As pediatric bladder & bowel physical therapists we know that many parents think that their child is not constipated.  However, when we partner with you to discover and monitor your child’s bowel movement habits, kids and parents find it enlightening to realize that the bowels are not actually functioning as well as they thought.

How can physical therapy help?  We will address constipation & also daytime bladder habits!

The first step in you and your child’s physical therapy journey will be to have an evaluation.  We work closely with parents and children to create a safe and trusting partnership, so that you and your child feel supported, well cared for and hopeful to experience improvements.  Our approach with children is positive, encouraging and rewarding.  We celebrate your child’s success and intentionally motivate your child to achive the goals we create together.  The evaluation will include a discussion regarding your child’s bladder and bowel habits, developmental milestones, diet and other questions.  These things all help us to help you and your child.

Certainly, we will be addressing bedwetting by treating any underlying constipation.  We do not prescribe medications.  Instead, we provide you and your child clear at-home methods to improve constipation while also giving you and your child effective, therapeutic treatment in our clinc.  We provide gentle, hands-on manual therapy to help promote intestinal mobility.  Additionally, we practice with your child effective toileting strategies, which includes not holding in your poop and listening to your body and knowing when to go to the toilet.  In nearly all cases, when constipation is adequately addressed, we can stop bedwetting.  This is because physical therapy works! And we are specifically trained in pediatric bowel & bladder developmental stages and how to treat problems with these.  At Purple Mountain PT, we also can partner with your child’s healthcare team to effectively treat constipation problem, if present.  We will advise you and develop a plan to implement a variety of interventions that have been shown in clinical studies to be important physical therapy treatment components to stop bedwetting.  Our treatment includes behavior modifications, dietary recommendations, pelvic floor retraining through exercises and gentle guidance, manual therapy (external only), and exercise to strengthen the core and hip musculature.

Physical Therapy Pelvic floor muscle re-training to help stop bedwetting.

The pelvic floor is responsible for holding pee and poop in and letting it out. Sometimes when children have developed bedwetting, constipation or urinary problems (such as incontinence, frequency, urgency or holding their pee too long), the pelvic floor muscles get confused and need to be retrained. This means that when the pelvic floor needs to relax in order to empty the bladder or the bowel, it may not be relaxing fully. It also may not be engaging well during the day if your child is experiencing daytime bladder or bowel leaks.

For children, pelvic floor retraining is focused on external treatment so they can learn to tune back into their body and build awareness of the pelvic floor musculature.  We use positive and effective methods to help your child learn the movement patterns and techniques needed to control the bowel and bladder, both for holding things in and for letting things go.

Manual therapy (external only) can be effective to help stop bedwetting and pediatric bladder & bowel problems!

We partner with parents to provide your child therapeutic and effective treatments.  Physical therapy can stop bedwetting and, in doing so, also can improve your child’s self esteem and resolve shame and embarrassment.  Sometimes our treatment includes gentle, hands-on treatments that are directed to your child’s spine, abdomen, pelvis or legs.  To be clear, all treatment for a child is external and gentle.   For example, when stool gets backed up in the rectum it is very common that peristalsis (the coordinated contractions of smooth muscle in your large intestine) gets disrupted. Manual therapy to the abdomen, lower back, and hips can help restore optimal digestion and improve posture to reduce constipation and also calm down an overactive bladder.  We also use exercise that are fun and developmentally appropriate to promote posture, breathing mechanics, and mobility of abdominal tissue and the hips/pelvis.

Children with constipation commonly have weakness in their hips and core musculature that is contributing to their voiding difficulties.

At Purple Mountain Physical therapy we develop individualized exercise programs that address your child’s specific deficits in a  fun and engaging way so that their bedwetting can stop and their bladder and bowel control during the daytime can be optimized, as well!

Behavior modifications that can help stop bedwetting!

In physical therapy, we may work on addressing behavior modifications, such as toileting behaviors.  It is common that we find kiddos who don’t like to use the toilet.  Or sit on the toilet and hold their breath and strain incorrectly.  We are experts at identifying and coaching you and your child for how to effectively gain control of your bowel and bladder so bedwetting can stop and urinary frequency, urgency and incontinence can also resolve.  Here is a link to a booklet about pediatric bedwetting that may be helpful for families to use at home

The Rectum is Important to Optimize to Stop Bedwetting and our physical therapy will help you and your child know how to improve this!

The rectum (the last part of your intestine before the anus) is a sensing organ. When it is functioning normally, it will communicate to the nervous system as it fills and give appropriate sensations to go to the bathroom. When the rectum has been stretched, as in a child who is chronically constipated, the rectum switches from a sensing organ to a storage organ. That means that the delicate signal system from the rectum to the brain has been disrupted. To allow this communication system to heal, we often recommend a bowel program to give your child an opportunity to empty their bowels on a regular basis.

What’s Your Child’s Toileting Frequency?  Our physical therapy will optimize daytime bladder and bowel function in order to stop bedwetting!

We help you and your child become aware of how often they urinate and have a bowel movement and what is normal/optimal.  We address toileting frequency and coach you and your child on how to either increase how often you urinate (if your child holds urine too long) or lengthen times between urinations (if your child urinates too frequently).  Improving daytime urination habits and getting them optimized is crucial to stopping bedwetting.  This is why physical therapy can help!  We address all the things that are playing into your child’s bedwetting.

What’s your child’s toileting postures?  Techniques?  Breathing habits? Pelvic Floor engagment?

Together with the parent, we will likely also assess how your child physically sits on the toilet. We love a stool or squatty potty to help fully empty the rectum. When your child is sitting on the toilet they should be able to sit with their feet slightly wider than hip distance and planted firmly on a flat surface. Their trunk should be upright with hips hinged forward, so that their arms can rest comfortably on their lap. This posture promotes pelvic floor relaxation and complete emptying of the rectum.

A slumped posture can make it more difficult to poop as well! When your child slouches on the toilet, it puts the pelvic floor in a shortened position which may also make it more difficult to have a complete bowel movement.

Does Your Child Strain? Physical therapy can help this in order to stop bedwetting!

Many children try to strain when sitting on the toilet. If you notice your child’s face is turning red or they are holding their breath while attempting to poop, it is likely that their pelvic floor is not functioning optimally. This may actually be making it more difficult for them to have a healthy bowel movement. Having your child attempt to blow up a balloon, blow into a straw, or blow a pinwheel while toileting is a simple way to try to help their pelvic floor work more effectively.

Would Your Child Benefit from Playing an online Game while on the toilet?  Probably not!  It won’t help stop bedwetting and, in fact, is not advised in a physical therapy program.

We know that some kiddos just don’t like to use the toilet!  They avoid it!  The household gets stressed and the parent comes up with a reward system to entice the child to get on the toilet.  Quite often parents give rewars, such as you can play an online game when you are sitting on the toilet.   We’re parents, we get it that  you need to use what works for your kiddo.  However, to have an effective bowel movement, your child needs to learn to tune into their body.  They need to be able to know what it should feel like.  Our physical therapy program for your child may include effective treatments to help your child learn how to listen to their body, so they can actually feel when they should go to the toilet to urinate or have a bowel movement.  We have found that it takes time and repetition for your child to tune into their body. Unfortunately, if they are distracted by a video or game, then this learning simply is not happening.  And, sorry parents, but if you read your phone during your own toileting habits, that is not recommended for the same reasons:  you need to tune into your body and relax, too!

How long should I have my child sit on the toilet?

A potty try should be about 5 minutes. Sometimes it can take that long for the muscles of the pelvic floor to fully relax and let down, which is needed for a poop! However, sitting for too long can lead to straining and negative associations with toileting.

To stop bedwetting, positivity helps!  Our physical therapy works to stop bedwetting, to improve daytime continence and to boost self esteem!

One key to our success with your child is we reward your child and help them to feel motivated to have success!  We love to see a child proud of themselves and we work to stop your bedwetting so you can come back to us to report your success!

We always recommend making bathroom time as positive and enjoyable of an experience as possible. If your child has developed an aversion to the toilet, we may work on progressively increasing comfort and tolerance to the bathroom and the toilet to reduce resistance.

How can I reward my child?

If a reward is used for toileting, we always recommend it happens AFTER an ATTEMPT for a bowel movement. We emphasize attempt because your child may have very little control over whether or not they actually evacuate stool during a potty try, but if they are completing the correct behaviors (detailed above) they are doing everything in their power to be successful on the toilet. That deserves some major kudos!

Dietary suggestions to help stop bedwetting.

Fiber is a major factor in determining stool form and has a huge impact on constipation problems!

95% of Americans do not get enough fiber in their diet.

What is fiber anyway?

Fiber is the part of food that does not digest to create energy. Foods that are high in fiber usually have a lot of crunch or texture to them. Examples of foods high in fiber include: pears, apples, broccoli, carrots, avocado, kale, lentils, and much more!

Low fiber foods are usually highly processed and/or smooth in texture. Examples of low fiber foods include: cheese, candy, white bread, pasta (if not whole grain)

Fiber recommendations for children can vary based on who is giving the recommendations:

  • Upto age five, generally 10-15 grams of fiber/day is recommended.

  • After 10 years old children should be consuming fiber at adult levels, 25-35 grams/day (Williams 1995)

  • 14 g of fiber for every 1000 calories eaten (American Heart Association)

  • Age 1-3: 19 grams; Age 4-8 25 grams; Age 9+ 30 grams (Institute of Medicine)

  • Do you see how confusing this can be?  The range for kids is anywhere from 10 grams/day upto 35 grams/day!  The bottom line is that you can look at your child’s stool consistency and see whether they may be getting too little fiber (which is commonly the problem).

Stool form can be one indicator of whether or not your child has the correct amount of fiber and water in their diet.  However, stool form by itself does not determine if your child is constipoated.  A stool the shape of a banana is generally optimal and easy to pass.  Small or large balls are generally not great.  A child can have the optimal stool shape (banana) but still not be fully emptying their rectum, so it gets complicated to know what is going on.  This is why a pediatric bowel and bladder physical therapist is a good partner for your family to deliver your results that can help stop your child’s bedwetting.

Fluid Intake

Appropriate water intake is essential for health of your child’s bladder and bowel function. Limiting water will not reduce bedwetting or daytime incontinence and in fact can make the situation worse. Maintaining adequate hydration promotes better bowel function and reduces constipation which will help reduce stress on the bladder and reduce bladder leaks.

A good benchmark for water intake is about half of your child’s body weight in ounces.

For example: a child who weighs 46 pounds should drink about 23 ounces of water per day.

However, fluid requirements vary a lot based on your child’s activity level. If they are very active and sweating, they will likely need more water.

A good indicator of adequate hydration is their urine color. A well hydrated kiddo should have urine that is very pale yellow to clear.

What if my child won’t drink water?  Does it all have to be water?

Water is the most ideal source of hydration for kids (and adults!).  For some children there can be a clear correlation between what type of fluid they drank and their bladder function. Watch for trends. Does your child drink apple juice, for example, and then have to urinate frequently?  Or does the bedwetting worsen?  Some other liquids such as milk or highly acidic drinks can be irritating to the bladder and increase the likelihood of urinary dysfunction, including pediatric urgency, incontinence, and bedwetting. Drinks that are high in calories, like sodas, also deliver more calories with very little fiber which can make constipation worse.

For kids who don’t like water, putting a splash of juice in with their water or putting some cut strawberries or lemon in their water can make drinking a little more fun and flavorful without adding too much of the bladder irritants.

The Bottom Line regarding how to stop bedwetting:

Bedwetting is common, but not normal and has known psychological stress on your child and your household.   Bedwetting is often driven by constipation and improper daytime habits for the bladder.  As pediatric pelvic physical therapists, we know how to effectively and positively help your child to learn how to use their bladder and bowel optimally.  We also know how to teach a parent to support your child.  This isn’t easy to overcome, but our expert care brings clarity to a puzzling situation.  Constipation and bedwetting are multifactorial and individualized care is necessary, which is why we take the time to learn about your child’s daytime and nightime bladder and bowel habits. If you are interested in learning more about our pediatric physical therapy to help stop bedwetting, contact us today and we can begin with an evaluation.  Our doctors of physical therapy promise to give you our best!

Peace,

Dr. Maureen O’Keefe, DPT and the Purple Mountain Physical Therapy Team