Author| Dr. Maureen O’Keefe, specialist in bladder and bowel physical therapy
If you are wondering how much bedwetting is normal, we’ve got answers for you!
We are Purple Mountain Physical Therapy and we specialize in providing treatment to children, of all ages, who experience bedwetting. We are located in Grand Rapids, MI and patients come to us from all over the state to receive our care. If you are interested in learning more about our physical therapy to help pediatric bedwetting and bladder or bowel control problems, you can reach us at (616) 516-4334 or contact us here.
When is bedwetting normal and how much bedwetting is too much?
Between ages 2 and 4 most kids stop bedwetting. However, upto age 6 years old 16-20% of kids still experience bedwetting. After age 6, if a child still experiences bedwetting, this is considered not ideal and something for which treatment guidelines mandate that treatment intervention should occur. In fact, it is not normal to experience any bedwetting after age six, although it is happening in upto 1 in 5 kids.
Is there anything that can be done to stop bedwetting? Yes! Pediatric bladder & bowel physical therapy can help.
Our doctors of physical therapy are specially trained in pediatric bladder and bowel development and rehabilitation. We work with children of all ages and all backgrounds. Some kids are typically developing, other kids experience regression with their bladder or bowel control and some kids have ongoing bedwetting. Regardless of your child’s problem, we are able to help you. To learn more about our pediatric bladder and bowel physical therapy, including our bedwetting program, contact us here or call (616) 516-4334.
What are normal bladder control milestones? At what ages would a parent know that bedwetting is not normal?
~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). If you would like to read about potty training, here is some information we have for you.
4 years old: daytime and nighttime dryness achieved.
If at 4 years old, bladder and bowel control continue to be a real struggle and frustration for you or your child, consider bowel and bladder PT.
Watch for signs that bedwetting is a problem, such as psychological distress, constipation, daytime troubles, a parent feeling angry with the child over bladder/bowel issues and toilet avoidance. If you are wondering how much bedwetting is normal, it is likely that your child would benefit from pediatric bladder physical therapy.
At Purple Mountain PT we 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! To learn more about our physical therapy to help your child’s bedwetting, contact us here.
Once your child is 6 years old, if bedwetting persists, The International Children’s Continence Society (ICCS) recommends active treatment.
“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. If you are interested in learning more about our physical therapy to help pediatric bedwetting and bladder or bowel control problems, you can reach us at (616) 516-4334 or contact us here.
Our pediatric bowel and bladder physical therapy is an excellent option that is therapeutic, uplifting, effective and does not rely on medications or alarms.
What if my child is a pre-teen or older, can physical therapy help bedwetting for these ages? Yes we can!
We work with any person under the age of 18 who experiences bedwetting. If your child is “older”, have no fear, we commonly help adolescents and teens who have bedwetting. Even though this is a private matter inside your home, the truth is that there are countless adolescents and teens who struggle with bedwetting. We recommend getting treatment at an earlier age, simply because it can help ease anxiety and household stress and promote your child’s social skills when bowel and bladder control has been achieved. But, any child who is struggling, even an adolescent or teen can benefit from bladder and bowel physical therapy. To learn more about our physical therapy to help your child’s bedwetting, contact us here.
If you are wondering how much bedwetting is normal, it is likely that your child falls into a category of being 6 years of age or older and would benefit from pediatric bladder physical therapy.
The mental health strain that bedwetting has on both kids and parents is well known. By providing you treatment for bedwetting, we find our kids and families improve their stress and anxiety around their bladder control issues.
Parents, we are here to support you and your child. We understand the stress that bedwetting can cause parents, the household and your child. We know that bedwetting can contribute to stress, anxiety and avoidance of some social activities, such as sleep-overs. We have heard from parents that they are fatigued from laundry with washing sheets and pajamas. With bedwetting, children may experience embarrassment and sometimes the parents also experience this embarrassment. If you would like to learn more about our physical therapy to help pediatric bedwetting and bladder or bowel control problems, you can reach us at (616) 516-4334 or contact us here.
Here is a quote from one paper, regarding the mental health impact of bedwetting.
“The study found a higher rate of parent-reported psychological problems in children with bedwetting and combined wetting compared with those with no wetting problems.”
–Journal of Pediatric Psychology, Volume 32, Issue 5, June 2007, Pages 605–616
The psychological challenges found in this study included separation anxiety, social fears, general anxiety, attention & activity problems, oppositional behavior, conduct problems and antisocial activities. Because we are pediatric bladder and bowel physical therapists, our training includes understanding of these stressful factors that can be going on for your child who has bedwetting.
We are here to help your child stop bedwetting by delivering you high quality physical therapy that works! To learn more about our physical therapy to help your child’s bedwetting, contact us here.
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.
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).
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. To learn more about our physical therapy to help your child’s bedwetting, call 616-516-4334 or contact us here.
Fluid Intake Influences Your Child’s Bedwetting. And we aren’t simply referring to drinking water before bed. It is the fluid intake during the whole day!
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.
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.
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.
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. To learn more about our physical therapy to help your child’s bedwetting, call 616-516-4334 or contact us here.
The Rectum is Important when it comes to Bedwetting! For kids who experience bedwetting, often their rectum is stretched out and filled with stool.
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. The good news is that a child’s stretched out rectum can heal and return to adequate size, although it does take time. It also take diligence at home to optimize bowel function. Our doctors of physical therapy will support and guide parents and children along their journey to resolve bedwetting and heal their rectum and gut. 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. To learn more about our bowel program to help your child’s bedwetting, contact us here.
Pediatric bladder and bowel physical therapy may be exactly what your child needs to improve their control:
A child who wets his or her pants (diurnal enuresis) or experiences bedwetting (nocturnal enuresis) needs help. Our physical therapist can design a program for your child that facilitates their learning to control their bladder and bowel, including with bedwetting. This isn’t always easy to overcome, but our expert care brings clarity to what is sometimes a worrisome problem.
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. To learn more about our physical therapy to help your child’s bedwetting, contact us here.
In physical therapy for bedwetting we teach your child effective toileting posture, techniques for controlling their bladder and bowel and use effective exercises to enhance their core muscle awareness, strength and control.
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.
To achieve our goal or resolving your child’s bedwetting, we also must assess and teach your child effective toileting postures, techniques, breathing habits and pelvic floor engagement.
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. We teach your child how to relax, sit on the toilet and achieve a complete urination and bowel movement. This is an important portion of improving bedwetting, because kids often have poor daytime bladder and bowel habits that contribute to nighttime wetting. It is not normal to experience any bedwetting beyond age six, although it may be somewhat common. We are here to help your child overcome this issue. If you are interested in learning more about our physical therapy to help pediatric bedwetting and bladder or bowel control problems, you can reach us at (616) 516-4334 or contact us here.
Does Your Child Strain when passing a bowel movement? If so, it may be contributing to 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. To learn more about our physical therapy to help your child’s bedwetting, contact us here.
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.
Sometimes parents give a reward to a child for sitting on the toilet, to encourage the child to use the toilet. However, an online game, while on the toilet distracts your child from the task at hand. To pass an effective bowel movement or to completely empty their bladder, your child needs to learn to tune into their body. 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. Instead, if rewards are needed, we suggest rewarding them after they tried to use the potty, even if they didn’t actually complete their bowel movement. To learn more about our physical therapy to help your child’s bedwetting, call 616-516-4334 or contact us here.
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.
Treatment is mandatory for pediatric bedwetting! We are ready to help your child’s bedwetting. Don’t allow it to persist, the psychological consequences aren’t worth ignoring this problem.
This is such an important point to make. In spite of our culture that may not support children and parents to overcome bedwetting, you need to get treatment for this. It is not normal to experience bedwetting after age 6. So, the answer to the question of how much bedwetting is normal for a child is none. No bedwetting is the goal, although we know that upto 20% of kids 6 years old and up struggle with bedwetting. There are effective treatments to help your child overcome this problem. We are here to help. If you are interested in learning more about our physical therapy to help pediatric bedwetting and bladder or bowel control problems, you can reach us at (616) 516-4334 or contact us here.
One key to our success with your child is we help your child to feel motivated to have success! We love to see a child proud of themselves and we work to stop bedwetting so you return to us and report 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. To learn more about our physical therapy to help your child’s bedwetting, call 616-516-4334 or contact us here.
Purple Mountain Physical Therapy, located in Grand Rapids, MI offers in-person and telehealth physical therapy for kids who have bladder and bowel problems, including bedwetting. We understand you may be frustrated by the ongoing challenging with getting your child to not wet the bed, but good treatment exists. We pledge to give you and your child a supportive place to receive excellent care. If you are interested to learn more about our program for pediatric bladder and bowel care, including bedwetting or constipation treatment, you can call us at (616) 516-4334 or contact us here.
Peace,
You may be interested in these additional articles we’ve written about pediatric bladder and bowel issues:
Why Does My Ten Year Old Wet The Bed?
How do I Stop My Child From Wetting the Bed at Night? Tips
Does Physical Therapy Help Constipation?
Does Chewing Help Constipation?
Why is My Child’s Poop So Big?
