Good afternoon, everyone!
Today we are going to have a quick chat about your kiddos and what it takes for your kiddos to be dry throughout the night. I will also be going over some tips-and-tricks on helping them try!
Some of this information can also be found in the vlog interview with Dr. Amanda Thompson, located on my personal FB page, on 10/20/19.
First- lets define Bedwetting!
Bedwetting is common and is not considered abnormal until your kiddo is over the age of 7. However, some physicians don’t consider it a problem until between 9-10 years old.
Bedwetting is called Nocturnal Enuresis in the medical community and there are two types.
Primary Nocturnal Enuresis is where the child has never remained dry throughout the night for 6 + months. For MOST children, primary nocturnal enuresis is not a result of a medical condition.
Secondary Nocturnal Enuresis is where a child begins to wet the bed again after having completed a 6 month or more dry spell. Secondary is generally associated with a medical or psychological condition. This type of bedwetting is generally not a result of bad behavior or laziness.
Potential Causes of Bedwetting
Genetics
Genetics can play a large role in whether a child will wet the bed. The “bedwetting gene” is prevalent in 1 out of 2 children who have one parent who wet the bed. 3 out of 4 children will wet the bed if both parents experienced nocturnal enuresis growing up. If the child does not have a family connection, they only have a 15% change of experiencing bedwetting.
Biology
For a child to be dry through the night, some biological aspects have to occur. The Anti-Diuretic Hormone is a hormone that is secreted by the brain. It works by causing water in the urine to be reabsorbed by the body, thus decreasing the volume of urine entering the bladder while the child is asleep. If their body is not developing this hormone yet, which could take up to age 9, or the kiddo does not produce enough of the hormone, the child may still wet the bed.
Another aspect can be the brain-bladder connection. Often times, children who are considered bedwetters tend to also be described as “deep sleepers”. Deep sleep affects the communication abilities between the bladder and the brain. If the child cannot recognize the signals from the bladder to the brain due to the heaviness of sleep, they will not be able to contract the pelvic floor muscles (to stop the flow of urine), wake up, and use the toilet appropriately. As the child grows and matures, this brain/bladder connection and muscular control around the bladder should continue to develop. These aspects can also be improved with treatment.
Some children have small bladders- like the actual organ is smaller than what is considered “normal”. If they have a smaller organ, there is less room available for the storage of urine while asleep and may result in the child not being able to hold the amount of urine produced at night. These kiddos tend to urinate more often during the day and are seen to have “sudden urges” to run to the bathroom to try to prevent accidents.
Constipation
Constipation can play a large role in bedwetting as well. If the colon/rectum has a large amount of stool present, it can push into the normal area of the bladder. This will decrease the storage area of the bladder, therefore, decreasing the amount of urine it can hold. The pressure from stool onto the bladder may also interfere with the signals from the bladder to the brain, which can decrease the child’s ability to appropriately respond to bladder fullness signals. These issues can and will remain until the stool or blockage is removed.
Psychological or Physical Trauma
For Secondary Nocturnal Enuresis, physical and psychological traumas may be an underlying cause of bedwetting resurfacing in a previously dry child. Emotional stress can disrupt the child’s normal routines resulting in bedwetting. The results of these traumas can last for short or long periods of time and should never be taken lightly. If you or your child has experienced a trauma, you should seek both physical and emotional assistance to address any and all symptoms brought on by or as a result of a traumatic experience. Examples of traumatic events may include sexual abuse, moving to a new home/school, death of a loved one, and divorce.
Other Medical Conditions
There are some medical conditions that are also associated with bedwetting including neurological conditions, kidney or bladder structural abnormalities, Urinary Tract Infections, Type I Diabetes, Sickle Cell Disease and Sleep Apnea. However, these are less likely than other reasons presented above.
Quick Info for Parents
Before you begin to worry about your kiddo- there are some general guidelines that I like to give parents.
Normal age to stop wetting the bed is between 3-5 years.
BUT- a child CANNOT control bedwetting until:
The child has been dry throughout the day- that means WITHOUT A SINGLE ACCIDENT- for 6 months or greater
Their body begins producing the Anti-Diuretic Hormone
AND enough of that hormone is produced.
Only 70% of 3 year-olds are dry during the DAYTIME
A.K.A we cannot expect those who aren’t dry during the day to be dry at night!
The Antidiuretic Hormone is generally produced between 3 and 5 years old.
Ways you can help your kiddo:
Stay positive! If your child is older and experiencing social anxiety about the condition, they won’t need any extra help feeling bad/anxious about it.
Make sure your kiddo is getting enough water during the day! Yes- this seems like the opposite of what they would need. BUT, if they have irritants in their bladder, you want to help them get rid of those prior to going to bed. If the irritants are still present after going to sleep- the bladder will want to empty sooner rather than later.
Your child should be drinking HALF their body weight (in ounces) throughout the day.
Try to limit the consumption of bladder irritants. Examples would be milk, orange juice, apple juice, tomato sauces, and chocolate.
Do not allow the child to drink anything other than water after 3 pm or when they come home from school. DO NOT LIMIT HOW MUCH WATER THEY DRINK… I know, it seems counter intuitive!
Set a bladder schedule. Most children do not empty their bladders enough during the day which can lead to pelvic floor weakness and dysfunction- which can lead to leakage of urine.
Help to ensure that they are not constipated! Their poos should look like soft bananas. If they are closer to pebbles or the child is straining to poop- they are most likely constipated.
Talk to your physician about potential medication and get into see a Pelvic Floor Physical Therapist!
I hope this was helpful! If you have any further questions- feel free to reach out!
Dr. Paige Hubert, PT
Owner/Physical Therapist at Recharged Performance Therapy
Resources:
https://www.urologyhealth.org/urologic-conditions/nocturnal-enuresis-(bedwetting)
https://my.clevelandclinic.org/health/diseases/15075-bedwetting
https://www.facebook.com/paige.mcmillan.3/videos/vb.100000570241241/2969085273120452/?type=3