Nope, Deep Sleep Doesn't Cause Bedwetting

Steve Hodges, MD

 At my pediatric urology clinic, just about every parent of a bedwetting child is convinced that “deep sleep” explains the wet sheets.

Parents tell me, “She’s such a deep sleeper that you could blast Motorhead in her room and she wouldn’t budge.”

Or, “When he’s out, he’s out — there’s no chance of waking him up.”

In many cases, the child’s pediatrician has confirmed this theory or suggested it in the first place. And when families search online, they find additional support for the idea that deep sleep causes bedwetting.

For example, under the heading “Causes of Bedwetting,” the American Academy of Pediatrics (AAP) states: “Your child is a deep sleeper and does not awaken to the signal of a full bladder.” This statement tops a list of 8 bedwetting “causes.” And in an article titled "Nocturnal Enuresis in Teens," the AAP lists among the “contributing” factors to teenage bedwetting: “a deep sleep pattern that can be part of normal adolescent development, inconsistent sleep schedule and limited hours sleeping.”

On its website, the Enuresis Treatment Center calls bedwetting “a treatable sleep disorder” and claims that “targeting treatment to changing the sleep pattern will not only end the bedwetting, it will allow the bedwetter to experience better night’s sleep.”

There are two problems with the deep-sleep theory: 1.) it makes no sense, and 2.) no evidence supports it.


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Exercising During Your Second and Third Trimester

Dr. Kristin Anderson ,PT, DPT, OCS, CLT

As your baby continues to grow, you are going to be experiencing more wonderful changes in your body. Your abdomen is growing, meaning that the abdominal muscles are no longer in a prime position to work or help support you. Hormones are creating increased laxity of your joints to prepare to make room for the growing baby in your pelvis. Your diaphragm (breathing muscle) is rising, meaning there is less room for you to expand your lungs. You may notice that it is easier to get out of breath, even just walking up the stairs! To top it off, your heart is having to work harder because it is working to circulate 50% more blood volume then it normally does!

Our bodies are amazing and we need to appreciate the changes that our bodies are going through. Here are some guidelines for exercise in your second and third trimester. Please refer back to our article on exercise in the first trimester in our blogs!

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Comfortable Sex Positions for Women with Pelvic Floor Disorders

Life can take its toll on your lady parts. Pregnancy, childbirth, menopause, and even chronic constipation and obesity can weaken your pelvic floor muscles. These important muscles act as a hammock, stretching across your pelvis and holding your organs (bladder, bowel, uterus, vagina) firmly in place.

When the pelvic floor muscles are weakened or the connective tissues of the pelvic area are damaged—whether from a rambunctious baby doing somersaults in your belly, or hormonal changes during menopause—you can develop a pelvic floor disorder (PFD).

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Has Your Constipated Child Achieved the "Spontaneous Poop"?

Steve Hodges, MD

Has your child achieved the vaunted “spontaneous poop”?

That’s a hot topic in our private Facebook support group! “Spontaneous poop” is a term I mention in The M.O.P. Book but don’t explain in detail. It’s worth further discussion.

By “spontaneous poop” I mean a bowel movement that is not preceded by an enema — one that the child feels coming on and “just happens.”

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Sleep Health

By Dawn Sandalcidi, PT, RCMT, BCB-PMD

One third of the US population suffers from sleep disorders. Sleep disruptions occur across a person’s lifespan, for example:  erratic sleep patterns during teen years, new babies, work or kid stresses, hormones and pain are all big culprits when it comes to having difficulty falling asleep, staying asleep or getting sufficient sleep. 

Getting good sleep is necessary for optimal health and poor sleep impairs function. 

Quality sleep is imperative for the function of your body systems including:  immune system function, healing, pain management, cognitive function, learning, memory and cardiovascular function.

Sleep is a basic human need. Without adequate sleep, people can experience:

·         Increased pain perception 

·         Loss of function

·         Decreased quality of life

·         Increased depression and/or anxiety

·         Attention deficits

·         Disruption in ability to process information

·         Memory impairment

·         Decreased ability to learn new motor skills or exercise putting people at risk for balance issues and falls 

·         Decreased functioning in work related and recreational activities, as well as self-care


The cost of insomnia is over $100 billion per year! 

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PARENTS: Advocate for Your Child to Use the Bathroom at School!

By Dawn Sandalicidi, PT, RCMT, BCB-PMD

I have been working with children who experience bowel and bladder issues for over 30 years. One of my primary concerns is that children are not allowed to use the bathroom during the school day except for scheduled times. This leads to holding patterns and decreased fluid intake throughout the day, which can lead to constipation and bladder and bowel problems!

This is a crazy cycle that needs to stop!  Parents need to educate themselves on normal bowel and bladder health.

I can certainly understand the concern teachers have with children taking advantage of bathroom privileges. However, in the elementary school population, children always want to please their teacher and feel ashamed if they need to ask to use the bathroom too often.  Middle school students lose homework passes and classroom privileges for using the restroom and are given rewards for NOT listening to their bodies.

Shana Peeples, 2015 National Teacher of the Year, had a unique approach.  She allows her students to use the bathroom whenever they feel the need as long as they're respectful when they get up to leave the room and return without disruption.  Her approach was not always well received with administration however it has worked!  In her article (linked below), she discusses trusting the students with their own bodily functions.

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How to Avoid a Bedwetting Relapse!

By Steve Hodges, MD

When bedwetting stops, it's easy to move on with life — that's when constipation creeps back.

To avoid relapse, it's critical to complete the entire M.O.P. regimen. You may even want to maintain daily enemas after your child has 7 days of dryness — perhaps an extra week or two. Then, stick with enemas every other day for more than the recommended 30 days.

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Taking Control of Your Pain: Part 1

By Mara Towne, PT, DPT

Pain. Even reading the word evokes a negative feeling for most people.  This can be especially true when a person has been dealing with pain for several months or years!  Pain is a protective mechanism.  Without pain we would not be able to live. However, when pain becomes chronic, it no longer protects us and often hinders our day to day activities. Chronic pain consumes people’s lives.  Often people have numerous tests and appointments with different specialists trying to find the source of their pain. With all this back and forth, you can lose your sense of self in the process. It is very challenging to know what you can do to manage your pain on your own. Where can you begin?

This blog is part 1 of a series in which we will unravel what people can do to manage their pain at home with help and support from their physical therapist. The materials and information in this blog are from an excellent continuing education course called, Transforming Your Clinical Practice: Integrating Cognitive, Behavioral and Motivational Skills into Physical Therapy presented by Kristin R. Archer PhD, DPT and Stephen T. Wegener PhD, ABPP of Vanderbilt University. The handouts attached are reproduced and distributed with their expressed permission.

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By Kristin Anderson, PT, DPT, OCS, CLT

Have you noticed the “Me Too” campaign occurring on Facebook? The campaign is designed for women to post “Me Too” if they have experienced any form of sexual trauma in their lives.

If you have seen the campaign, what where your initial thoughts?  Did the number of women who posted surprise you?  Did you yourself post or did you privately know you had experienced sexual trauma as well?  Regardless of your response, did you know that 1 in 3 women experience sexual assault in their lifetime?

In addition to emotional distress, physical changes and pain can also occur from sexual trauma. If you or a loved one has experienced sexual trauma and now have pain with penetration (from a tampon, women’s wellness exam or intercourse), this could be due to the trauma you’ve experienced.  Why does this occur?

After we have experienced trauma, our bodies want to protect ourselves. To protect our bodies, our autonomic nervous system (which is the part of the nervous system responsible for our fight or flight response) can cause an involuntary response to increase the muscle tension of the pelvic floor.  Even though you may be in a safe situation, for example: getting a speculum exam from a trusted doctor, you may still experience pain. What can you do about this?

Physical therapy may be the answer!  Physical therapists are trained to help restore normal muscle tension and utilize strategies to help the body understand how to adapt to healthy situations. It is also important that you form a team around you to support yourself after a trauma has occurred. This team can include a psychologist and a physician, as well as, a physical therapist. 

There is help to heal both physically and emotionally! Contact us today.  Our experienced, compassionate and caring staff wants to help!

Physical Therapy’s Scope of Practice Extends Beyond Aches and Pains

Physical therapy is an obvious choice when you’ve sprained an ankle or developed tennis elbow, but what about when you need to boost your mood? Though highly skilled in methods that improve mobility and reduce pain following an injury, physical therapists can also play a key role in improving a patient’s mental health.

Exercise, a core component of any physical therapy regimen, is known to benefit patients with mild to moderate mood disorders such as depression. Depression is an underlying condition often associated with chronic illnesses and orthopedic injuries that limit mobility and participation in daily activities. With depression affecting one in 10 Americans at some point in their lives, physical therapy is another avenue to diagnose and treat the associated symptoms.

Physical activity reduces feelings of anxiety, depression and stress by improving the patient’s cognitive function and self-esteem. Moreover, studies have shown that aerobic exercise decreases overall tension levels, elevates and stabilizes mood and improves sleep. Because exercise’s mind-altering effects are temporary, however, patients should work with a physical therapist to develop a regular exercise routine to ensure continued benefits.

Patients can expect to work closely with a physical therapist to develop a custom treatment plan based on a thorough assessment and detailed patient history. PTs are trained to recognize the signs and symptoms of depression and identify the ways in which mental health disorders interfere with a person’s ability to enjoy life. Each individual care plan includes some combination of flexibility, strength, coordination and balance exercises designed to achieve optimal physical function.

Physical therapists may be trained to identify and treat a wide range of movement disorders including sprains and strains but they’re also adept at identifying and reducing symptoms of depression. Developing behaviors that maintain good mental health is an important part of overall health and wellness, and it’s never too late to get started.

Depression in Patients with Chronic Illnesses

Depression is one of the most common complications for patients with chronic illnesses like heart disease, multiple sclerosis and diabetes. A chronic illness often introduces major life changes that restrict a person’s mobility, independence and ability to enjoy and participate in regular activities. A physical therapist is trained to identify and address symptoms of depression in patients with these life-altering diseases.

According to an Archives of Internal Medicine review article, exercise can reduce depressive symptoms in patients with chronic illnesses. Based on the authors’ findings, the article concluded that “patients with depressive symptoms indicative of mild-to-moderate depression and for whom exercise training improves function-related outcomes achieve the largest antidepressant effects.”

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Exercise in your First Trimester of Pregnancy

In honor of National Women’s Health and Wellness Day!

By Kristin Anderson, PT, DPT, OCS, CLT

In honor of National Women’s Health and Wellness Day in September, we wanted to remind you of the benefits of exercise!  Health and wellness is important at every stage of life, but today we want to focus on pregnancy since this can be a time of confusion and frustration for many women. Due to the large amount of information (and not always credible information), knowing what intensity and duration of exercise to engage in during pregnancy can be overwhelming. We see graphic images of women doing high intensity work outs, while other sources may tell us to not do any activity. The American College of Obstetrics and Gynecology (ACOG) published research in 2015 on standards of exercise. Remember, these are guidelines and we want to help you walk through them. 

With all women prenatal care is vital to the health of you and your baby!  Please check with your doctor if you have any of these medical conditions so that they can help guide you with your exercise protocol.

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Back to School, Back to You!

By Mara Towne, PT, DPT

It’s back to school time for kids in Colorado!  This is a great time for patients to refocus on self care!  Summer gets busy with vacations and a lack of a consistent schedule.  However, now that the kids are back on a schedule, isn’t it time to put your health back on your schedule as well?

Many of our patients have been mentioning in the last few weeks that they have not been able to be as consistent with their home exercises.  They would like to have better consistency. But, how do we make this happen?

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5 Easy Diet Tips to Help Prevent Bladder Leakage

Bladder leakage (called urinary incontinence or UI), is a common problem. In fact, one in three womenwill experience some form of UI in her lifetime. The physical stress and strain of pregnancy and childbirth, and hormonal changes during menopause, are common contributing factors.

The bladder, uterus, and bowel are held firmly in place by the pelvic floor muscles, which extend across the pelvis like a hammock. These vital muscles can become weakened over time, resulting in bladder leaks when you strain from laughing, coughing, sneezing, or other exertion. This is called stress urinary incontinence, and it’s one of the most common forms of UI.

Kegel exercises with a bladder biofeedback device like PeriCoach can help strengthen the pelvic floor muscles over time, reducing episodes of bladder leakage.

Diet matters, too. Certain foods can irritate the bladder or otherwise increase the likelihood of bladder leakage. Here are 5 diet tips to prevent bladder leakage.

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The Way You POO is Harming You (Seriously!) and Here's Why

This morning I noticed something.  When having a bowel movement, I come onto the balls of my feet while seated on the toilet. I’ve never noticed this habit before the Relaxx Footstool was sent to us for review.

Prior to the inventions of toilets, people squatted outside or used chamber pots to do their business.  


Many experts and doctors have long advised people suffering from constipation and hemorrhoids to elevate their feet on the potty.  Rebekah Kim, “a colorectal surgeon at the Center for Pelvic Floor Disorders at Virginia Hospital Center” told NPR:

Kim says one of the first things she tells patients who struggle on the john is get a stack of telephone books or a stool to rest their feet on…

“Squatting on a stool can reduce the amount of straining on the toilet, which may mean less hemorrhoids, but there are no clinical studies proving that,” she says. 1)

Even medical texts from the 1960s advised squatting.  According to Gastroenterology: The small intestine, absorption and nutrition, the colon, peritoneum, mesentery, and omentum by Henry L. Bockus, “The ideal posture for defecation is the squatting position, with the thighs fixed upon the abdomen.”2)


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Regular Sleep Makes for Happier College Students

The new school year is around the corner!  Get your students off on the right foot with good sleep habits!

SOURCE: Associated Professional Sleep Societies, news release

Between studying and socializing, college students often have crazy sleep schedules, and new research suggests that a lack of regular sleep may dampen students' well-being.

"We found that week-long irregular sleep schedules are significantly associated with lower self-reported morning and evening happiness, healthiness and calmness during the week, even after controlling for weekly average sleep duration," said study author Akane Sano.

A research scientist with the Media Lab Affective Computing Group at the Massachusetts Institute of Technology, she made her comments in a joint news release from the American Academy of Sleep Medicine and the Sleep Research Society.

The study findings were based on a month-long tracking of more than 200 college students between the ages of 18 and 25.

For 30 days, investigators monitored when the students went to sleep and for how long. They also asked participants to keep diaries to assess overall feelings of well-being.

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9 Bladder & Pelvic Floor Mistakes You Might Make Daily

Bladder and bowel control: most of us don’t appreciate it until it’s gone. You may find that loss of control happened suddenly, such as after childbirth. Or it may have sneaked up on you over time: last year you wore a pantyliner to absorb leaks, but now you rely on regular pads to do the job. Learn with Perine the 9 bladder and pelvic floor mistakes you might be making every day to sabotage your ability to control the bladder and bowels.

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Potty-Training Mom Smears Poop on Son's Face: This Doctor Isn't Shocked

Dr. Steven Hodges, MD


“I wiped poop on my son's face tonight. I don’t feel bad either.”

That apparently is how one Oklahoma mom handled (literally) her 4-year-old’s latest poop accident, in an incident she posted on Facebook.

The backlash was so harsh that she closed her Facebook account. I’m glad her post provoked outrage, but in truth, this is just an extreme version of a scenario that plays out all the time: children getting blamed for accidents.

In my decade treating children with enuresis (pee accidents) and encopresis (poop accidents), I’ve seen kids shamed by their parents right in my exam room. “He’s just being lazy” or “She’s old enough to know better” or “He’s doing it for attention. There’s no way a 10-year-old could poop in his pants and not notice.”

But there is!

If you read past the Oklahoma mom’s shocking first sentence, you will see the frustration and lack of knowledge I encounter daily in my clinic. “It’s like he doesn’t care to poop in his pants,” the mom writes. “It literally DOESN’T BOTHER HIM.”

I  know it seems impossible a child could not appear to care that he is sitting in poop, but this is easily explained: The accidents don’t bother this child because he cannot feel them. His rectum has lost sensation, and he does not notice when poop falls out.

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Some Children Don't Outgrow Bedwetting

By Steve Hodges, M.D.

Virtually every bedwetting patient in my clinic was assured by a pediatrician or urologist that on some magical day in the future, he or she wouldwake up dry, never to wet the bed again.

As the mom of a 16-year-old patient told me, “Every year, through age 5, 8, 10, 14, the pediatrician kept saying, ‘Don’t worry, he’ll grow out of it.”

Parents in our Facebook support group report receiving the same “reassurance.”

One mom posted: “Starting when my son was age 6, we were repeatedly told by two different family practitioners, “This happens. Don't worry, he'll outgrow it. A few comments that stand out in my memory: ‘When he really wants to stay dry he will." And: "Just wait till he really wants to sleep over at a friends' house. Suddenly he won't want all this attention anymore."

This boy is now 11 years old and still wetting the bed.

Another mom posted: “We were told every year at our son’s physical that he would outgrow it.

Finally, I took my son’s bedwetting into my own hands. A 15-year-old is not going to outgrow bedwetting!!”

She is right.

In fact, without appropriate treatment, even a 9-year-old is unlikely to outgrow bedwetting, research suggests — especially if the child wets nightly and has daytime symptoms.


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How Did Health Care Get to Be Such a Mess?

Christy Ford Chapman, New York Times

The problem with American health care is not the care.  It's the insurance.  

Both parties have stumbled to enact comprehensive health care reform because they insist on patching up a rickety, malfunctioning model.  The insurance company model drives up prices and fragments care.  Rather than rejecting this jerry-built structure, the Democrats' Obamacare legislation simply added a cracked support beam or two.  The Republican bill will knock those out to focus on spackling other dilapidated parts of the system.  

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