Bedwetting: Facts and Myths

Facts:

·         Bedwetting affects 15% of girls and 22% of boys

·         5-7 Million US children are affected

·         Boys are 50% more likely than girls to wet the bed

·         10% of 6 year olds continue to wet

·         Spontaneous cure rate 15% per year thereafter

·         1-3% of 18 year olds still wet their beds

·         Less than 50% of all bedwetting children have bedwetting alone without also experiencing daytime urinary leakage or constipation

·         Bedwetting is genetic – if 1 parent was a bed wetter the child has a 40% chance of wetting the bed and if both parents were bed wetters the percentage goes up to 77%

 

Myths:

·         Your child is lazy

·         Your child is doing this to get attention

·         Your child is just a deep sleeper

·         You have to wait to grow out of it

 

The International Children’s Continence Society (ICCS) is a great resource for exploring the research on this topic and other pediatric voiding issues. www.i-c-c-s.org

 

What causes Bedwetting?

There are many philosophies discussed in the research. Here are some listed below

 

·         Hormone deficiency- our bladders empty about every 2-3 hours during the day however at night we can hold over 8 hours! This happens because our bodies produce an Antidiuretic Hormone when we sleep to slow kidney function thereby producing less urine to empty into the bladder. If this hormone is not being produced the kidneys produce as much urine at night as  in  the day. Good this it empties out in our sleep or our bladders would be dangerously large and possibly reflux urine backward into the kidneys. (I’m confused on the wording of the sentence prior to this: is it The good news is…?) Clearly not behavioral!!

 

·         Constipation- Dr. Steven Hodges has researched and written extensively on the topic of constipation causing pressure from the rectum against the bladder making it irritable during sleep. His research has supported the fact that once the bowel is cleaned out on a daily basis the bedwetting episodes diminish.  See It’s No Accident by Dr. Hodges or visit https://www.bedwettingandaccidents.com for more information on this topic.  This is another example of a physiological cause of bedwetting versus behavioral.

 

 

·         Sleep Disturbance and Nasal Airway Obstruction.  Dr. Neveus and colleagues reported that 43.5% of children with snoring or obstructive sleep apnea became dry after adenotonsillectomy. Dr. Kovacevic also found increases in antidiuretic hormone  in responders post-operatively.

 

Take Home Message

 

·         Active treatment for bedwetting should begin at age 6

·         The Impact is mainly psychological and may be severe ( I don’t know where this is listed above? Maybe saying that there are physiological causes?)

·         Children with bedwetting have abnormal psychological test scores, however, once the bedwetting is resolved the test scores return to normal

·         “Treatment is not only justified but mandatory”

ICCS Standardization document 2010

 

There is help!

 

At Physical Therapy Specialists we specialize in bedwetting, urinary leakage, constipation and other voiding issues in children. Let us ease   your family’s suffering through this very treatable condition!

 

 

References

 

·         Al- Zaben FN, Sehlo MG. Punishement for bedwetting is associated with child depression and reduced quality of life. Child Abuse Negl. 2014

·         Hodges SJ, Colaco M. Daily enema regimen is superior to traditional therapies for nonneurogenic pediatric overactive bladder. Global Pediatric Health, 2016, 3: 1–4

·         Austin, P., Bauer, S.B., Bower, W., et al. The standardization of terminology of lower urinary tract function in children and adolescence: update report from the standardization committee of the international children’s continence society. J Urol (2014) 191.

·         Treatment response of an outpatient training for children with enuresis in a tertiary health care setting. J Pediatr Urol. 2012.

·         Hodges SJ, Anthony EY:Occult megarectum:a commonly unrecognized cause of enuresis. Urology. 2012 Feb;79(2):421-4. doi: 10.1016/j.urology.2011.10.015. Epub 2011 Dec 14.

·         Kovacevic L, Wolfe-Christensen C, Lu H, Toton M, Mirkovic J, Thottam PJ, Abdulhamid I, Madgy D, Lakshmanan Y. Why does adenotonsillectomy not correct enuresis in all children with sleep disordered breathing? J Urol. 2014 May;191(5 Suppl):1592-6.

·         Nevéus T, Leissner L, Rudblad S, Bazargani F. Acta Paediatr. 2014 Jul 15. doi: 10.1111/apa.12749. [Epub ahead of print]Orthodontic widening of the palate may provide a cure for selected children with therapy-resistant enuresis.

Hodges, Steve J. It’s No Accident-Breakthrough solutions for your child’s wetting, constipation, UTI’s and other potty problems. © 2012. Lyons Press, Guilford, Connecticut.