How Pelvic Health Physiotherapy Can Help Support Bedwetting (Enuresis)

Lauren Rudko, PT MSc. PT
Pelvic Health Physiotherapist

Enuresis (bedwetting) can be difficult for many families, especially if daytime dryness comes quickly during the toilet learning process. While many family doctors may take a “wait and see” approach, it’s typically recommended that a family takes a closer look into reasons why the wetting might be happening if it still persists by age five. Often, removing nighttime diapers or pull-ups without knowing why nighttime wetting is happening does not improve the issue and can increase stress for the child and family. The following blog post provides an overview of why enuresis may happen and what avenues to explore to support your child. 

Types of Enuresis

Enuresis can be classified as “primary” or “secondary” depending on if a child has had a prolonged period of dryness at night. Primary enuresis accounts for approximately 90% of cases, where children have not had a period of dryness that lasts for 6 months. Secondary enuresis occurs when a child has been dry for 6 months or more when the wetting resumes. 

Common Causes of Primary Enuresis 

Constipation:

Constipation can cause nighttime wetting because if there is a back up of stool in the intestines, it can press down on the bladder, making it harder for the bladder to hold urine. This can lead to leaking during the day and/or night. Pelvic health physiotherapy can help get your child back on track if they are struggling with constipation and nighttime wetting. 

Hormonal Reasons:

Anti-diuretic hormone is released by our bodies as we sleep, which decreases the amount of urine produced. The production of this hormone is necessary to keep us dry at night (and not having to wake up to pee!). There might be a few reasons why your child isn’t producing this hormone, including how your child is sleeping and genetics. If your child is a restless sleeper or shows signs of sleep apnea (snoring or open mouth breathing with sleep), they might not be falling into a deep enough sleep or waking too frequently for their body to procude the anti-diuretic hormone. In some casses that involve snoring or open mouth sleeping, removing tonsils and/or adenoids can resolve bedtwetting. Genetics can also play a role with the production of this hormone. If a close family member (i.e. parent, sibling, aunt/uncle) had bedwetting until a later age, it’s often a sign that your child’s bedwetting may be due to a genetic reason. However, it’s also important to investigate other potential causes as multiple causes can be present at the same time. If you suspect that hormonal reasons could be why your child is having bedwetting, your family doctor can help to create an action plan. 

Daytime Bladder Function:

How your child’s bladder is functioning during the day can have an impact on how it functions at night. If your child is peeing very often during the day, they might not be filling their bladder to its full capacity, making it harder for their bladder to hold more urine at night. If a child is withholding their pee during the day, it can make it hard for them to empty completely before bed. Or if a child isn’t hydrating enough during the day, they may be drinking a lot in the evening, which increases the amount of fluid their body is processing when they’re in bed. Ensuring that your child is regularly emptying their bladder and hydrating well throughout the day can help to support good daytime bladder habits which can also help resolve nighhttime concerns. Speaking with a pelvic health physiotherapist can help your family investigate what might be happening during the day to impact nighttime wetting. 

Causes of Secondary Enuresis 

The causes of secondary enuresis can be slightly more serious than primary enuresis and should be brought to your doctor’s attention quickly. These include: diabetes, constipation, developmental abnormalities, spine concerns, kidney disease and sickle cell disease. Secondary enuresis can also be caused by many of the causes of primary enuresis - so taking a closer look at changes in your child’s diet, social environment and toileting habits can also provide clues as to why wetting might be happening. 

Bedwetting can be a frustrating issue to deal with for many families. However, with some investigation, it’s possible to find lasting solutions. Consulting with your family doctor and a pelvic health physiotherapist can help your family during this process.

If your kiddo is struggling with bedwetting, reach out! We can help improve quality or life and overall function for your child. Book your discovery call with one of our Paediatric Pelvic Physiotherapists today!