Bedwetting: how can pelvic floor physiotherapy help?
Bedwetting, or nocturnal enuresis, is a common concern among parents as they navigate the developmental stages of their children, teens and adults. While it's a widespread issue, it is often seen as a taboo topic and it is essential to recognize that bedwetting is often a treatable condition, and pelvic floor physiotherapy can help.
Bedwetting is defined as involuntary urination during sleep in children over the age of five. It is crucial to differentiate between primary and secondary enuresis. Primary enuresis refers to a child who has never been consistently dry at night, while secondary enuresis involves a child or teenager who starts wetting the bed after being consistently dry for a period.
There are several factors that can contribute to bedwetting in children and teens, and understanding these factors is a crucial step in addressing the issue. Some common causes include:
Constipation: Probably the most common reason for bedwetting and incontinence, constipation and impacted stool can add extra pressure on the bladder, affecting its capacity and sensitivity and hence lead to bedwetting.
Behavioural factors: Some behavioural factor can also lead to bedwetting. A diet low on fibres, picky eating, and inconsistent bedtime routines can also lead to bedwetting. Moreover, it is crucial to encouraging regular toileting habits that contribute to a better bladder control.
Emotional Stress: Changes in the child's life, such as starting school, moving to a new place, or family issues, can contribute to bedwetting.
Hormonal Imbalance: Some children may produce (for several reasons) insufficient antidiuretic hormone (ADH), which regulates urine production during the night.
Delayed Development: The neurological pathways responsible for bladder control may develop more slowly in some children, leading to bedwetting.
Genetics and family history: If one or both parents experienced bedwetting during childhood, there is an increased likelihood that their child may also face the same issue
Above it all, it is important to highlight that because this topic is taboo, it is also associated with shame and families and children/ teenagers often don’t feel comfortable to discuss it. Unfortunately, not always bedwetting improves by itself so treatment may be required to many.
How can pelvic floor physiotherapy help with bedwetting?
On the initial appointment the pelvic floor physiotherapist will conduct a thorough assessment to identify any underlying issues that may be contributing to bedwetting. This may include an examination of pelvic muscles and its coordination. Know that this assessment, particularly in children, is non-invasive.
Once some patterns that may lead to bedwetting have been found, it is important to work towards developing a plan that can help with developing healthy bladder and bowel habits. This may involve body awareness exercises that may help to recognize and respond to the sensations of a full bladder or bowel. It is important to work and improve the control over urination and in order to promote control, pelvic floor exercises can help.
Although social media often describes pelvic floor exercises with the goal to strength, for bedwetting often the goal is coordination of the pelvic floor muscles. Contrary to generalised beliefs, a good pelvic floor is not one that is stiff. A good pelvic floor should also able to relax to allow the bladder and the bowel to fully empty and it is strong withing its whole range (not only at the end of the range).
These exercises can however be hard to do without feedback hence, biofeedback devices can be used. These can give real-time feedback, which greatly helps with better understanding and improving muscle function.
Addressing pelvic floor, bladder and bowel as well as behavioral factors, in conjunction with the medical / allied health team and other therapeutic interventions, is essential for a comprehensive and effective approach to managing bedwetting in children.
Bedwetting can be a challenging experience for both children and their families, but the good news is that effective solutions are available. Pelvic floor physiotherapy offers a patient centred care approach to address the root causes of bedwetting, empowering children and teenagers to achieve dry nights and fostering their overall well-being.
If you're concerned about bedwetting, consider consulting with a pelvic floor physiotherapist to embark on a path towards lasting resolution and improved quality of life.
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