By Amy Tinetti – Women’s, Men’s & Children’s Pelvic Health Physiotherapist
As parents, it can be frustrating when our child does not achieve dryness by the time we expect. The never-ending washing and smell! However, you’re not alone. We have many parents ask us the same two questions –
- When should my child not wet the bed?
- When should my child not have bladder leakage (urinary incontinence) accidents during the day?
These are difficult questions to answer as the age children achieve dryness is variable.
Most children achieve daytime bladder control by age 4 and night time is when the child is school age (~4/5), however, some children may have accidents from time to time until they are 7 or 8.
Bedwetting can run in the family, if one parent was affected by bedwetting as a child there is a 30% chance their child will too. If both parents wet the bed as a child there is a 70% chance their child will.
The Continence Foundation of Australia suggests parents should start to seek help for bedwetting if:
- the child who has been dry suddenly starts wetting at night
- the wetting is frequent after school age
- the wetting bothers the child or makes them upset or angry, or
- the child wants to become dry.
Bedwetting
Some of the causes of bedwetting include:
- Slower physical development: small bladder capacity, long sleeping periods and underdevelopment of the bodies alarms to signal a full bladder
- Overproduction of urine at night: caused by not enough antidiuretic hormone being produced at night
- Structural problems
- Attention deficit hyperactivity disorder: children with ADHD are 3 times more likely to have night-time urinary incontinence
- Obstructive sleep apnoea
- Anxiety: events that may cause anxiety in children can be physical or sexual abuse, unfamiliar social situations, moving or starting a new school, major family events (birth of a new sibling, a death or divorce)
- Genetics
Daytime Bladder Leakage
If your child is regularly wetting during the day after age four/five then it is time to seek professional assistance. There are a number of different reasons as to why a child may not achieve daytime dryness, and a continence physiotherapist can assist you and your child to work out what it may be and support you on the journey to achieve dry days and nights!
Causes of daytime urinary incontinence:
- Overactive bladder – a combination of the following:
- Urinary urgency – unable to delay urination
- Urge urinary incontinence – bladder leakage on the way to the toilet
- Increased urinary frequency during the day and/or at night
- Under-active bladder – the child not emptying their bladder regularly and it is overfilling and causing leakage
- Incomplete emptying of the bladder
- Urinary tract infection
- Structure problems (rare but need to be ruled out)
Which health professional should I seek first?
It’s best to see your GP first so they can rule out any urinary tract infections and do any necessary investigations to rule out structural or nerve issues. If these all come back clear then you can bring your child to see a continence physiotherapist. However, you do not need a referral from your GP to see a continence physiotherapist.
How is Bedwetting & Daytime Leakage Treated by a Continence Physiotherapist?
After accounting for normal growth and development where:
- bladder capacity increases
- natural body alarms become activated
- an overactive bladder settles down
- production of ADH becomes normal
- response to the body’s signal that it is time to void improves
A continence physiotherapist will work with the child and the parents to discuss the past and present bladder and bowel issues.
Using this information, we will teach your child bladder training strategies (such as timed voiding), checking your child’s fluid intake and output, voiding (weeing) strategies, checking pre/post bladder capacities with real-time ultrasound, using TENS (transcutaneous electrical nerve stimulation), checking there is no constipation and helping with bed alarms for bedwetting.
We have a variety of techniques to help your child – and every child is different, so we adapt our approach to your child’s personality. For example, we have work booklets where your child may prefer to draw, which helps us understand their thoughts and emotions around the issue.
We also work in conjunction with your GP or specialist if medications are required.
Working with children is an absolute joy and we make it clear to them that they are not lazy, naughty or attention seeking and we are there to help them.
To make an appointment with Amy Tinetti, call us on (08) 6389 2947 or click here to book online.
