“Summer-time, and the living is easy” as the song goes, except when your child is not able to do activities and take trips and visits because of bedwetting and daytime wetting, and because of embarrassment about wetting and pull-ups. At Embody, in addition to working with adults, Rebecca Meehan PT WCS PYT works with kids and their parents to address pediatric pelvic floor problems. Summer time and no school schedule is a great time to begin to work on resolving bedwetting, daytime wetting and dribbling, constipation and encopresis (fecal incontinence). All of these are treatable, and there is no time like the present to get started! Here are some facts about pediatric pelvic floor dysfunction (PFD):
- Bedwetting (enuresis), daytime wetting, and encopresis are NOTHING to be ashamed of!! They are treatable! No one is at fault.
- In almost all instances, bedwetting and encopresis are not behavioral and “on-purpose.” In most situations, they are not caused by stress, although you can imagine that they can create stress in your child, and can cause the child to not want to participate in activities, to sleep over or have sleep-overs, or to go to sleep-over camps (and in teens, this becomes a stressor when they are looking at college). Stress and changes in life and family might contribute to these problems, but again, typically not the cause.
- Bedwetting, in most instances, is NOT because the “bladder is too small” or because the child “sleeps too soundly.”
- Bedwetting affects 5-7 million US children, and boys are 50% more likely than girls to wet. 16-20 % of 5 year old wet, and that number drops after age 6. (ICCS)
- After age 8-10, the numbers do not drop as much, meaning that early on your child may “outgrow” bedwetting as many MDs say, but by age 9, it is less likely. Treat earlier…not later!
- 2% (or more-based on the phone calls from adults I receive)of 18 year olds and adults continue to have enuresis…that’s over 840,00 teens and young adults.
I could go on with statistics, and I will share them with anyone interested, but my primary message is to begin to treat your child and allow them to do normal activities without fear. How do we do this? It all begins with an in-depth history and discussion with your child and with you, and I ask you to keep track of some specific information and charts. We have an anatomy lesson because I want these kids to understand what is going on, what we are looking at and why. I do a physical exam, looking at mobility, strength, postural patterns, and breathing. THERE IS NO INTERNAL work done with kids!! It is not scary or painful.
We talk about findings, discuss next steps, set goals, and I communicate with your pediatrician and if any additional information is needed, discuss that with her or him. There IS homework, for your child, and depending on their age, also for you. Each child and family is different, and so is treatment, although it is based on research and clinical findings. Because we are creating change in habits and patterns, it does not happen overnight (sorry!); typically, I see the kids for the first visit, again a week or 10 days later, and then every 10 days to 2 weeks and as improvement occurs, taper from there. The kids report back to me in between appointments to let me know how they are doing and with any questions.
Some questions that I get, or things that some of my patients have tried in the past:
- Bed alarms alone: 46.8% relapse rate (Tuncell)
- Online retraining programs: These seem to be “one size fits most” and rely heavily on the ability of the individual to do the work independently. I see people who have tried these programs and have NOT solved their problems, so unable to speak to the efficacy.
- At Embody, I was trained in the Dry Bed Training™ program created by Dawn Sandalcidi PT that incorporates retraining as well as Pelvic Floor Retraining. Programs combining Pelvic Floor retraining (exercise and biofeedback but no internal!) with nighttime schedule retraining or alarms have shown 100% success in 10 of 12 kids (Pekalby)
- Kids are not “mini-adults” and treating kids with pelvic floor problems is not the same as working with adults. (this means that although mom might be doing “kegels” to help with her leakage, the program will be different with kids).
- Cost: pull-ups seem to range in cost from about 20 cents to $2.50 per pull up (or more depending on the size and the absorbency). Embody Physiotherapy does not accept insurance, but you receive a receipt to submit to your insurance company. 100% of your time spent at Embody is with Rebecca and each program is designed for each child specifically. Life and activities back and decreasing need for pull-ups vs the cost of solution visits.
- There is no perfect time of year to begin this program, instead, I think that the right time is not. Don’t ask your child to wait longer to be dry…let’s get started on solutions!
From the ICCS 2010: “Treatment is not only justified, but is mandatory.”
Are you ready for solutions? Please contact me and learn more: firstname.lastname@example.org or 412-259-5342
Tuncel A, Mavituna I, Nalcacioglu V Tekdogan U, Uzan A. Long-term follow-up of enuretic alarm in treatment in enuresis nocturna 2008, Vol 42, No 5, Pages 449-454
Veiga ML, Lordelo P, Farias T, Barroso C, Bonfirm J, Barroso U Jr. Constipation in children with isolated overactive bladders. J Pediatr Urol. 2013 De; 9 (6Pt A): 945-9.