As pelvic floor or pediatric specialists we often hear as an aside that our patients, or our patient’s children, suffer from bedwetting. Sadly, they are often told that they will outgrow the condition. The International Children’s Continence Society (ICCS) advises that, “not only is treatment justified, it is mandatory.”1 Here’s why:
- 20-30% of children with bedwetting fulfill the criteria for psychiatric disorders with a 2-4x higher rate compared to non-wetting children (von Gontard, Neveus 2006).
- Bedwetters who are punished by their parents exhibit depression and reduced quality of life (Al-Zaben 2014).
- Children who wet during the day and at night exhibit increased fear and anxiety (van Gontard 2011, 2014).
My goal is to spread the word and educate as many therapists as possible to treat this delightful patient population. Together we can end the suffering of both the child and the parent. I wrote the following tips to help us get started in the clinic immediately:
1. Avoid Foods that Irritate the Bladder
Some foods and beverages irritate the bladder, resulting in it emptying frequently. Here are a few examples:
- Spicy foods
Being acidic in nature, these foods irritate the bladder. Surprisingly, milk can also increase urinary urgency and frequency.
2. Avoid Drinking Before Bed
It’s not a good idea to drink just before bed. Many children love spending time with a parent before going to sleep. They use a glass of water as an excuse to spend more time together. It’s best to use this time to share a book before bed rather than a drink.
3. Drink Throughout the Day
A child’s fluid intake depends on their activity level, and if they live in a hot and humid region. It’s best to advise parents to look at the color of their child’s urine. If it is dark yellow and odorous, the child is not getting enough fluids and is dehydrated. The urine should look opaque yellow.
Water is always the best option.1 Dehydration can also lead to constipation! It is best to drink throughout the day versus all at one time. This maintains bladder homeostasis of regular filling and emptying.
4. Empty the Bladder Throughout the Day
The bladder is healthiest when it fills and empties on a regular basis. Many children do not like to take the time to go to the bathroom, and hold their urine. This can lead to bladder leaks on the playground at school. Some hold their urine all day waiting until they are home to go to the bathroom, leading to an irritated bladder at night. Try to design a schedule that accommodates your patient’s school schedule and activities.
5. Avoid Constipation and Straining
Constipation is common in our culture with our Standard American Diet. When the bowel is full it presses on the bladder causing more irritation, especially at night. Recommend that your patients eat at least 5-7 fruits and vegetables a day to avoid constipation.
The strategies discussed are just the tip of the iceberg when it comes to bedwetting assessment and treatment. However, these 5 tips provide a great starting point that you can recommend TODAY so your patients wake up dry.
- USDA, Make Better Beverage Choices - 10 Tips Nutrition Education Series, https://www.choosemyplate.gov/ten-tips-make-better-beverage-choices