Nocturnal Enuresis (Bedwetting)
When I was nine years old, I dreaded sleepovers. I'd had plenty of accidents in my friends' beds (and one particularly tragic time in a sleeping bag). I tried hiding it, but that usually brought more trouble. Sometimes I wet the bed, and sometimes I didn't, and I was afraid to leave it up to chance. I remember overhearing a family friend say once, "Isn't she too old to be wetting the bed?" I was devastated!
I know it can be discouraging when our bodies don’t perform the way we expect them to perform. With nocturnal enuresis, disbelief easily and naturally turns into shame. And whether you’re a child of five years of age or above, a teenager, or a full-fledged adult, speaking up about this nightly disorder can be difficult.
You may be one of millions avoiding sleepovers in fear of an accident, or maybe someone you care about has unsuccessfully attempted to stop nightly urine leakage. Perhaps you’ve avoided the subject with others—including your doctor. You thought maybe you could get by with “managing it” at the expense of living a full life.
But guess what? Your bladder is not the boss--you are! If you're looking to start the journey to take back control, you've come to the right place.
WHAT IS NOCTURNAL ENURESIS?
Nocturnal enuresis is also known as bed wetting and is the involuntary leakage of urine while sleeping.
Yikes! I know. The word bed wetting is jam-packed with negative associations. It is commonly considered a “baby thing” or a bad childhood habit., but adults can suffer from it, too, and it’s more common than you think! According to the National Association for Continence, bedwetting affects 20% of children age 5 and 2-3% of adults. You cannot assume a child will “outgrow” bed wetting!
Another misconception is that bed wetting is the result of laziness. But bed wetting is involuntary, and any person who wets the bed needs support and reassurance.
Nocturnal enuresis isn’t just a slight annoyance. It has a very negative impact on social activities and self-esteem. Not to mention how expensive it can become when you add up the cost of pull-ups or pads, laundry, replacement mattresses, medications, etc.
Additionally, constipation and other bladder or urination problems often accompany bed wetting. (Walker, 2019)
Thankfully, it's also something that we can treat with physical therapy. If you or someone you know is suffering from the embarrassment, fear, and high cost of bed wetting, there IS hope!
You might not have thought of it as a "physical therapy problem," but in order to understand the benefits of therapy, it's helpful to understand what's going on inside the body.
THE ANATOMY OF YOUR PELVIC FLOOR MUSCLES (PFM)
Everyone has layers of muscle that support their pelvic organs called pelvic floor muscles (PFM). Pelvic floor muscles start at the pubic bone at the front and stretch to the tailbone at the back, functioning like an internal hammock at the base of the pelvis.
In females, the pelvic floor muscles wrap around the vaginal canal, the anus, and the urethra (the canal leading from the bladder), while in males the pelvic floor muscles wrap around the urethra and the anus.
The pelvic floor muscles help to control what goes out and what comes in. If your pelvic floor muscles lack strength, flexibility, or coordination, many problems can occur with each of these canals.
When considering the bladder, your pelvic floor muscles should be strong enough and coordinated enough to keep the urethra closed until you choose to empty your bladder. Normally, tiny stretch receptors inside the bladder send messages to your brain that it is time to empty your bladder once it is full. Your brain should then wake you up to empty your bladder. When you are ready to void, the pelvic floor muscles relax to allow the urine to empty from the bladder.
With bed wetting, this process isn’t working correctly. There are several theories on WHY this occurs. If you would like to dig deeper into this, I would strongly encourage you to read “The MOP book” by Dr. Steven Hodges.
The bottom line: for those experiencing bed wetting , the bladder and pelvic floor muscles may not be doing the right thing at the right time. The good thing is that they can be trained! Bladder and pelvic floor muscle retraining can be very effective at relieving many urination issues. (Kuwertz-Broking, 2018)
TREATING NOCTURNAL ENURESIS
If you or your loved one could improve or eliminate bed wetting, wouldn’t a few hours each week be worth it?
A combined approach has shown to be the most effective approach to treating bed wetting. This approach includes bladder training, eliminating constipation, an enuresis alarm, motivational therapy, and pelvic floor muscle training. (Hoebeke, 2006).
By spending time on correcting the issue, you can train your bladder and pelvic floor muscles to do the right thing at the right time.
A dedicated and expert pelvic floor physical therapist will develop and coordinate a treatment plan especially for you. Most health insurance plans, including Medicare, Medicaid, and Tricare will cover pelvic floor physical therapy for uncoordinated or weak muscles.
Not sure where to find a pelvic therapist? On myPFM.com we have links to four extensive pelvic health databases to find a therapist! Go to the menu section on our home page and click on “Who can help.”
Check out our new book "Don't Cry, Stay Dry" book on Amazon. This book is great for both children and parents and helps to explain bed wetting.
And while you're out there exploring the web for more help, check out our amazon store* to see some of our favorite resources and products for pelvic floor disorders.
Are you ready to improve your quality of life, reduce symptoms, and get back to living life? It’s our goal to get you there.
Let us know how nocturnal enuresis has affected your life in the comments section below.
By Zemrie DaCosta with Jeanice Mitchell, PT and Emily Reul, PT, DPT
Adults and bedwetting. Continence NZ Website. https://www.continence.org.nz/pages/Adults-and-Bedwetting/52/. Published 2015. Accessed November 3, 2019.
Adult bedwetting (sleep enuresis). National Association for Continence Website. https://www.nafc.org/adult-bedwetting. Accessed November 3, 2019.
Nocturnal enuresis. Bowel and Bladder Community Website. https://www.bladderandbowel.org/bladder/bladder-conditions-and-symptoms/nocturnal-enuresis/ Accessed November 3, 2019.
Pediatric bedwetting. National Association for Continence Website. https://www.nafc.org/pediatric-bedwetting/. Accessed December 8, 2019.
Shreeram S, He JP, Kalaydijan A, Brothers S, Merikangas KR. Prevalence of enuresis and its association with attention-deficit/hyperactivity disorder among U.S. children: results from a nationally representative study. J Am Acad Child Adolesc Phychiatry. 2009 Jan;48(1):35-41. doi: 10.1097/CHI.0b013e318190045c.
Walker RA. Nocturnal Enuresis. Prim Care. 2019 Jun;46(2):243-248. doi: 10.1016/j.pop.2019.02.005.
Hoebeke P. Twenty years of urotherapy in children: what have we learned? Eur Urol 2006. 49:426–424
Kuwertz-Broking E, von Gontard A. Clinical management of nocturnal enuresis. Pediatr Nephrol (2018) 33:1145–1154 DOI 10.1007/s00467-017-3778-1