Treatment for Bedwetting

Pediatric Pelvic Floor Rehabilitation

Hasbro Children’s Rehabilitation Services offers the pediatric pelvic floor program to address bedwetting and other concerns such as daytime urinary incontinence, urgency, frequency, dysuria, and dysfunctional elimination. Our mission is to improve the physical and emotional well-being of children and promote the highest quality of life for all children and their families.  

Bedwetting, or nocturnal enuresis, is involuntary urination while asleep, after the age at which bladder control occurs. Most children start to stay dry at night around the age of three. However, it is not uncommon for children to continue to be wet overnight; up to one third of five- to six-year-olds experience nighttime wetting, and approximately 10 percent of seven- to eight-year-olds experience nighttime wetting.

Types of Childhood Bedwetting

• Primary: the most common form of bedwetting. This occurs when a child is toilet trained during the daytime, but continues to have nighttime leaks.
• Secondary: This occurs when a child is dry at night for six months or longer and then nighttime leaks reoccur.

What Causes a Child to Wet the Bed?

Causes of bedwetting are unknown, but common theories include:

• Increased urine production at night or not enough ADH antidiuretic hormone    
• Anxiety/ emotional issues
• Family history
• Deep sleep
• Poor daytime voiding schedule
• Constipation
• Diet

Bedwetting can have negative effects on a child’s psyche. They may experience poor self-esteem, guilt, frustration, anger, shame, feelings of failure, humiliation, and embarrassment. Children frequently report that they are unable to go to sleepovers or attend camps due to bedwetting.

About 20 to 30 percent of children with nocturnal enuresis are two to four times higher than non-wetting children to fulfill criteria for psychiatric disorder. Childhood bedwetting also contributes to parental or caregiver stress, due to the added need for frequent laundry loads or the purchase of pull-ups or diapers.  

Treatment Options for Bedwetting

Pediatric pelvic floor rehabilitation is a behavioral- and exercise-based treatment approach to bedwetting. A child should be at least six years old when referred to physical therapy for bedwetting. Following a physical therapy assessment and completion of a bladder elimination log, the child is scheduled for three follow-up sessions for behavioral modifications, biofeedback, and a nighttime waking program.

Behavioral Modifications

These are the first and most influential part of the bedwetting program. Participation and follow-through with behavioral recommendations are vital to the child’s success. 

Behavioral modifications include:

• Robust daytime fluid intake before 4 p.m.
• Daytime voiding schedule approximately every 2 hours
• Nighttime fluid restriction (unless the child participates in nighttime sports, or in high humidity)
• Healthy diet and bowel habits

Biofeedback

External surface electrode biofeedback is also used for neuromuscular re-education of the pelvic floor muscles to address proprioception, coordination, and relaxation of the pelvic floor muscles in order to improve daytime bladder emptying and sensation. 

Nighttime Waking

If the child does not experience less bedwetting after behavioral modifications and biofeedback, then the family may be instructed to begin nighttime waking. Most children have leaks in the first four hours of sleep or one to two hours before waking. The family is instructed to perform a specific nighttime waking schedule that is adjusted weekly according to the child’s success. 

What to Expect

Children are typically followed for three to five physical therapy sessions. Significant improvements are usually seen within the first two or three visits, depending on participation and follow-through with the home program and recommendations.

If children are following the program and yet not making progress, then they are referred back to the pediatrician for further assistance. 

Learn more about children's rehabilitation services