Bed wetting can be an extremely frustrating problem to have, for kids and their parents. Why does it happen? What might be causing it? How can physio help?

Pediatric pelvic health physiotherapy is an integral part of the care team for children that are experiencing persistent bed wetting aka nocturnal enuresis. Many children go through daytime potty learning, and just seem to never really quite get the night-time down pat. For others, they breeze through daytime and night-time dryness, and then at some point the night-time problems start and just get worse over time. If you are struggling with potty learning check out our blog.

So why does bed wetting happen?

Evaluating movement and coordination is critical in identifying underlying reasons for bed wetting

Bed wetting can in some instances simply be a result of a deep sleeper and an immature bladder. These are kids that will eventually just grow out of it. Many children, however, fit into the “underlying contributing factors” category. Our ability to be continent (hold our urine) at night can be impacted by a number of factors. Here we will go through two main issues:

  1. Constipation
  2. Daytime urinary dysfunction

Constipation

Often times we think of constipation as children going days on end without bowel movements, having extreme difficulty evacuating the bowel, tears, and an overall dramatic experience (which definitely may be the case). BUT some of the time constipation looks like multiple bowel movements a day, quick trips to the washroom, and stool being evacuated without having an actual sensation of the “I need to poop”

The question is how does constipation impact bed wetting? During appointments we take the time to sit down and draw out the relationship (clients get signed copies to take home because the artistic talent is top notch!) – but imagine that the bladder is a balloon, and the abdomen is like a Tupperware container. If the bowel is a long skinny balloon that also fits into the container there is only a certain amount of space in there. When we start to stuff the bowel with some extra stool, it will take up more space in the container. This will leave less space for the bladder, and it will get squished before it can send a signal of “I’m full go pee!” resulting in bed wetting. Biggest take away?

Really the child has no signal that they need to go!

Discussing bed wetting can be challenging especially as a child ages, but making children comfortable and confident is the goal

Daytime Urinary Dysfunction

When a parent comes with their child for an appointment and the only reason is “bed wetting” there is a good chance that it isn’t JUST bed wetting. In order for the problem to be strictly nocturnal enuresis, it needs to be present in the absence of any daytime abnormalities. Many children that come in have several daytime issues going on, and often the parents don’t even realize it! Here are a few things that often come up during discussions with children:

  • decreased urinary frequency during the day (<4x/day)
  • increased urinary frequency during the day (>7x/day)
  • leaking urine during the day
  • altered sensation to void (not sensing the urge to go, or having the urge and being unable to go)
  • voiding difficulties (feeling the urge to go and not being able to)

We struggle especially with school aged children as we often don’t know what their bathroom habits are! Our society tends to significantly limit our bathroom involvement with our kids after they have potty learned, even though they may need parent support until age 5 to ensure they are building positive bowel and bladder hygiene routines!

 

If you have a child that is holding their bladder all day, you can imagine that might impact night-time dryness. If they are having any sort of daytime dysfunction, the night-time wetting will have difficulty resolving independently, since our kids are sleeping (hopefully!) at night, the greatest impact we can have on bed wetting is by working on the daytime dysfunction and/or constipation!

 

Ultimately, bed-wetting in many instances is not something that the child is wanting to do or has control over (despite what many of our friends and relatives will tell us). If you have a child that is wetting at night at any age, it may be worth it to think about some of these factors. When in doubt, give us a shout!

 

Book an assessment for your child!

Haylie has been practicing pelvic health and focused in prenatal and post-partum care since graduating from the U of S MPT program in 2011. She officially added to her practice pediatric pelvic floor therapy in 2017. Haylie has been advocating for treatment for women, ensuring appropriate and effective care throughout pregnancy and post-partum, and helping all expecting and post-partum moms ultimately brought her to open her family-friendly clinic since opening in 2014. She now adds to this education and treatment provision her knowledge and experience in pediatric pelvic health providing workshops and presentations in addition to assessment and treatment. At Warman Physio clients are encouraged to bring their infants and children to treatment. Haylie was recognized as YWCA Women of Distinction for Health & Wellness in 2017, the ABEX Young Entrepreneur Award Recipient in 2018, and a finalist in the 2019 SABEX and WMBEXA Awards.

You may have seen that our Saskatoon location is now open for appointments. Signe Bone is providing some new treatment techniques for Warman Physio, and one of those treatments is CranioSacral Therapy. We thought our clients would like to know what CranioSacral Therapy (CST) is all about!

The Basics – Where it started

CST was pioneered and developed by John E Upledger, an osteopathic physician from 1975-1983 with extensive scientific studies at the Michigan State University. Upledger was a clinical researcher and Professor of Biomechanics at MSU.

 

What CST treatment involves

When coming in for an appointment you can expect to feel supported and cared for as the therapist will apply subtle movements on the spinal and cranial bones to bring the central nervous system into harmony. Signe will evaluate and address the movement of the cerebrospinal fluid (CSF), which can be restricted by trauma to the body (such as falls, accidents, infections and general nervous tension). By gently working with the spine, skull and sacrum, these restrictions for nerve passages are eased and movement of the CSF through the spinal cord can be optimized. A nervous system free of restrictions enables the body to return to its highest levels of performance. When attending an appointment for CST alone, the treatment can be provided with the client fully clothed. If CST is combined with more traditional massage techniques the client will dress-down appropriately for the treatment with instruction from the therapist. Treatments independently last on average 60 minutes.

What Types of issues can CranioSacral Therapy benefit?

There are a wide array of things that CST can be beneficial in treating including:

  • Migraines and headaches
  • Chronic pain
  • Central Nervous System Disorders (ie spasticity, seizures, hearing problems)
  • Trouble sleeping
  • Reflux
  • Anxiety
  • Orthopedic problems
  • Scoliosis
  • Chronic fatigue

Special continuing education in CST can be done in order to specifically work with infants and children in addition to the adult populations.

 

Want to book in with Signe? You can choose the type of treatment you will receive when you book online!

 

 Signe’s passion for understanding the human body began at a young age with her own sports and repetitive strain injuries from her former schooling as a musician. After seeing the healing benefits of movement, breath awareness, massage therapy and physio,  Signe was inspired to focus on her training in Visceral Manipulation and CranialSacral therapy. After learning and seeing how amazing and intricate the body is, and the impact these treatments can impart on the body, she has developed a treatment style that incorporates all these various techniques to provide the best treatment to each client based on their own unique needs.
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Family Focused – What does that MEAN?

We see many people talking about being family friendly, kid friendly, family centred, or family focused in their business. What does this truly mean at Warman Physio?

When looking to start the clinic, I had worked in several places that were “family friendly”, but didn’t have any change tables, toys, or ways to keep kids occupied. This puts the onus 100% on the parents to remember to bring things for the kids (who may unpack the bag before you leave), and check to make sure that everything is charged (as we sometimes discover that technology requiring a charge isn’t always charged when we want it…) and the snacks are the snacks that the kids will actually eat (and hopefully not make a a colossal mess). Which is a huge undertaking when you are a new mom, or just frazzled trying to get the kids out of the house!

What I wanted to achieve at the clinic is a family friendly environment for everyone. I want each person who comes to the clinic to feel like family, sort of like coming home. The goal is for everyone, regardless of what service, issue, or injury they may be coming in for to get this ‘vibe’. For me, it has been a critical focus that when adding new therapists and staff that we stick to this value – being warm, welcoming, and compassionate. (It is written right into the clinic vision and mission statements!)

At the clinic you will find toys, games, books, swings, chairs, wraps, and carriers all intended to help keep babies and older children happy and content during appointments (regardless of what mom remembers to bring!)

The clinic treats babies and children right up to older adults; we truly are able to help everyone across the lifespan!

Ensuring that everyone is treated like an extended family member is the environment you can expect at Warman Physio.

The biggest reason why I wanted this particular feel is because I often heard that people would avoid going for needed appointments because they were unable to afford childcare; or they didn’t have support around to help watch their children while they attended their treatments. Not because they couldn’t (or were told they couldn’t) bring their babies to appointments, but because the environment of acceptance that sometimes babies cry and appointments don’t go as planned made bringing their kids to appointments difficult and uncomfortable. Now don’t let me give you the wrong impression – the therapists want the kids and babies to come, but when it’s not the “norm” it can be a difficult distraction to overcome!

Seeing prenatal and postpartum women, infants and children at the clinic has been the clinic ‘niche’ from the beginning – we just do it a lot! So having that colicky baby that cries the whole time? We’ve got this. Having that baby that needs to lay on momma the whole time? No problem. Having the two big kids that for some reason just NEED to both be on the blue chair? We can figure that out too. Our therapists will hang onto babies, use the swings, and help older kids problem solve during appointments, and sometimes (when mom is comfortable), Laura will snag some of the babies and wander around with them so the mommas can focus on their appointments. It is wonderful to have the content babies and kids in at the clinic, but the kids that are more ‘challenging’ aren’t any less welcome. We enjoy seeing all the kids that come in and want them to feel welcome as well!

So if you have been waiting until you’re back at work, have been putting off coming because you can’t afford childcare, or simply just didn’t know what to do with the kids for your appointments, don’t hesitate to book in with us! We even have kids attend massage appointments with parents sometimes (but I get wanting to be able to get into fully relaxed mode!) 😉

We are here to welcome you into our Warman Physio family – wherever you may fit!

Haylie has been practicing pelvic health and focused in prenatal and post-partum care since graduating from the U of S MPT program in 2011. She now adds to this education and treatment, her knowledge and experience in pediatric pelvic health providing workshops and presentations in addition to assessment and treatment. Haylie has been advocating for treatment for women, ensuring appropriate and effective care throughout pregnancy and post-partum, and helping all expecting and post-partum moms since she started practicing. This ultimately brought her to open her family-friendly clinic in 2014.  At Warman Physio clients are encouraged to bring their infants and children to treatment if they need. Haylie was recognized as YWCA Women of Distinction finalist for Health & Wellness in 2017, the ABEX Young Entrepreneur Award Recipient in 2018, and a finalist in the 2019 SABEX and WMBEXA Awards.

You’ve already read all about WHY pelvic health is also important for men, now let’s dive into a case study!

Case Study – Male Pelvic Health

CT is a 43 year old male seeking help because he is having problems with leaking urine whenever he does physical activity. He has also been experiencing consistent sharp/burning pains around his rectal area. In the beginning he was leaking only a few drops of urine and feeling slight discomfort in his pelvic floor… but after a few months CT is leaking his full bladder and his pain has greatly increased. He is afraid to participate in golf, fishing, and jogging because this is when he leaks the most urine.

During the pelvic assessment it is found that CT has a weak pelvic floor (2/5 strength), and a lot of tension/tightness of his pelvic floor muscles. He is educated that he needs to strengthen his pelvic muscles in order to close his urethra (tube which pee comes out), so that he does not leak before he is able to get to the bathroom, or when participating in golf, fishing, and jogging. CT also requires training in relaxation exercises, and stretches for his pelvic floor, which will decrease the tightness and therefore stop the pain that he has been experiencing.

After the assessment CT is sent home with a breathing exercise, several pelvic floor stretches, and a muscle strengthening exercise.

At the next session CT reports having decreased episodes of leaking and reduced pain in his pelvic area. During a follow up evaluation CT now has 3/5 pelvic strength and a decrease in muscle tension. The therapist manually releases his pelvic muscles and he is once again sent home with progressed pelvic floor strengthening exercises and stretches.

After a few more weeks and 2 or 3 more sessions CT is no longer leaking and feels no more pain and discomfort in his pelvic floor. He is educated to keep up with his exercise program occasionally to maintain strength and proper length of his pelvic floor.

 

Not all pelvic health issues will present the exact same, and as such there is no one-size fits all program that will work for everyone. Need help with your pelvic health complaint? Don’t hesitate to contact us or book an appointment. Not sure if your issues can be helped by a physiotherapist? Give us a call, or send a message, we are happy to help you sort through it.

Book a pelvic health assessment with Scott

Book an orthopedic assessment with Scott

Scott Golding is a Pelvic Health Physiotherapist that has a special interest in male pelvic health and rehabilitation. He is passionate about advocating and supporting men in their pelvic health journey. He has completed the U of S Level 1 and Pelvic Health Solutions courses for pelvic health Level 2, and 3 in addition to orthopedic and integration of pain science courses. He has been working with both women and men for pelvic health and orthopedic issues since graduating in 2016.

 

He is driven to provide excellent care in a safe and comfortable environment for his patients. Scott believes that pelvic floor health needs to be a fundamental aspect of a healthy life, as many individuals struggle in silence. 

 

“My future goals include becoming a strong support and resource for men as it relates to pelvic, and general health. I want to help decrease and remove the stigma associated with male pelvic health and provide exceptional resources for men who need or are seeking help.”

As a pelvic health therapist one of the biggest questions I get is – wait, WHAT exactly do you do?!

For an adult (age 18+) pelvic health assessment there is a wide variability as to what this will look like, but for a general appointment you can expect for us to ask a detailed history – and this will include some really thought provoking questions for many! The questions and history will vary slightly depending on the issue that you are coming in with (leaking, pelvic organ prolapse, pelvic pain, etc) but the basics will all be covered. I want to know… What are you coming in for, what is the story behind it? Is this getting better/worse? What have you tried to date? (remember, pelvic health therapy is more than kegels!) Your OBGYN history (kids, how they were delivered, when, how big, instruments, length of labor/pushing, etc). Bladder & bowel history (all about voiding patterns, changes, etc) among others.

Once we are done all the questions, and we get an idea of what you are hoping to accomplish, we will complete a physical exam as well. Looking at how you move (walking, squats, etc) may be completed, and abdominal evaluation (diastasis recti, coordination and palpation).

When explaining to people what we do throughout the day we often get these skeptical looks!

In the majority of cases for adult pelvic health we will also aim to complete a pelvic exam**. In order to be a pelvic health physiotherapist, we have additional coursework that allows us to be certified to complete these exams. We check for reflexes and sensation, movement and positioning of the pelvic floor, as well as muscle contractility and pelvic organ position. Muscle coordination between the pelvic floor and rest of the abdominal muscles is also evaluated (what happens when someone coughs or creates what we call a valsalva maneuver). In some instances, usually not on the first day, there may be an indication to evaluate the client in standing as well.

**In some instances when individuals are experiencing pelvic pain conditions, a complete pelvic health evaluation may not be achieved on the first appointment – and this is ok! We do not need to push through pain in order to get the process going, so there is no need to “grin and bear it” for these appointments, we want to know if something is uncomfortable! There are also instances where a pelvic exam is not appropriate which is evaluated on a case by case basis. It is important to remember that there is always an option to not complete a pelvic health exam at an appointment, with careful consideration with your provider we want to ensure you get the best treatment in a fashion that is suitable for you.

What you will head home with for homework will be dependent on what exactly we find (tightness, weakness, coordination issues, etc) to get you starting your road to resolving your particular issue or issues, but each person will have a unique plan to achieve their goals!

Many people come to their appointments worried about how things will go, anxious it will be awkward, and end up leaving feeling relieved and confident in their plan. As pelvic health therapists we do our best to keep you comfortable and provide the education you need to really take control.

Start your road to recovery today! Book an appointment with one of our therapists!

Have questions? Feel free to send us a message and we will do our best to help you get your answers!

Haylie has been practicing pelvic health and focused in prenatal and post-partum care since graduating from the U of S MPT program in 2011. She officially added to her practice pediatric pelvic floor therapy in 2017. Haylie has been advocating for treatment for women, ensuring appropriate and effective care throughout pregnancy and post-partum, and helping all expecting and post-partum moms ultimately brought her to open her family-friendly clinic since opening in 2014. She now adds to this education and treatment provision her knowledge and experience in pediatric pelvic health providing workshops and presentations in addition to assessment and treatment. At Warman Physio clients are encouraged to bring their infants and children to treatment. Haylie was recognized as YWCA Women of Distinction for Health & Wellness in 2017, the ABEX Young Entrepreneur Award Recipient in 2018, and has been nominated for the 2019 SABEX and WMBEXA Awards.