Kids Continence Service

Most children are dry over night by the age of 5. Bedwetting also known as nocturnal enuresis is when the bladder empties involuntarily during sleep in a child over the age of 5. It happens in approximately 1 in 5 children, and by age 6-7 years 1 in 10 children have night time accidents. It is not caused by laziness or attention seeking behavior, and is often a complex condition which can cause distress for both the child and the family. 

What causes it?

4 main causes of bed wetting:

• Inability to wake up to a full bladder 
• Overactivity of the bladder at night
• Increased amount of urine made at night by the kidneys
• Constipation

It is NOT caused by:

• Immaturity
• Laziness
• Bad behavior or being rebellious
• Drinking after dinner

Learn more about bedwetting myths here

When should we seek help?

The biggest reason to seek help is 

• If it is bothering your child, making them feel angry or upset
• If they simply express that they want to become dry at night
• If your child was dry at night, but then suddenly starts wetting the bed again
• Most children who are not dry by the age of 7 or 8 should receive treatment as the problem may not resolve by itself.

Children tend to be dry during the day by the age of 3 ½. However all children are different and develop at different rates. There are many reasons a child may have accidents and it is important for us to explore this with you in order to come up with an effective treatment plan. When a child has accidents during the day, it is not because the child is behaving badly. It is because the bladder is behaving badly. It is important to identify what is causing this to happen and put a strategy in place to re-train the bladder. There is often a strong relationship between the bladder and the bowel therefore, we will also look into bowel habits and whether this is effecting the bladder’s behaviour. 

Constipation is when ‘poo’ or bowel motions are difficult to pass and less frequent. When there is constipation, the poo tends to be hard and dry, you may notice the poo is like small little pellets or just that you only pass small amounts, you may have tummy pains, cramps, pain with straining, spending a long time in the toilet, or feeling as if you have not emptied completely. Another sign of constipation can be when there is smearing on the undies. Faecal incontinence, also known as “soiling” is the accidental loss of liquid or solid faeces. This can be due to a range of factors including constipation, diet, or underlying medical issues.

What is “normal” can vary from person to person. A diagnosis of constipation requires more information than just how often you do a poo… we need to ask lots of questions about your bowel habits!

Our assessment will take into account your symptoms, circumstances, any previous medical history, we will ask you about your diet and fluid intake, exercise levels and any other factors that could affect bowel function. An individual bowel management plan will be provided to you to solve problems such as constipation, diahorrea or faecal incontinence.

It should never been painful when you pass urine or a bowel motion. Pain can be an indication of infection (e.g. a urinary tract infection – UTI), constipation, muscle tension or could be due to a skin problems (tears in the skin e.g. anal fissures, or dermatological issues e.g. vulvovaginitis).

Pain should always be assessed as this can lead to changes in toileting habits which can cause longer term problems. If your child expresses pain or fear of pain when they wee or poo this is an indication that they require a medical or physiotherapy review.

Some children may experience pelvic pain. This may be a generalised ache or sharp stabbing pain in the pelvic region. Within the clinic we often see children, particularly girls as young as 6 years old, experiencing sharp stabbing vaginal or rectal pains, spasms or aching in the pelvis. These symptoms are commonly experienced in young dancers and gymnasts and are often caused by pelvic floor muscle tension, abdominal muscle tension and musculoskeletal imbalances. 

Pain should always be fully investigated to avoid these symptoms from becoming chronic. Our physiotherapists are able to appropriately assess and teach strategies in order to manage these symptoms. Treatment may include a combination of education, manual therapy, diet and lifestyle changes. Internal pelvic examinations are not performed on children, however real-time ultrasound may be used to assist with pelvic floor muscle biofeedback.