Category Archives: Pediatric Pelvic Floor PT

Bedwetting- what’s a parent to do?

baby-1151351_1280

Bedwetting is fairly common in children. In fact, close to 1 in 10 children over 5 years of age experience frequent bedwetting, or enuresis, meaning having accidents more than 3 nights per week. Bedwetting has many causes, but the most common (according to the International Children’s Continence Society) are:

  • Most bedwetting children are very difficult to arouse at night
  • Many children have kidneys that produce too much urine at night
  • The bladder may be smaller or contract too frequently in children who experience bedwetting

If your child is experiencing bedwetting frequently, and is over 5 years of age, there is help available! The first step is to talk with your pediatrician. Your doctor may refer your child to a specialist, or may treat the child herself.  The doctor will evaluate your child for other medical problems which can be related to bedwetting, and may recommend using a common medication called Desmopressin which helps for children who are producing too much urine at night. If your child is having daytime accidents or constipation, it is important that these problems are addressed before the bedwetting. This is crucial as we find that often times, nighttime problems resolve once the daytime problems are addressed.

Many parents are shocked to learn that physical therapists like myself often help children with bedwetting problems—we do! Typically, we help with the following:

  • Supporting you and your child build stellar bladder habits. Typically, parents and children are given diaries to fill out at the first visit so we can look at everything from fluid intake to volume of urination, frequency of urination, regularity of bowel movements, and other factors. This helps us make very specific recommendations for your child to improve habits which may be contributing to problems. Remember, if your child is having daytime accidents along with nighttime problems, we will always address the daytime problems first!
  • Managing constipation or other bowel problems. Constipation is the worst—and often plays a huge role in bladder problems! We work with children to make sure they are “happy poopers”—teaching children how to sit properly on the toilet, improve dietary habits, and build a strong bowel routine.
  • Making sure the pelvic floor muscles are working properly. Some children will have “dysfunctional voiding” or “paradoxical contractions” basically meaning their pelvic floor muscles are not relaxing when they should to help the child empty the bladder or bowels. We use external surface electrodes and animated biofeedback to help parents and children see a visual of the muscles and retrain the needed coordination for proper functioning. This is important to make sure the bladder is emptying the way it needs to during the day.
  • Managing an alarm training program. After medication, alarms are actually one of the most recommended first-line treatments to improve bedwetting. There are some alarms that go on the bed itself, and others than clip inside the child’s pull-up or underwear. Typically, kids who regularly experience bedwetting are heavy sleepers, so the alarm helps to wake the child up to use the bathroom. Your physical therapist will help train your family how to use the alarm, and checks in with you regularly to make sure everything is going as it should.
  • Daytime or nighttime bladder training. If the alarm doesn’t work, dry bed training can be used to help identify the time the accident is occurring and slowly train the bladder. This technique is designed specifically for the individual child based on diary information. For both this and alarm training, Moms and Dads play a big role in making this successful!

Do you have any questions about physical therapy for bedwetting? Colleagues, is there anything you would like to add about physical therapy for enuresis? Please let me know in the comments below!! If you live in the Atlanta area and your child is experiencing bedwetting, call my office today to set-up an appointment!

Here are a few great resources on bedwetting:

Educational Booklets from the International Children’s Continence Society (ICCS): There are so many great ones here on everything from constipation to bedwetting!

Practical consensus guidelines for the management of enuresis: A journal article published by the European Journal of Pediatrics in 2013, open access.

PottyMD.com: A great website that sells books, alarms, watches, etc. to help children with potty problems.

“Do you need to go potty?” 5 Tips to Improve your Kiddo’s Bathroom Health: Written by me J

4 Children’s Books to Improve your Child’s Bathroom Health: Written by me—a great one on bedwetting in there J

Have a great week!

Jessica

TBT: 4 Children’s Books to Improve Your Child’s Bathroom Health

I know it’s been a while since I had a good throw-back for you of an old post— this one was written just last fall about books I love for the kiddos I treat! If you are new to the blog, you may now know that along with treating adults, I also treat children with bowel and bladder problems in physical therapy. I had a great meeting yesterday with a local pediatrician. Along with talking about treating children for constipation, bed-wetting (enuresis) and other bladder problems, we also talked about children’s books! I promised I’d share some of my favorites with him, so thought you might as well benefit too! Hope you enjoy! 

First, let me say that I LOVE children’s books. I love the photos, the stories, the fantasy–I have many wonderful memories of my mother and father reading classics like Goodnight, moon!, The Rainbow Fish,and  Alexander and the Terrible, Horrible, No Good, Very Bad Day. Maybe that’s why I loved seeing all of the children’s books specifically written to help kids with bathroom health. Regardless, here we go– 4 books to improve your child’s bathroom habits (in absolutely no particular order).

1.) Everyone Poops by Taro Gomi

Everyone Poops

What child doesn’t love a book with the word “poop” in the title? Everyone Poops is perfect for the child who is embarrassed of having to have a bowel movement. Although embarrassment may not seem like a big deal initially, it is important to recognize that for some children, embarrassment could be the start of a pretty big problem. Often children who are embarrassed to have a bowel movement will develop chronic holding patterns which can create painful hard stool, bowel leakage, and difficulty having bowel movements. I love Everyone Poops because it’s funny, fun, and normalizes having a bowel movement to take away the fear. Plus, it only costs $4.99 on Amazon.com–who can say no to that?

2. Look Inside: Your Body (Usborne Look Inside)

Look Inside

Ok, I will be honest with you– this may have recently become my most favorite children’s book ever! How could it not be? It literally has over 100 flaps to open inside! When this arrived to my clinic I forced my poor student to listen to all of the fun little facts under each flap in this book. It is filled to the brim with excellent information on the body and even has a beautiful 2-page spread on the digestive system. Plus, it’s interactive–your child can lift a flap and see how the bicep muscle works…lift another flap and see how our ears hear!  My only beef is that they really did not include much information on Urinary function…but other than that, it is amazing! It may have just become my book I give all of my pregnant friends for their new kiddos. Amazon.com $10.48 and worth every penny!

3. It Hurts When I Poop: a Story for Children Who Are Scared to Use the Potty, by Howard J. Bennett

Hurts to Poop

Back to the poop– Constipation is the worst! And fear related to using the bathroom can be equally as bad as embarrassment in creating holding patterns and constipation in children. This book was written by a physician who provides a relatable story for children fearful of using the bathroom. The story follows a young boy Ryan as he goes to see a doctor to help with his constipation. Dr. Bennett also does a great job at providing great recommendations for kids and parents to help improve bowel function! I especially love his page on “foods that make poop hard” and “foods that make poop soft.” This book is an absolute must for children dealing with constipation. The reviews on Amazon.com really say it all, and this book only costs $8.96.

4. Sammy the Elephant and Mr. Camel: a Story to Help Children Overcome Bedwetting, by Joyce Mills and Richard Crowley

Sammy and Camel

How could you not love the sweet story of an elephant who struggles with carrying water, is mentored by a camel, and goes on to save the town by putting out a fire? This wonderful story not only provides a powerful image for children having difficulty with enuresis (bedwetting), but it also is great for improving self-esteem in children and decreasing feelings of guilt or low self-worth. This book also includes information in the back for helping parents take the next steps to improve a child’s bladder function. An excellent read for kids and parents alike! And only $8.96 on Amazon.com!

I hope you will consider picking up some books if your child is having bowel or bladder problems! Do you have any other great books for this? Let us know in the comments!

Have a great Thursday!

~ Jessica

TBT: “Do you need to go potty?” 5 Tips to Improve Your Kiddo’s Bathroom Health

child-316211_640

Today’s throwback (yes, I know it’s Friday– I’m sorry, I was busy yesterday!) comes from a post I did a year ago on improving bathroom habits in children. This has been modified from my original post to reflect my most current thoughts and current practice patterns. Hope you enjoy! 

As you may know, I have advanced training in working with children with bowel and bladder dysfunction in pelvic physical therapy. Often times, this is shocking to many people to hear as most of us are somehow under the impression that children don’t have these sorts of problems. But the truth is, these problems are SO common in children! Amazingly, there are many easy things parents can do to make huge differences for their children!  I often here my adult patients say,

“But you don’t understand, I’ve been constipated since I was 5 years old– it must run in my family! ” 

What if we changed the habits of our children early to promote healthy bowel and bladder habits? Could we truly make a difference for them later on in their lives? Could we prevent them going in to their physical therapist and having to say statements like the one above? I believe we can do just that!

Here are your 5 tips to start making those changes today!

1. Encourage adequate fluid intake (mostly water!) and fiber intake!

The average person should consume 5-8 8-oz cups of fluid per day–and your child is no different! Fluid is SO important for both the bladder and the bowels! For the bladder, having adequate fluid decreases the risk of urinary tract infections, encourages normal bladder urges, and allows for a normal light colored urine instead of a dark concentrated urine. As an aside, taking in too many sweet sugary drinks, caffeinated drinks, and carbonated drinks will actually irritate the bladder and is something we want to try to avoid. (Note: Remember this if your child has difficulty with bed wetting!). For the bowels, adequate fluid allows for a soft stool that is easy to pass! If your child is not getting enough water, he or she will likely have a  more firm stool as the intestines have worked to absorb the fluid your child needs for normal bodily functions. Many a patient has been “cured” of constipation simply by drinking more fluid!

Fiber is also very important to encourage a good bowel consistency. The American Academy of Pediatrics recommends children take in between their age + 5 and their  age +10 grams of fiber per day (i.e. a 5 year old would need between 10 – 20 grams/day). There is some debate in this, so check with your pediatrician to get their recommendations. Good fiber sources include fresh fruits and vegetables, whole grains, oatmeal, granola, seeds and nuts! For good recipes for your kids, check out Gina’s recipes from Skinnytaste.com that are “Kid Friendly” here. Also, one of my favorite books for parents, Overcoming Bowel and Bladder Problems in Children, has a wonderful index of fiber-filled kid recipes!

watermelon-846357_640

2. Encourage your child to listen to his or her normal body urges.

This goes for both the bladder and the bowels as well! Quick lesson on anatomy and physiology–We have a normal reflex in our colon that helps us hold our stool to empty at an appropriate time (Yay!). Unfortunately, if a person holds stool for too long, the normal colon response to help us poop is dampened–meaning it won’t work as well! For the bladder, over suppressing bladder urges can cause problems with emptying that bladder, daytime accidents and frequent urinary tract infections. Many times, children become distracted with playing, watching TV, etc. and will hold off on going to the bathroom when they do have that urge. Parents should try to be aware of how long it has been since their child has urinated, and try to encourage a frequency of at least once every 2 hours (this will vary some depending on the age of the child).

3. Get your kids moving! 

I’m sure you’ve heard it in the news these days that children need to get moving more! But, to take a new spin on it, encouraging your kids to move more will actually help keep their bowels more regular! Yes, it’s true, exercise is a stimulant to the bowels. So, encourage your kids to get outside and play, ride their bikes, do family walks and games– the more your kids move the better!

4. Help your child develop a bowel routine 

This one ties in perfectly with our last point. Here’s the scenario:

“8 year old Mary is not a morning person. Mom has a hard enough time getting Mary out the door in the morning, and this often means eating a bagel on the way to school. After Mary gets to school, she often needs to go #2, but is too embarrassed to go and holds it the whole day.”

Unfortunately, kids like Mary often develop constipation from over suppressing those urges! The sad thing with this is that if a child suppresses urges for bowel movements, the stool will often become hard and may even cause pain when the child does go to the toilet. Over time, children can end up with overly stretched colons and may even need to use laxatives/medication for a period of time to loosen the stool and help the colon return to it’s normal position. All of this can be minimized by building a routine for your kids in the morning (or evening) to help encourage a normal bowel movement.

This video from the Children’s Hospital in Colorado helps to shed more light on bowel problems in children:

We know that the colon LOVES consistency, so try to encourage your kids to spend some time (at least a few minutes) on the toilet at the same time each day. We also know that the colon loves fluid (hot especially), hot food, and exercise! So, a good bowel routine would look like this:

“To help Mary’s bathroom habits, Mom started waking Mary up 30 minutes earlier. Mary starts her day with a warm bowl of oatmeal, then plays with her pet dog.  After they play, Mary heads straight to the bathroom to have a BM.”

Yes, building a routine takes some extra time–but it is well worth it to prevent constipation in your kiddos!

5. Encourage proper toilet positioning and breathing on the potty

Yes, there is a right way to sit on the toilet. For children, most toilets are too tall and this makes it difficult for them to relax the muscles around the anal canal to help them poop without pushing hard. Kids will compensate by straining, but over time this can be very detrimental to their pelvic health. To help them out, get a small stool to go in front of your toilet seat which will help encourage them to fully relax their muscles. Encourage them to lean forward and relax on their knees. This will help straighten out the rectum to encourage easy emptying.

Image

Image from our good friends at squattypotty.com. Check them out!

Then, and most importantly, make sure they have time. Encourage them to read a book or magazine and give their colon a few uninterrupted minutes to “do its thing.” I recommend they spend this time doing slow breathing (Potty Yoga) and relaxing. If they feel like they need to push, encourage them to breathe while they push to avoid the typical valsalva maneuver we often see. Learning this will help them so much both now and in the future! For more information, read this excellent post from my colleague, Jenna Sires, called “Are you Pooping Properly?

What have you tried to help encourage good bathroom habits for your kids? Are your children having problems not addressed above? Feel free to comment below! Here’s to a healthy upcoming generation!

~ Jessica