One of the most useful tools for a healthcare provider is to have a great deal of information about the symptoms and general habits of the child. Consider keeping a symptom diary of daily habits and routines for a two week period prior to a medical appointment. You should take care to note when your child voids during the day and night, when accidents occur (time of day or night), the amount of urine voided, drinking patterns (does your child drink a lot of fluids in the later afternoon/evening? Does your child get up to drink something during the night?), what your child drinks (sugary fluids, caffeinated, etc.), when constipation occurs, if fecal soiling occurs, the nature of the urinary stream (is the urinary stream is strong and constant? Is there continuous dribbling?), if there are recurrent infections, and the number of wet versus dry nights. Any and all of this information can help a healthcare provider determine the cause of the problem and the appropriate treatment.

At the time of the appointment, you should be prepared to supply such information as well as questions related to medical history, medication, and family medical history. In addition to helping you find options to help cure bedwetting it is also important that you see a healthcare provider to rule out any other more serious problems that may cause bed wetting as a side effect.

Treatment Options

A variety of options are available to end bedwetting. Effective treatment for bed wetting has also been show to greatly improve the self-esteem of the child. Treatment options may vary based on the severity of the problem, the age of the child, the impact on the family. Both pharmacological and behavioral treatment options exist. To better combat the problem a combination of treatments may be used if necessary.

The most important aspect of all treatment options is the child’s involvement in treatment and motivation to dedicate the time and energy necessary. For this reason, some younger children may not be motivated and ready for treatment. This should be considered and if necessary treatment postponed until the child is ready.
It is also important for parents to be motivated and supportive of the child.

Behavioral Treatments Include:

Withholding Fluids: Limiting a child’s intake of fluids in the late afternoon and evening before bedtime, thereby causing a decreased amount of urine at night, may be a helpful first step to reduce wet nights.

Urotherapy : This behavioral treatment option implements a regular schedule of voiding during the day with voiding occurring every 2-3 hours.

Wakening: This treatment option involves the parent either randomly waking the child during the night or at schedule times once the child is asleep in order to urinate. If choosing this option, it is very important that the child be fully awake and aware. Otherwise the process encourages urinating while sleeping. This option also requires a high level of parental involvement to wake the child in the middle of the night and put them back to bed.

Reward System: While the child cannot control nocturnal enuresis, this option involves positive reinforcement of behavior the child can control, such as voiding before bed and at regular times during the day, as well as helping clean sheets and strip the bed. Rewards in some cases have consisted of sticker charts for positive behavior with a prize when a certain number of stickers have been won. Punishments for wet nights or rewards for dry nights are NOT appropriate as the child has no control over these.

In any case, until they are able to overcome this it is best to use underpads in bed in order to keep the urine from getting to the mattress.

Bed wetting, is the involuntary voiding of urine during sleep, with a severity of at least 3 times a week in children over the age of 5. A mentally handicapped child is generally expected to become dry at night when he or she reaches the mental age of four. It is estimated that more than 5 million children in the US experience nocturnal enuresis.

One of the most difficult aspects of bed wetting is its effect on children and their families. The greatest impact is on the child’s self-esteem. Bedwetting is often a source of great embarrassment for the child causing him or her to refrain from certain age-appropriate activities such as a sleep-over for fear of a bedwetting accident. Bed wetting can have an effect on school performance and later sexual activity as a result of the low self-esteem bedwetting can cause. Often parents become frustrated with continued bedwetting as it is a drain of time, energy, and money with constant cleaning and bed changing. Sometimes bedwetting can be a source of embarrassment for the parents who may view the problem as a result of bad parenting or a mischievous child, neither of which are true. It is crucial to remember that bedwetting happens to MILLIONS of children and that bed wetting is not the fault of the child or the parent.

Ages 1-2: The child has a conscious sensation of the bladder filling with urine.

Ages 2-3: The ability to urinate or to voluntarily stop urinating develops and children begin to learn the etiquette surrounding urination.

Ages 3-4: Most children by the age of the 4 have achieved urinary control and are dry both day and night.

Causes

Many causes of nocturnal enuresis (bed wetting) exist. Bedwetting is not a result of laziness or disobedience on the behalf of the child. Bedwetting is caused by many factors.

Bedwetting has been found to be genetically linked. One study has shown that a child of two bedwetting parents has a 77% chance of becoming a bedwetter. When one parent wet the bed as a child, his son or daughter was found to have a 44% chance of becoming a bedwetter. While little scientific support exists, many hold the “deep-sleep” theory which blames the exceptionally deep sleep some children experience as the cause of wetting the bed. Because a child is so deep in sleep, his brain and body ignore the signals of a full bladder.

Another cause cited for primary bed wetting is a “smaller” bladder. This does not mean, however, that the physical size of the bladder is smaller for bedwetting children than for their peers. Instead it means that their Functional Bladder Capacity (FBC) -the amount of urine the bladder will hold until sending a signal to the brain indicating it is time to urinate- is a smaller volume than that of their peers.

Another cause of bedwetting has to do with ADH or anti-diuretic hormone. ADH is a signaling hormone which tells the kidney to decrease the amount of urine produced. Normally the body produces more ADH at night causing the kidneys to produce less urine. Decreased urine production at night allows an individual to sleep through the night without having to urinate. Some people do not produce more of this hormone at night, as they are supposed to, and therefore produce a large amount of urine at night. In similar cases, the body produces ADH but the kidneys do not respond and continue to produce the same amount of urine.

Multiple Sclerosis, a disease of the central nervous system that impairs the coordination and strength of muscles, can also impact bladder and bowel control. Bladder dysfunction is estimated to affect approximately 80% of those diagnosed with Multiple Sclerosis. Just as Multiple Sclerosis symptoms vary and differ in severity from person to person so too can the symptoms, types, and levels of incontinence.

According to the National Multiple Sclerosis Society “bladder dysfunction develops because MS blocks or delays transmission of nerve signals in areas of the central nervous system that control the bladder and urinary sphincter”. Those with Multiple Sclerosis may experience the need to urinate frequently or urgently, urination hesitancy, frequent need to urinate at night, or be incontinent. Medication side effects, a “spastic” bladder that doesn’t hold a normal amount of urine, or a bladder that improperly empties can all lead to bladder control issues.

The advancements in treatment and management provide many benefits to both those living with incontinence and their caregivers. Disposable products offer effective, affordable, and convenient solutions for light, moderate, and heavy levels of incontinence. Today’s superabsorbent technology eliminates the worry of odor, leakage, and skin breakdown. High performance products comprised of superabsorbent polymers ensure that urine is quickly absorbed into the product’s core thus keeping the skin dry. Polymers also neutralize urine’s harmful bacteria that cause odor and can lead to urinary tract infections or skin breakdown. High performance products provide the security of knowing that they will hold large amounts of urine without leakage and prevent embarrassing accidents.

Pelvic Floor Exercises or Kegel exercises are one of the treatments for stress urinary incontinence (SUI). The exercises are designed to make your pelvic floor stronger and make you more able to tighten your pelvic floor muscles before pressure increases in your abdomen (example: when you sneeze, cough or laugh).

How do I do the exercise?

Identify the muscles

First you need to find your pelvic floor muscles. Try to tighten your muscles around your vagina and back passage and lift up, as if you’re stopping yourself from passing water and wind at the same time. A quick way of finding the right muscles is by trying to stop the flow of urine when you’re on the toilet. Don’t do this regularly because you may start retaining urine. Once you’ve found the muscles, make sure you relax and empty your bladder completely. You can add resistance to the exercise through gripping a hard object such as a Kegel exerciser.

Contract the muscles correctly

The movement is an upward and inward contraction, not a bearing-down effort. When you first start the exercises, check that you are doing them correctly. Put your hands on your abdomen and buttocks to make sure you can’t feel your belly, thighs, or buttocks moving. Don’t hold your breath. You should be able to hold a conversation at the same time or try counting aloud while you’re doing the exercises. Don’t tighten the tummy, thigh, or buttock muscles because you’ll be exercising the wrong muscle groups.

Fast and slow contractions

You need to train your pelvic floor muscles through repetition, in the same way as you would train a muscle.

Slow contractions:

Slow contractions help to increase the strength of your pelvic floor. They help your muscles to hold back the urine. Lift your pelvic floor muscles to a count of ten. Hold the muscles tight for 10 seconds. You may find at first that you can only hold the contraction for one or two seconds, so concentrate on lifting your muscles and holding the contraction for as long as you can. Gradually increase the time until you reach 10 seconds. Relax your muscles and rest for 10 seconds. Repeat the contractions up to 10 times.

Fast contractions

Fast contractions help your pelvic floor to cope with pressure, for example when you sneeze, cough or laugh. This works the muscles that quickly shut off the flow of urine. Lift your pelvic floor muscles quickly. Hold the contraction for one second. Relax the muscles and rest for one second. Repeat the contractions 10 times.

How do I know they are working?

You can test your muscle strength with the stop-start test. When you urinate, partially empty your bladder and then try to stop the flow of urine. If you can’t stop it completely, slowing it is a good start. Try the test every two weeks or so to see if your muscles are getting stronger. Don’t do the test more often than this.

The pros of pelvic floor exercises

They’re simple, cheap and effective. You can do them when sitting, standing or lying down.

The downside of pelvic floor exercises

You have to keep doing them for the rest of your life. It can take up to 15 weeks before you see any difference. If you haven’t noticed a difference after three months, see your doctor.

Bed wetting, is the involuntary voiding of urine during sleep, with a severity of at least 3 times a week in children over the age of 5. A mentally handicapped child is generally expected to become dry at night when he or she reaches the mental age of four. It is estimated that more than 5 million children in the US experience nocturnal enuresis.

One of the most difficult aspects of bed wetting is its effect on children and their families. The greatest impact is on the child’s self-esteem. Bedwetting is often a source of great embarrassment for the child causing him or her to refrain from certain age-appropriate activities such as a sleep-over for fear of a bedwetting accident. Bed wetting can have an effect on school performance and later sexual activity as a result of the low self-esteem bedwetting can cause. Often parents become frustrated with continued bedwetting as it is a drain of time, energy, and money with constant cleaning and bed changing. Sometimes bedwetting can be a source of embarrassment for the parents who may view the problem as a result of bad parenting or a mischievous child, neither of which are true. It is crucial to remember that bedwetting happens to MILLIONS of children and that bed wetting is not the fault of the child or the parent.

Ages 1-2: The child has a conscious sensation of the bladder filling with urine.

Ages 2-3: The ability to urinate or to voluntarily stop urinating develops and children begin to learn the etiquette surrounding urination.

Ages 3-4: Most children by the age of the 4 have achieved urinary control and are dry both day and night.

Causes

Many causes of nocturnal enuresis (bed wetting) exist. Bedwetting is not a result of laziness or disobedience on the behalf of the child. Bedwetting is caused by many factors.

Bedwetting has been found to be genetically linked. One study has shown that a child of two bedwetting parents has a 77% chance of becoming a bedwetter. When one parent wet the bed as a child, his son or daughter was found to have a 44% chance of becoming a bedwetter. While little scientific support exists, many hold the “deep-sleep” theory which blames the exceptionally deep sleep some children experience as the cause of wetting the bed. Because a child is so deep in sleep, his brain and body ignore the signals of a full bladder.

Another cause cited for primary bed wetting is a “smaller” bladder. This does not mean, however, that the physical size of the bladder is smaller for bedwetting children than for their peers. Instead it means that their Functional Bladder Capacity (FBC) -the amount of urine the bladder will hold until sending a signal to the brain indicating it is time to urinate- is a smaller volume than that of their peers.

Another cause of bedwetting has to do with ADH or anti-diuretic hormone. ADH is a signaling hormone which tells the kidney to decrease the amount of urine produced. Normally the body produces more ADH at night causing the kidneys to produce less urine. Decreased urine production at night allows an individual to sleep through the night without having to urinate. Some people do not produce more of this hormone at night, as they are supposed to, and therefore produce a large amount of urine at night. In similar cases, the body produces ADH but the kidneys do not respond and continue to produce the same amount of urine.

Multiple Sclerosis, a disease of the central nervous system that impairs the coordination and strength of muscles, can also impact bladder and bowel control. Bladder dysfunction is estimated to affect approximately 80% of those diagnosed with Multiple Sclerosis. Just as Multiple Sclerosis symptoms vary and differ in severity from person to person so too can the symptoms, types, and levels of incontinence.

According to the National Multiple Sclerosis Society “bladder dysfunction develops because MS blocks or delays transmission of nerve signals in areas of the central nervous system that control the bladder and urinary sphincter”. Those with Multiple Sclerosis may experience the need to urinate frequently or urgently, urination hesitancy, frequent need to urinate at night, or be incontinent. Medication side effects, a “spastic” bladder that doesn’t hold a normal amount of urine, or a bladder that improperly empties can all lead to bladder control issues.

The advancements in treatment and management provide many benefits to both those living with incontinence and their caregivers. Disposable products offer effective, affordable, and convenient solutions for light, moderate, and heavy levels of incontinence. Today’s superabsorbent technology eliminates the worry of odor, leakage, and skin breakdown. High performance products comprised of superabsorbent polymers ensure that urine is quickly absorbed into the product’s core thus keeping the skin dry. Polymers also neutralize urine’s harmful bacteria that cause odor and can lead to urinary tract infections or skin breakdown. High performance products provide the security of knowing that they will hold large amounts of urine without leakage and prevent embarrassing accidents.

Urge urinary incontinence (UI) is defined as the unwanted urine leakage that happens shortly after the sudden, intense desire to urinate. Urge UI is caused by involuntary bladder contractions that occur as your bladder fills. Occurs when nerve passages along the pathway from the bladder to the brain are damaged, causing a sudden bladder contraction that cannot be consciously inhibited. Urine loss is usually in large amounts that soak underwear and even outer clothing. Stroke, dementia, Alzheimer’s Disease, and Multiple Sclerosis (MS) can all cause urge incontinence. Urge Incontinence is a major symptom of Over Active Bladder (OAB).

Fecal incontinence is a difficult condition to face. However, awareness has increased tremendously over the past 10 years. Treatment continues to expand and provide patients and their healthcare provider options specific to their needs. Talk to your doctor about treatment options that are right for you.

Sometimes even small lifestyle changes such as dietary modification or eliminating certain medications (a side effect of certain medications is diarrhea) can be helpful in regaining bowel control. Taking medications or increasing fiber to change the consistency of the stool may provide relief, since a person can usually better control stool when it is firm rather than loose or liquid. The first steps to controlling incontinence are to normalize stool consistency with increased fiber intake, to bulk up stool, and to exercise the pelvic floor. Often, treatment includes both medical and behavioral therapy.

•  Lifestyle Modifications — If your fecal incontinence is associated with constipation, then good fluid intake, regular exercise, and regular bowel habits can be helpful. Having a good breakfast with tea or coffee and then routinely going to the bathroom may help get and keep you regular. Alternatively, for some people avoiding caffeine may be helpful.
• Medications — Your provider will review your prescribed and over-the-counter medication to determine if any may cause constipation. If you are constipated, then regular laxative and stool softeners as recommended by your provider will be important. If you have diarrhea, supplements to firm stool can increase bowel control since firmer stool is usually easier to control than liquid stool. None should be taken, however, without recommendation of a healthcare provider.
• Exercise — Pelvic floor muscle exercises and Kegel exercises, when performed regularly and correctly can greatly improve the anal sphincter muscle tone. This often leads to increased bowel control and a reduction or elimination of fecal incontinence episodes within a few weeks. To perform the exercise, contract the muscles of the anus as tightly as possible (as if you are trying to prevent the passage of gas) for a count of five and then relax. Repeat 30 times, three times daily.
• Biofeedback –Biofeedback is a non-invasive technique that converts anal sphincter muscle contractions to a visual meter on a computer screen to help a patient become more aware of their anal sphincter muscles. This technique can be used to teach or supplement exercises.

People who continue to experience fecal incontinence despite other treatments may require surgery to regain control. Surgical options depend on the cause of the incontinence, the severity of the problem, the health and age of the patient, and the clinical judgment of the surgeon.

Management Options

• Fecal Incontinence Collection Systems — With multiple options ranging from bags adhered directly to the skin to catheters and tubes attached to a collection bag, there are many management options for fecal incontinence.
• Absorbent Products — A variety of disposable or reusable absorbent products that may be used during treatment exist.
• Skin Products — Fecal material can cause many problems including skin irritation and breakdown, which increase the risk of infection and are often painful for the patient. Many products exist to help maintain skin integrity including special cleansers that maintain skin pH while cleansing, moisturizers, and moisture barriers that help protect the skin from irritants or moisture. Many also include fragrances and anti-bacterial components both of which should be used with caution. Fragrance can often increase irritation, exacerbating the problem, and routine anti-bacterial use remains controversial as little evidence exists about its effectiveness.

Incontinence (in-CONT-ti-nunce) is the loss of bladder or bowel control. A broad range of conditions and disorders can cause incontinence, including birth defects, pelvic surgery, injuries to the pelvic region or to the spinal cord, neurological diseases, multiple sclerosis, poliomyelitis, infection, and degenerative changes associated with aging. It can also occur as a result of pregnancy or childbirth. In itself, incontinence is not a disease - it is a symptom.

There are several basic types of urinary incontinence:

1.   Urge incontinence, or overactive bladder, is the urgent need to urinate, often with the inability to get to a toilet in time. It occurs when nerve passages along the pathway from the bladder to the brain are damaged. Sudden bladder contractions occur that cannot be consciously controlled.
2. Stress incontinence occurs when pelvic muscles have been damaged, and the bladder leaks during exercise, coughing, sneezing, laughing, or any body movement which puts pressure on the bladder.
3. Mixed incontinence occurs when symptoms of both stress and urge types of incontinence are present, and is very common.
4. Overflow incontinence is the leakage that occurs when the body produces more urine than the bladder can hold.
5. Fecal incontinence is the inability to control the passage or loss of gas, liquid and/or solid stool. This condition can vary from being partial, in which a person loses only a small amount of liquid waste, to complete, in which the entire solid bowel movement cannot be controlled. Incontinence from surgery is a temporary condition that follows operations such as hysterectomies, caesarean sections, prostatectomies, lower intestinal surgery, or rectal surgery. Incontinence can also occur due to other reversible factors, often outside of the urinary tract, such as restricted mobility.
6. People who suffer from incontinence may feel their healthcare provider does not understand what they are going through, but it is very important to speak with your doctor if you’re having a problem with incontinence.

The National Associate for Continence (NAFC) has prepared this Bladder and Bowel Control Diagnostic Tool to help you determine and understand the type of incontinence your symptoms indicate. This web tool is not meant to substitute a diagnosis from a qualified healthcare provider and is not provided by Disposable Medical Express.