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Children and Bedwetting
Sarah Hendrickson talks about children and bedwetting. Ms. Hendrickson discusses causes, solutions, the support that parents can give to their children, and non-medical interventions.
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Learn more about Sarah Hendrickson, PA-C
Sarah Hendrickson, PA-C
Sarah Hendrickson is a board-certified physician assistant with Wake Med Physician Practices – Pediatric Urology. She received her bachelor’s in biology and master’s in public health from East Carolina University in Greenville, North Carolina, and master’s in physician assistant practice from Campbell University in Buies Creek, North Carolina.Learn more about Sarah Hendrickson, PA-C
Transcription:
Children and Bedwetting
Maggie McKay: Bedwetting can be an emotional process for parents and children. And today, we're going to talk with Sarah Hendrickson, physician assistant with WakeMed Pediatric Urology, to find out how to manage it.
This is WakeMed Voices, brought to you by WakeMed Health and Hospitals in Raleigh, North Carolina. I'm your host, Maggie McKay. Welcome, Sarah.
Sarah Hendrickson: Thank you. Yeah, thank you for having me. I love that WakeMed does these podcasts and there've been some great episodes in the past. So I'm excited to talk about bedwetting today.
Maggie McKay: Thank you. We're excited to have you. Bedwetting is common and a bit of a mystery. Can we talk about how many adolescents struggle with this?
Sarah Hendrickson: Sure. Yes, it's very common. It affects 15% of children at age five and decreases down to 5% at age 10. But even after 15 years old, we can see up to 2% dealing with this still. And so it can be such a source of shame and psychological distress, not only for the patient, but also for the parents attempting to manage and make this better for their children. So there are often many contributing factors and causes and it can be a bit of a mystery to know what is the underlying issue for each child.
Maggie McKay: So, what are some of the causes?
Sarah Hendrickson: There are several conditions that commonly occur in children with nocturnal enuresis, is what we call bedwetting in the medical field. So acknowledging these conditions and addressing them first is important. And typically, the pediatricians do a great job in talking to families about this. We see associations with sleep disordered breathing or sleep apnea and bedwetting. Also, conditions such as diabetes, urinary tract infections and general bladder dysfunction can contribute.
Constipation is routinely an issue in these adolescents and teenagers, and it may not be impressive enough for the parents to notice or pick up on, but still enough to be a large contributor. I explain it this way, your stool is stored in the colon and urine is stored in the bladder, and these two structures are very close together. And so as the colon fills and stretches, it can put pressure on the bladder, making that muscle be what we call overactive. And so all of my patients know that I'm going to completely grill them about their poop and I get a lot of eye rolls and you've-got-to-be-kidding-me-looks, but hey, this can be just the complete cause of their nighttime issues. And so we see kids, you know, with daytime accidents as well from this, but even just fixing, you know, their poop and regulating it can take away their nighttime wetting.
Maggie McKay: Wow. I never heard that.
Sarah Hendrickson: Yes. Yeah. So, all my patients when they walk in, they say, "I know you're going to talk to me about my poop," so they're used to it now. But we also see, you know, genetics when parent has a history of prolonged night wetting, as much as 50% of their children are affected. So there are just so many causes to this condition and it can be often complicated to tease out what the contributing factor is.
Maggie McKay: Is stress evera cause?
Sarah Hendrickson: Stress is a huge cause with daytime wedding. And that is another condition that we see a lot of children with and a totally, you know, separate podcast and conversation. But we see stress contribute to dysfunctional voiding a fair amount and dysfunctional voiding can in turn then trigger nighttime wetting, so certainly related and certainly part of our initial workup and questions that we ask.
Maggie McKay: What about kidney or bladder issues? Is that associated with bedwetting?
Sarah Hendrickson: So typically, there are not any underlying kidney and bladder issues in a child that just has bedwetting and no other issues. In almost all cases, bedwetting is going to resolve spontaneously. Now, if we see that they have daytime accidents or recurrent urinary tract infections or frequency or urgency, any underlying neurologic disorders, then certainly we do some other tests. Something as simple as an ultrasound of their kidneys can answer a lot of those questions. But often bedwetting is something that resolves with time on its own. And so we just need to help the patient and the family manage it the best way until it does resolve.
Maggie McKay: So speaking of that, like you said earlier, it can be a source of shame and psychological distress. So how do parents support their children through this and get success finishing it up and being done with it?
Sarah Hendrickson: I mean, if any of our listeners have a child who struggles with this, it is so important for them to know it will get better. I tell my patients every day, "This is not going to be a struggle of yours forever." It is so important to know that this is not something that the child can typically control. It is not done purposely and they should never be punished or shamed for it. They are likely carrying a lot of shame and guilt from this. And so our job as part of their support team is to give them strategies, set some realistic goals, manage expectations, maybe employ some various non-medical strategies. And then, our job in the pediatric urology team is to then move into optional medications when it becomes extremely disruptive to the child. But as the parent, just, you know, being there to support them and motivate them but help reduce that psychological distress that these patients are under.
Maggie McKay: So how do they do that? Nonmedical interventions or medications?
Sarah Hendrickson: Yeah, nonmedical interventions commonly. And so, managing expectations and just determining where they are in their stress level with this, and also how often they are wetting. To give you an example, you know, if it's a six or a seven-year-old who is wetting typically every night and they aren't yet bothered by this, then we help the family manage it by using nighttime pads and pull-ups and protective equipment on the mattress and helping, you know, them set a plan in place so that they are less bothered by this and stressed by this. And just the reassurance and telling them this will get better, there are no other, you know, daytime issues or problems that indicate a, you know, renal disorder is helpful. Versus if I see a 13-year-old who is wetting every night, but has no daytime issues and they are extremely bothered by these symptoms and it is affecting them socially and emotionally, then we talk about the strategies I just mentioned, but we also may consider, using a medication in that child to help them, become dry until they outgrow it.
Maggie McKay: Sarah, is there anything else you'd like to share with parents going through this, and children?
Sarah Hendrickson: Yeah. Along with the treatment options, I think it is important to talk to patients about their urinary habits during the day. I want them to pee five to seven times during the day, making sure to really take their time and pee before bed. So many of us struggle with water intake. Kids are going through school, not drinking, not peeing. And then they come home and they try to make up for it. And so I would just advise taking a couple of days to really track how much they are drinking and how often they are peeing and pooping and how this affects them. If they wake up at night, we want to make sure that they get up and go to the toilet, even if they are already wet. Avoid caffeinated drinks and soda. And so reducing fluid intake in the evening may be helpful for some children, but not an option if they are playing a sport in the evening or extracurricular activities where they're sweating and need to that fluid loss.
But my final thoughts, I think, on this and really I try to bring across to parents and teenagers and adolescents in the office is a couple of things. One, you are not alone. There are many adolescents and teenagers and parents struggling with this, and there are people likely in your school quietly dealing with this as well. You know, secondly, this will get better. It will resolve without us, you know, doing anything oftentimes, but there are some strategies that can make dealing with it easier. And then, you know what we talked about a lot at the beginning is just that this condition carries with it, a lot of shame and psychological distress. And so, parents, your encouragement and support is really needed here. And I know it can be extremely frustrating when you start your day with cleaning sheets, but it does, make a difference just employing some of these strategies with your kids.
Maggie McKay: Thank you so much, Sarah, because, you know, that's not really something a lot of people will feel comfortable talking about, bedwetting. So I'm sure you really helped a lot in explaining how to manage it.
Sarah Hendrickson: Yeah, we try to take the stigma out of it. Just help patients to feel comfortable and know that they are not alone. And that there are certainly so many strategies that we can dig into in the office and, you know, possibly discussing medication. So there are options and Dr. Bukowski and I are always happy to see them in the office and really have an in-depth discussion with patients and their families about this condition.
Maggie McKay: Thank you so much, Sarah Hendrickson, physician assistant from WakeMed Pediatric Urology. To schedule an appointment with WakeMed pediatric urology, visit wakemed.org. I'm Maggie McKay. This has been WakeMed Voices, brought to you by WakeMed Health and Hospitals in Raleigh, North Carolina. Be well.
Children and Bedwetting
Maggie McKay: Bedwetting can be an emotional process for parents and children. And today, we're going to talk with Sarah Hendrickson, physician assistant with WakeMed Pediatric Urology, to find out how to manage it.
This is WakeMed Voices, brought to you by WakeMed Health and Hospitals in Raleigh, North Carolina. I'm your host, Maggie McKay. Welcome, Sarah.
Sarah Hendrickson: Thank you. Yeah, thank you for having me. I love that WakeMed does these podcasts and there've been some great episodes in the past. So I'm excited to talk about bedwetting today.
Maggie McKay: Thank you. We're excited to have you. Bedwetting is common and a bit of a mystery. Can we talk about how many adolescents struggle with this?
Sarah Hendrickson: Sure. Yes, it's very common. It affects 15% of children at age five and decreases down to 5% at age 10. But even after 15 years old, we can see up to 2% dealing with this still. And so it can be such a source of shame and psychological distress, not only for the patient, but also for the parents attempting to manage and make this better for their children. So there are often many contributing factors and causes and it can be a bit of a mystery to know what is the underlying issue for each child.
Maggie McKay: So, what are some of the causes?
Sarah Hendrickson: There are several conditions that commonly occur in children with nocturnal enuresis, is what we call bedwetting in the medical field. So acknowledging these conditions and addressing them first is important. And typically, the pediatricians do a great job in talking to families about this. We see associations with sleep disordered breathing or sleep apnea and bedwetting. Also, conditions such as diabetes, urinary tract infections and general bladder dysfunction can contribute.
Constipation is routinely an issue in these adolescents and teenagers, and it may not be impressive enough for the parents to notice or pick up on, but still enough to be a large contributor. I explain it this way, your stool is stored in the colon and urine is stored in the bladder, and these two structures are very close together. And so as the colon fills and stretches, it can put pressure on the bladder, making that muscle be what we call overactive. And so all of my patients know that I'm going to completely grill them about their poop and I get a lot of eye rolls and you've-got-to-be-kidding-me-looks, but hey, this can be just the complete cause of their nighttime issues. And so we see kids, you know, with daytime accidents as well from this, but even just fixing, you know, their poop and regulating it can take away their nighttime wetting.
Maggie McKay: Wow. I never heard that.
Sarah Hendrickson: Yes. Yeah. So, all my patients when they walk in, they say, "I know you're going to talk to me about my poop," so they're used to it now. But we also see, you know, genetics when parent has a history of prolonged night wetting, as much as 50% of their children are affected. So there are just so many causes to this condition and it can be often complicated to tease out what the contributing factor is.
Maggie McKay: Is stress evera cause?
Sarah Hendrickson: Stress is a huge cause with daytime wedding. And that is another condition that we see a lot of children with and a totally, you know, separate podcast and conversation. But we see stress contribute to dysfunctional voiding a fair amount and dysfunctional voiding can in turn then trigger nighttime wetting, so certainly related and certainly part of our initial workup and questions that we ask.
Maggie McKay: What about kidney or bladder issues? Is that associated with bedwetting?
Sarah Hendrickson: So typically, there are not any underlying kidney and bladder issues in a child that just has bedwetting and no other issues. In almost all cases, bedwetting is going to resolve spontaneously. Now, if we see that they have daytime accidents or recurrent urinary tract infections or frequency or urgency, any underlying neurologic disorders, then certainly we do some other tests. Something as simple as an ultrasound of their kidneys can answer a lot of those questions. But often bedwetting is something that resolves with time on its own. And so we just need to help the patient and the family manage it the best way until it does resolve.
Maggie McKay: So speaking of that, like you said earlier, it can be a source of shame and psychological distress. So how do parents support their children through this and get success finishing it up and being done with it?
Sarah Hendrickson: I mean, if any of our listeners have a child who struggles with this, it is so important for them to know it will get better. I tell my patients every day, "This is not going to be a struggle of yours forever." It is so important to know that this is not something that the child can typically control. It is not done purposely and they should never be punished or shamed for it. They are likely carrying a lot of shame and guilt from this. And so our job as part of their support team is to give them strategies, set some realistic goals, manage expectations, maybe employ some various non-medical strategies. And then, our job in the pediatric urology team is to then move into optional medications when it becomes extremely disruptive to the child. But as the parent, just, you know, being there to support them and motivate them but help reduce that psychological distress that these patients are under.
Maggie McKay: So how do they do that? Nonmedical interventions or medications?
Sarah Hendrickson: Yeah, nonmedical interventions commonly. And so, managing expectations and just determining where they are in their stress level with this, and also how often they are wetting. To give you an example, you know, if it's a six or a seven-year-old who is wetting typically every night and they aren't yet bothered by this, then we help the family manage it by using nighttime pads and pull-ups and protective equipment on the mattress and helping, you know, them set a plan in place so that they are less bothered by this and stressed by this. And just the reassurance and telling them this will get better, there are no other, you know, daytime issues or problems that indicate a, you know, renal disorder is helpful. Versus if I see a 13-year-old who is wetting every night, but has no daytime issues and they are extremely bothered by these symptoms and it is affecting them socially and emotionally, then we talk about the strategies I just mentioned, but we also may consider, using a medication in that child to help them, become dry until they outgrow it.
Maggie McKay: Sarah, is there anything else you'd like to share with parents going through this, and children?
Sarah Hendrickson: Yeah. Along with the treatment options, I think it is important to talk to patients about their urinary habits during the day. I want them to pee five to seven times during the day, making sure to really take their time and pee before bed. So many of us struggle with water intake. Kids are going through school, not drinking, not peeing. And then they come home and they try to make up for it. And so I would just advise taking a couple of days to really track how much they are drinking and how often they are peeing and pooping and how this affects them. If they wake up at night, we want to make sure that they get up and go to the toilet, even if they are already wet. Avoid caffeinated drinks and soda. And so reducing fluid intake in the evening may be helpful for some children, but not an option if they are playing a sport in the evening or extracurricular activities where they're sweating and need to that fluid loss.
But my final thoughts, I think, on this and really I try to bring across to parents and teenagers and adolescents in the office is a couple of things. One, you are not alone. There are many adolescents and teenagers and parents struggling with this, and there are people likely in your school quietly dealing with this as well. You know, secondly, this will get better. It will resolve without us, you know, doing anything oftentimes, but there are some strategies that can make dealing with it easier. And then, you know what we talked about a lot at the beginning is just that this condition carries with it, a lot of shame and psychological distress. And so, parents, your encouragement and support is really needed here. And I know it can be extremely frustrating when you start your day with cleaning sheets, but it does, make a difference just employing some of these strategies with your kids.
Maggie McKay: Thank you so much, Sarah, because, you know, that's not really something a lot of people will feel comfortable talking about, bedwetting. So I'm sure you really helped a lot in explaining how to manage it.
Sarah Hendrickson: Yeah, we try to take the stigma out of it. Just help patients to feel comfortable and know that they are not alone. And that there are certainly so many strategies that we can dig into in the office and, you know, possibly discussing medication. So there are options and Dr. Bukowski and I are always happy to see them in the office and really have an in-depth discussion with patients and their families about this condition.
Maggie McKay: Thank you so much, Sarah Hendrickson, physician assistant from WakeMed Pediatric Urology. To schedule an appointment with WakeMed pediatric urology, visit wakemed.org. I'm Maggie McKay. This has been WakeMed Voices, brought to you by WakeMed Health and Hospitals in Raleigh, North Carolina. Be well.