Kids don't like wetting the bed any more than moms like dealing with soiled linens. For the child, bed-wetting may be a source of humiliation. For parents, it's a test of patience.

By age six, 90 percent of kids stay dry all night. That's small consolation for the children, mostly boys, who continue wetting the bed and must suffer the consequences, such as being unable to attend a sleepover party.

According to Dr. Kristina Suson, urologist at the Children's Hospital of Michigan, there are three contributors to bedwetting:

• Bladder capacity (how much the bladder can hold)
• Urine volume (how much urine is made)
• Arousal (ability of the bladder to wake up the brain)

Seeking treatment

Physical therapy can be effective in helping a child gain control of his or her bladder. A group of muscles and soft tissue, called the pelvic floor, supports the pelvic organs and helps control bladder function.

Problems can occur in children when the pelvic floor muscles do not work well with the bladder. This can happen when these muscles are too tight, too weak, or in spasm.

Children who experience difficulty with bladder control may be susceptible to bladder infections, constipation, difficulty sensing bladder fullness, or other problems due to incomplete emptying of the bladder. Children might have urinary leakage (wetting) during the day or night. Problems with bowel control may also occur.

Physical Therapy may help with the following:

• Child is over 5 years old and still wears pull ups
• Medication is needed for bladder or bowel control
• Leaking urine/loss of urine (enuresis)
• Bedwetting (nocturnal enuresis)
• Waking up at night to urinate (nocturia)
• Giggle incontinence: leaking urine before or during laughing
• Frequent urination or overactive bladder
• Infrequent urination or underactive bladder
• Constipation/diarrhea, painful bowel movements, over/underactive bowels

A physical therapist with specialized training in pediatric pelvic floor therapy will examine the muscles of the abdomen and pelvis with a parent present. Treatment often consists of muscle retraining, biofeedback, patient and family education, behavior and diet modification, soft tissue massage, stretching and strengthening of the pelvic floor and surrounding muscles, and a home exercise program. Experts from the Rehabilitation Institute of Michigan (RIM) and the Children's Hospital of Michigan are specifically trained to work with this population. A physician prescription for physical therapy is required to begin treatment. Services are provided at the following RIM locations: