Paediatric Pelvic Health

Bladder and bowel difficulties in children - including bedwetting, daytime wetting, soiling, and constipation - are common, often undertreated, and consistently under-discussed. Many families wait years before seeking help, often because they have been told the child will “grow out of it.” While many children do improve with time, physiotherapy significantly accelerates that progress and addresses the underlying bladder and bowel coordination that drives these symptoms. These are real, physical conditions - not behavioural problems.

Bedwetting (nocturnal enuresis)

Nocturnal enuresis - wetting the bed at night - affects approximately 15% of 5-year-olds, 7% of 7-year-olds, and 1-2% of adults. It is not a sign of laziness, deep sleeping, or emotional problems. Primary enuresis (the child has never been dry at night) is most commonly related to:

• Delayed maturation of the bladder-brain feedback system (the brain does not yet respond reliably to bladder fullness during sleep)
• Reduced nocturnal production of ADH (antidiuretic hormone), resulting in more urine produced at night than the bladder can hold
• Bladder overactivity or reduced functional bladder capacity

Medical causes (UTI, structural abnormalities) should be excluded by a GP or paediatrician first. Physiotherapy then addresses bladder training, voiding habits, fluid management, and bowel function (constipation is a major but often overlooked contributor to bedwetting).

Daytime wetting and urgency

Daytime urinary incontinence includes urgency (sudden, strong urge to void that is difficult to defer), dribbling, and wetting accidents during the day. In children who are toilet-trained, these symptoms often reflect bladder overactivity or dysfunctional voiding habits - including going to the toilet too frequently, too infrequently, or using poor voiding technique (rushing, straining). Physiotherapy establishes healthy bladder habits and, where the pelvic floor is involved, addresses muscle coordination.

Soiling and constipation

Soiling (encopresis) - the involuntary passage of stool into underwear in children who are or should be toilet-trained - is almost always associated with chronic constipation and faecal impaction. The mechanism is counter-intuitive: a severely constipated child’s rectum becomes so full that liquid stool leaks around the impacted mass and appears as “diarrhoea” or soiling. Treatment requires addressing the constipation first, usually with GP-directed laxative management, followed by physiotherapy for bowel retraining and pelvic floor coordination.

What does a session at Goji involve?

Our physiotherapist will take a detailed history - your child’s bladder and bowel habits, toilet routines, fluid and fibre intake, any previous assessments or treatment, and the impact on your child and family. This conversation is clinical, straightforward, and non-judgmental. Children are included in the conversation at an age-appropriate level; our physiotherapist is skilled at engaging children directly in a way that feels safe and not embarrassing.

The assessment includes:

• Bladder diary review: if you have kept a voiding diary (recommended), our physiotherapist will review it to map the pattern of wet and dry episodes
• Bowel assessment: stool consistency, frequency, straining, and any soiling - the Bristol Stool Scale is used as a child-friendly tool
• Toilet behaviour: posture, time spent, pushing vs relaxing, position of feet
• Pelvic floor assessment: in older children and where clinically relevant, an external assessment of pelvic floor muscle function may be performed. Internal assessment is not routine in paediatric pelvic health; our physiotherapist will explain any assessment clearly before proceeding

Treatment programmes are age-appropriate, involve parents closely, and use child-friendly tools (charts, reward systems, visual guides). The home programme is the core of treatment.

Frequently asked questions

My child is 7 and still wets the bed every night. Is this normal?

Bedwetting at 7 is not uncommon - approximately 7% of 7-year-olds still wet the bed. However, it is worth seeking assessment at this age, particularly if it is affecting your child’s confidence, social participation (sleepovers, camps), or if there has been no improvement. Earlier assessment leads to faster resolution.

My child is constipated and soiling. Our GP said to use laxatives, but it’s not working. Should we see a physio?

Yes. Laxatives address the stool consistency but not the voiding mechanics or pelvic floor function that often underlie persistent soiling. Physiotherapy adds the bowel retraining and pelvic floor coordination component. Continuing with GP-directed laxative management alongside physiotherapy typically gives the best outcome.

Is bedwetting related to my child’s diet?

Diet affects bowel function significantly - and because constipation is a major contributor to bladder symptoms, improving fibre and fluid intake often has a positive effect on both. Caffeine (in fizzy drinks, energy drinks, chocolate) is a bladder irritant and should be reduced. Our physiotherapist will advise on fluid and diet modifications as part of the programme.

My child is embarrassed about their bladder or bowel problem. How do you approach this?

With care and matter-of-fact normalisation. Our physiotherapist will speak to your child directly - explaining that many children have this, that it is not their fault, and that there are effective strategies. Sessions are structured to give children agency and involve them in setting goals. We do not use language that frames these difficulties as naughty, lazy, or deliberate.

At what age should children be reliably dry at night?

Most children achieve reliable night dryness between 3 and 5 years. However, some children take longer, and bedwetting at 5-6 years is not unusual. By age 7, most families and clinicians consider assessment appropriate if the child is still consistently wet at night.

My daughter started wetting the bed again after being dry for years. What could cause this?

Secondary enuresis (returning to bedwetting after a dry period) often has a triggering cause - including a urinary tract infection, a new stressor or life change, constipation, or rarely a medical condition. A GP assessment to rule out UTI and medical causes is the right first step. Physiotherapy supports the bladder retraining component once medical causes have been addressed.