Episode 191: Bedwetting After Preschool: Common, Not Normal

Hi and welcome to episode 191 of the Untethered Podcast. It's your host, Hallie. We're going to go ahead and jump right on into this episode. Let's get started. Quick disclaimer.

All information, content and material of this podcast are the opinions of the speakers and is for the informational purpose only and not intended to serve as a substitute for the consultation, diagnosis and or medical treatment of a qualified health care provider. Welcome to the Untethered Podcast. I am your host, Hallie Balkan. I'm a certified orofacial myologist, feeding specialist and mentor. This podcast is all about getting your questions answered and collaborating with colleagues to bring you the most up to date information in the orofacial myofunctional therapy, tethered oral tissue and airway space. I challenge you to keep an open mind and join my mission to get this information out to the masses.

Let's get started. Hey friends, it's your host, Hallie, and I want to dive into a topic today that I hear come up quite a bit actually, and that is bedwetting. Why am I talking about bedwetting? You're gonna find out. Here's the thing. We have a lot of pediatricians telling families that bedwetting is still normal at age 5, 6, 7, even 8, 9. And then, you know, they're telling, I've heard statements such as, oh, children, you know, potty train much earlier during the day and nighttime training. We can't always expect that until a child might be like eight or nine years old. What? Just because this may be common, it's not normal. So what I want to focus on is what could the, the cause, the root cause of bedwetting. Right. Nighttime enuresis. Here's the thing, there's different kinds, okay, so I'm not going to go into all of them today. There are different types of bedwetting that you can Google about, you can can read all about it. This is meant to be a short episode packed full of some really good helpful information. But the bottom line is, in a lot of children, there may be an airway issue. Okay, so let's dive into what that means. Okay. Airway issues sometimes are noticeable. If a child is mouth breathing, for example, Right. Maybe they don't have that Correct. Oral rest posture we talk about on this podcast quite frequently. What do I mean by that? Correct Rest posture. Oral rest posture is tongue up the palate, lips closed, teeth slightly apart, breathe through your nose. If we are not doing that right, maybe we do it during the day, but we don't do it at night. If we're not doing that at night, we're mouth breathing. This is telling us something is up with the airway. If the child is also bedwetting, we need to look a bit deeper into what may be going on. Because a child who is still bedwetting, arguably after preschool, school, or really even age 4, 4 years of age, this is telling us they're not getting good quality sleep at night. They're getting disrupted sleep. If the body is. The bladder is releasing itself right there, something is preventing them from getting deep sleep. Maybe you've heard me talk about it recently regarding my sleep study and how I was not going into REM sleep. Right. So if you're an adult who gets woken up throughout the night to go to the bathroom, this could be an airway thing. This isn't just for kids. Obviously, adults may have better control over their bladders at a certain age, but we see this go on even into the teen years for some of our patients with orofacial myofunctional disorders and airway issues. Okay, so we're not getting that full sleep cycle. We're not getting that deep sleep. We're not getting high quality sleep, right? It's disrupted, it's low quality. We're going to see other symptoms as well. And ultimately what happens, what's been explained by some colleagues is that when we're not going into that deep sleep, that like REM sleep, we're not getting the hormones needed to ultimately control the bladder. Right? The antidiuretic hormones, they help the bladder hold urine in rather than releasing the urine when we are asleep. So this is something that we should dive deeper into. If you have a child who is bedwetting past the age of four, they're daytime potty trained, but you're really struggling at night, or even an older child or teen adults, we need to look at the root cause. We need to figure out what the root cause is. Okay. I will tell you as well that as far as intervention goes, punishment and making a child or young adult feel poorly about this is not going to help in any way, shape or form because this is out of their control. Okay? This is the body. Like, this is a wake up call. The body is telling us to pay attention. Hey, something is off here. Hey, you know we need your help, right? So I encourage you to look into what might be going on. Okay? There is research that shows that there's a strong correlation between bedwetting, especially when, like daytime potty training is under control. But bedwetting, that correlation between bedwetting and sleep disordered breathing. And I've got lots of episodes on sleep disordered breathing. So go to untetherpodcast.com, put in sleep or SDB or sleep disorder breathing, you'll get some episodes. I think it's interesting when you actually start to look at the research, you'll find that many of these children snore. Right? The children who are wetting the bed are four times more likely to do so if they are snoring. And 46% of children with sleep disorder breathing are bedwetters. So what does that tell us? Right, And I'll, I'll share some of this research in the show Notes. It's telling us we need to pay attention because as you've seen me talk about on this podcast, maybe if you've taken any of my courses, the MYO method, for example, even in Feed the peds, when I talk about orofacial myofunctional disorders, these children are also more likely to have adhd, learning challenges, disabilities disorders. We sometimes see more behavioral challenges in some of these children as well. But hey, this makes sense. If they're not getting good quality sleep, their brain is not getting the restorative sleep it needs to restore, repair, grow, right, rest up for the next day. If we're not getting that restorative sleep, we're going to see this. We should almost expect it. And in children who are displaying those behaviors, we need to be assessing and ruling out these types of issues so we know if it's truly ADHD or is it a sleep disorder. We sometimes see these kids, you know, get sent for sleep studies and any type of sleep disturbance is a problem for a child. It doesn't matter if it's categorized as mild or it only happened a couple times during the night while they were sleeping. That's not normal. Common is not normal. Someone says, oh, we commonly see this. That's great. Still not normal. So what, what can help? Well, we talk a lot about, you know, opening the airway. So maybe their tonsils are enlarged, maybe their adenoids are enlarged. So could they have a tonsillectomy or an adenoid, an adenoidectomy or a tonsil adenoid or adenotonslectomy, Wrong direction. They could. But we don't necessarily see that that is the cure all in all children. We do see that children improve. In fact, I did pull up one article that talked about that that speaks to this. And, you know, this study was done, let's see. And this one's an old one, 1991, but it looked at the results of 115 children between ages 3 years of age and 19 years of age who had symptoms of upper airway obstruction and nocturnal eneresis. Right. Bedwetting. 12 children had secondary enuresis. 103 had primary. Okay. And primary is really more what we've been talking about, where they've never really received. They've never really gained control over their bladder at night. Maybe they have it during the day, but not at night. So these children had their. Let's see, their tonsils, okay. Removed. And it says surgical removal of upper airway obstruction, like such as tonsils, adenoids, led to a significant decrease or complete cure of nocturnal enuresis in 87 of the children studied, which was 76%. Okay. 11 children were also studied with polysomnographic tracings in an attempt to determine a relationship between sleep patterns and nocturnal enuresis. Now, here. Here's the thing. Depending on the study that you look at, some say that, okay, well, in this one study of 115 children, 76% after surgery, after, you know, upper airway surgery, had improvements or it was completely eliminated. Right. Other studies say 50%. Bottom line is it's not a 100% cure. Now, if there is an upper airway obstruction and you go to an otolaryngologist who says, yes, you know what? We. We do need to remove the tonsils and our ad. No. Is going to. That's. That may be beneficial, right? I can't say for sure it's going to, but that may be beneficial for your child. The thing is, when we've been breathing a certain way and we have certain patterns, right? Like mouth breathing, breathing very shallowly, shallowly from our chest or our clavicle, like our shoulders, our chest, our neck area, we feel like we're breathing up here versus down, down low, right? Belly breathing, diaphragmatic breathing. This has to be trained, right? This is something that we need to address. So if a child does not automatically start nasal breathing on their own, right. After a procedure, after the swelling goes down and nighttime bedwetting is not disappearing, and they still have these ADHD like behaviors, it doesn't mean that their procedure was not successful per se, but that's one piece of the puzzle. We likely need more. Okay, that's the point here. We definitely know that those who have intervention, right. We can see that are improving significantly versus those who did not receive intervention. But the type of intervention is what we need to look into, right? So there's also research that supports treating this with breathing exercises. And I will also, you know, share some of those studies in the show notes. I'm not going to go into all of those necessarily, but the thing that we need to take 10 steps back at and look at is one bedwetting, especially past like age four, may be common. It's not normal. Not normal. All right, so that begs the question, who do you see first? Where do we go? I would highly recommend if your child is of age 4, at least age 4 on up, you can seek an orofacial myofunctional therapist who is going to do an assessment and who's going to help you figure out, based on the information that you share with them, what the next steps are, what the recommendations are, if there are other team members or consults that need to kind of be pulled into the treatment plan. Right. And so hopefully this is just a bit of a PSA meant to be super fast episode, but a bit of a PSA to share the importance of breathing airway. Right. And not ignoring things like bedwetting past age 4 at nighttime. You know, if you. Obviously there can be other things that cause it too, but if you've ruled some of those things out or you're sitting here going, yeah, you know what? My child presents with adhd, like behavior is my child, you know, has some of these other things going on that, that Hallie's talked about, that I talked about today, highly recommend a myofunctional evaluation. Now, if you are a provider who is listening to this, I'm going to be talking about how we individualize treatment plans for Myo patients on December 7 and training that I'm doing. Typically we don't open up our MYO membership trainings to the public, but because I'm the one who's hosting, not just hosting, but giving this training, I am opening it up to providers in this space and we're going to talk about like the importance of airway health, airway treatment, you know, orofacial myofunctional disorders and tetheredural tissues and then the actual order of events that should happen. I'm going to share my case with you and the order of events that I experienced versus the order of events. Now, on the flip side, that I realized should have been followed because treatment planning and timing and when certain things happen along a treatment plan for a patient with an airway issue, one, it has to be individualized, but two, there are certain principles that we have to follow in order to make sure we are approaching that patient's case appropriately for that patient. Okay. Because there's a lot of, like, hard, fast statements out there these days that like, oh, you've got to do X, you got to do Y, stop this, start that. And I'm going to talk a bit about one of these topics, like, do we pause myofunctional therapy when we're in certain types of expansion appliances? I'm gonna do an episode on that, if not the next one, the one after coming up soon. But we need to know how to create treatment plans and timelines that are specific to the patient's needs and not fall prey to some of these things that we just hear kind of thrown around, you know, social media. So if you want to join me, go to airway first mayo.com and that will take you right over to the signup page. If you're already in the MYO membership, you already have full access to this. But I hope that this conversation surrounding nighttime bedwetting airway sleep, it just gives you a bit of an idea of what may be common but not normal and where you can start in terms of getting the help that your child needs by connecting with someone who can complete an orofacial myofunctional evaluation. If you need a referral, as always, you can DM me at Hallie Balkan on Instagram and I will reach out to my network and find out who may be in your area. I hope this is helpful and I look forward to chatting you, chatting with you on our next little short episode in our upcoming series. This is Hallie Sena. Talk to you guys soon.

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