There's a medical approach to end wetting?

Back to school time can be nerve-wracking for many children. Uncertainty about new classmates, teachers and homework requirements can stir up anxiety in even the most outgoing kids. But for children with voiding issues (bed and pants wetting), this time of year can be especially traumatic: The anticipation of dealing with it at school can be overwhelming for many kids and their parents.

In addition to the emotional strain caused by urinary incontinence, there can be serious medical concerns associated with the condition. Urinary tract infections and irrirative voiding symptoms are common side effects of several voiding conditions. If left untreated they can have long lasting consequences.

Fortunately for many local parents, there’s hope. Boston Children’s Hospital Voiding Improvement Program (VIP) offers individualized treatment through state of the art technology, ancient relaxation techniques—and everything in between—to help children overcome their wetting issues.

“The kids in our program are generally at an age where bed wetting and wetting their pants can really negatively impact their lives,” says Carlos Estrada, MD, a Boston Children’s urologist and VIP director.  “The anxiety and stress that accompanies these issues can be very hard for everyone to deal with.”

In a majority of cases treated by the VIP team, the urinary problems are more emotional than medical, but establishing that fact is an important first step.

“The very first goal of the program is to make sure we’re not missing a more serious medical cause of the child’s voiding issues,” Estrada says. “The good news is most times we’re not. Usually, the patients we see do not have a significant, underlying medical reason for their problem. And if they do, we’ll catch it early, which is important for customizing their treatment and addressing the problem quickly.”

Carlos Estrada, MD

Once the cause of the child’s wetting problem has been established a team of urologists and nurse practitioners get to work creating an individualized treatment plan that works best for that particular child. Depending on the patient’s needs, the following are examples of treatments offered by the program:


For many urinary problems, counseling is important tool for lessening anxiety about wetting. Often the child will be stressed about the problem, and that anxiety can then exasperate their symptoms. To offset this cycle, the VIP staff meets with the parents and child, and together they find ways to reduce frustration and emotional stress caused by their urinary dysfunction.

“A lot of these problems are rooted in children being very upset by their condition, but just telling someone to relax is a pretty vague request,” Estrada says.  “Our treatments are more interactive and help the child discover the stress reducing techniques that work best for him or her.”

Biofeedback Training

Biofeedback is a treatment technique that teaches people to improve their health by using signals from their own bodies. In the VIP program, non-invasive electrode pads can be used to monitor a patient’s muscle movements in order to determine how and when a child tenses up during urinating and study how full or empty their bladders are after going to the bathroom. With this information specialists can help identify potential obstacles to proper voiding and work with the patient and family on correcting them.

“By objectively analyzing where a patient’s problems are, you can more directly address their individual needs,” Estrada says. “By teaching these kids how to relax their muscles and mind we see drastic improvement in their ability to void appropriately.”

Reiki and Acupuncture therapy

Reiki and acupuncture have proven to be useful in reducing stress, which is often a key component of the VIP patients’ conditions.

Provided by Boston Children’s Integrative Therapies Team, Reiki is a holistic treatment that encourages healing through gentle touch. Acupuncture has been used to alleviate pain and treat diseases for more than 2,000 years. Acupuncture care at  Boston Children’s is done by licensed physicians who specialize in the practice.

“Parents need to remember that [wetting] issues are extremely common, they’re not anyone’s fault and they are treatable.”

The VIP will soon be expanding beyond Children’s main campus. In September, the program will also be available at Boston Children’s Hospital at Waltham. By offering the program in an additional location, Estrada is hopeful that he and his team will help even more struggling families deal with this difficult but treatable condition.

“Both emotionally and physically, urinary problems can be very stressful on families,” he says. “But parents need to remember that these issues are extremely common, they’re not anyone’s fault and they are treatable. The more people who are aware of that the better.”