What is a DRAM?

Understanding Daytime Wetting in Children: The “Why” Behind It Daytime bladder accidents, or daytime wetting, are surprisingly common in childhood. While many parents worry that something is “wrong” with their child, the truth is that bladder control is a complex process involving the bladder, pelvic floor muscles, bowel, nervous system, and even emotions. When one part of this system is under pressure, immature, or not communicating well with the others, wetting can occur. How Common Is Daytime Wetting? Research shows that daytime wetting is more frequent than many parents realise: Around 10% of children at age 5–6 experience daytime wetting. By age 7, prevalence drops to about 5%. At age 9, around 2–3% of children are still affected. This means that while most children develop bladder control naturally, a significant number need extra support to achieve dryness. 1. The Developing Bladder-Brain Connection To stay dry during the day, children need to: Feel the bladder filling (sensory signal) Recognise that signal as “I need to go” Respond quickly by activating the pelvic floor and then relaxing it at the right time on the toilet. In some children, this communication loop between the bladder and brain matures later. This can mean: They don’t notice bladder fullness until the last moment. This may result as a sudden strong urge and may present as them “dancing” or holding themselves. Their bladder muscle (the detrusor) may contract involuntarily, pushing urine out before they are ready. This explains why children often appear “fine one moment, bursting the next.” 2. Overactive or “Irritable” Bladder Sometimes the bladder itself is the driver. An overactive detrusor muscle contracts too frequently, leading to urgency and accidents. This may be linked to: Drinking bladder irritants (soft drink, caffeine, artificial colours/flavours). Post-bladder infection sensitivity. Constipation pressing on the bladder and reducing its capacity. Children with overactive bladder often experience frequent small wees, urgency, and may show classic “holding manoeuvres” like squatting or crossing their legs. 3. Constipation and the Bladder-Bowel Link Up to 30–50% of children with daytime wetting also have constipation. A constipated bowel takes up valuable space in the pelvis, which can reduce the bladder’s storage capacity. Treating constipation is often the first and most effective step in resolving bladder problems. 4. Pelvic Floor Muscle Dysfunction The pelvic floor muscles must hold on at the right time and relax at the right time. If these muscles are too tight or discoordinated, the child may not empty properly, which can lead to dribbling, urgency, or urinary tract infections. This is where pelvic health physiotherapists use age-appropriate education and biofeedback to help children learn how their muscles work. 5. Neurodivergence and Bladder Control Children who are autistic, ADHD, or have sensory processing differences often experience higher rates of bladder and bowel challenges. Studies suggest that children with ADHD are 2–3 times more likely to experience incontinence compared to neurotypical peers. The pathophysiology here can involve: Altered sensory processing: bladder fullness may not be felt until very late. Executive function differences: difficulty shifting attention from play or schoolwork to respond to body cues. Anxiety or rigidity: avoiding toilets outside the home due to sound, smell, or sensory overwhelm. Medication effects: some ADHD medications may influence urinary frequency or urgency. The key message: the bladder is working within the unique way that child’s nervous system processes information. 6. Behavioural and Emotional Factors Stressful life events, school changes, bullying, or family transitions can all impact bladder control. In these cases, the child’s nervous system may be on “high alert,” influencing bladder muscle activity and pelvic floor responses. Wetting in these cases is not deliberate — it’s the body’s way of responding to stress. How Treatment Helps When we understand why wetting occurs, treatment can be tailored to the child’s needs. A collaborative approach between pelvic health physiotherapists, GPs, and sometimes paediatricians may include: Bladder training: establishing healthy toileting routines. Constipation management: diet, fluids, or medication if required. Pelvic floor awareness: playful, child-friendly exercises to improve coordination. Behavioural strategies: rewards, charts, or visual schedules. Environmental changes: school toileting plans, sensory adjustments. With the right support, most children improve significantly — and many achieve dryness within months. The Takeaway Daytime wetting is rarely about laziness or misbehaviour. It is the result of interacting bladder, bowel, muscle, and brain factors – all of which can be supported with the right guidance. If your child experiences daytime wetting, know that you are not alone, and that early intervention can help prevent ongoing issues with confidence, social participation, and urinary health. Our team at Pelvic Health Melbourne works closely with families, GPs, and other health professionals to provide child-friendly, evidence-based care.

Understanding Mastitis & How Physiotherapy Can Help Mastitis is one of the most common challenges faced by breastfeeding women — and it can be incredibly painful and distressing. But the good news? With the right support and early intervention, recovery is usually quick, and breastfeeding can continue comfortably. What Is Mastitis? Mastitis is inflammation of the breast tissue, often caused by milk not draining properly (known as milk stasis). When milk remains trapped, it can irritate the tissue and lead to swelling, pain, and sometimes infection. Common signs and symptoms include: Localised breast pain, tenderness, or burning A firm, red, or hot area on the breast Swelling or lumpiness Fever, chills, and flu-like symptoms Feeling generally unwell or fatigued It’s important to seek help early — untreated mastitis can worsen quickly and may require medical treatment such as antibiotics. How Physiotherapy & Ultrasound Therapy Can Help Many people are surprised to learn that women’s health physiotherapists can play an important role in managing mastitis. Alongside medical care and lactation support, physiotherapy can help reduce pain, inflammation, and improve milk flow — especially when using therapeutic ultrasound. What Is Therapeutic Ultrasound? Therapeutic ultrasound uses gentle sound waves to help soften and disperse blockages within the breast tissue. The treatment is non-invasive, painless, and supported by evidence for its role in improving symptoms and promoting recovery. Ultrasound therapy can help to: Break down blocked ducts Reduce inflammation and swelling Improve milk drainage and flow Relieve pain and discomfort Support faster healing Sessions are typically short and safe to continue while breastfeeding. Beyond Ultrasound: Comprehensive Care At your physiotherapy appointment, we’ll do more than just treat the symptoms. We’ll look at the whole picture — what may have contributed to the blockage, and how to reduce the risk of it happening again. This may include: Reviewing your feeding or pumping techniques Recommending gentle self-massage and drainage methods Providing positioning advice for better milk flow Teaching preventative strategies for future episodes Every treatment plan is tailored individually — because every feeding journey is different. When to See Your GP If you experience fever, chills, or flu-like symptoms, or if your symptoms do not improve within 24–48 hours of treatment, it’s important to see your GP. Antibiotics may be needed alongside physiotherapy. The Takeaway Mastitis can be painful — both physically and emotionally — but it’s also very treatable. Early intervention and the right combination of care from your GP, lactation consultant, and women’s health physio can make a world of difference. Ultrasound therapy is a safe, gentle, and effective part of that recovery — helping you get back to feeding comfortably, confidently, and pain-free.

Period Pain: What Is Normal and When to Seek Help Many people experience discomfort or cramping during their period. It’s often dismissed as “just part of being a woman,” but not all period pain is normal. In fact, period pain (also called dysmenorrhoea) can vary widely in intensity and impact, and in some cases it may signal an underlying issue that deserves proper attention.  As pelvic health physiotherapists, we see many people who are unsure whether their pain is something they should live with, or whether there are strategies to help. The good news is: support is available. Why does period pain happen? Each month, the uterus contracts to help shed its lining. These contractions can temporarily reduce blood flow and irritate nearby nerves, leading to cramping sensations in the lower abdomen. Pain may also radiate to the lower back or thighs. For many, this pain is mild and lasts only 1–2 days at the start of the period. But for others, it can be more severe, long-lasting, and disruptive to daily life. When is period pain not normal? While some discomfort is expected, pain is not normal when it is: Severe, sharp, or ongoing beyond the first couple of days Preventing you from going to work, school, sport, or social activities Not improving with simple strategies like heat, stretching, or gentle exercise Associated with other symptoms, such as nausea, vomiting, bowel changes, heavy bleeding, or pain with intimacy If this sounds familiar, it may be worth seeking further support. In some cases, conditions such as endometriosis or adenomyosis can cause significant pelvic pain, and these are best managed with a team approach. How pelvic health physiotherapy can help? A pelvic health physiotherapist looks at how your muscles, posture, and movement patterns may be contributing to pain. Pain often leads to protective tension in the pelvic floor muscles, which can create a cycle of ongoing discomfort. Physiotherapy can help by: Assessing pelvic floor function: checking for muscle overactivity or tension that may be amplifying pain Teaching relaxation techniques: including breathing strategies, pelvic floor “drops,” and mindfulness-based approaches Prescribing gentle exercise and stretches: to ease cramping and improve circulation Lifestyle guidance: such as posture awareness, pacing strategies, and exercise modifications around your cycle Collaborating with your GP or gynaecologist: ensuring that if further investigation or medical treatment is needed, you have the right support Period pain is very common, but that doesn’t mean it should disrupt your quality of life or be brushed off as normal. If your periods are leaving you in bed, stopping you from enjoying daily activities, or not responding to simple strategies, it’s time to reach out for help. A pelvic health physiotherapist can work with you to reduce pelvic tension, support your body with movement and lifestyle strategies, and guide you towards further medical input if necessary. Pain is your body’s way of telling you something. Listening to it, and seeking the right support, is the first step towards feeling more in control of your cycle.