Bedwetting: 4 Truths Every Parent Must Know
The other day I saw a 16-year-old bedwetting patient who'd never had a dry night. His mom told me: "At age 5, 8, 10, the pediatrician kept saying, 'Don't worry, he'll grow out of it.' When he was 14, he wanted to go to Rome with the Latin club. I sent him with nine garbage bags for the bed."
In my practice, this story is typical. My clinic is full of tweens and teenagers whose parents have heard, for years:
"Don't worry—she's just a deep sleeper."
"Don't worry—her bladder hasn't caught up to her brain."
"Don't even worry about it until she's 7."
Naturally, parents do worry! Because their kids are getting teased, missing out on sleepovers, and losing self-esteem. Because pull-ups aren't cheap and 2 a.m. sheet-changes are exhausting. Because there's no end in sight.
Some 5 million children wet the bed, including more than 800,000 tweens and teens. Many have daytime pee and/or poop accidents, too. These conditions are highly treatable, yet families are offered hollow reassurance.
Here are four truths about bedwetting I hope will inspire families to take action.
Truth #1: Some children don't outgrow bedwetting.
All my bedwetting patients were assured that on some magical future day, they'd wake up dry. The reality: For some children, that day won't come.
It's true most bedwetting children do spontaneously stop, eventually. But some don't, and many wet the bed for years longer than they would have if they'd been treated appropriately.
Consider a study of 16,000 children in Hong Kong, which found 16 percent of 5-year-olds wet the bed. (Twenty percent of U.S. 5-year-olds wet the bed.) With each successively older group, the percentage of bedwetters dropped...until it didn't. After age 8, the drop-off was minimal; after age 10, it disappeared. The percentage of bedwetting 11-year-olds—2 percent—equaled the percentage of bedwetting adults.
Based on these findings, I've calculated that a bedwetting 9-year-old has a 70 percent chance of becoming a bedwetting adult.
Yet doctors prescribe patience. "Our pediatrician said not to worry until age 11 or 12 because there are such great pull-up-type products available nowadays," one mom told me.
Never mind that seventh-graders don't want to wear "pull-up-type products."
The Hong Kong findings confirm what I've observed: Bedwetting tweens and teens have severe symptoms. As these researchers concluded, the idea that bedwetting spontaneously resolves with age "probably applies only to those with mild enuretic symptoms"—kids who have accidents infrequently and only at night.
Truth #2: Bedwetting is caused by chronic constipation.
One reason doctors advocate waiting is they're unfamiliar with what causes bedwetting. They'll chalk it up to genetics, "an underdeveloped bladder," deep sleep, stress, or (unbelievably) laziness.
But these "causes" don't have any scientific basis.
Studies involving X-rays and anorectal manometry (a test measuring rectal sensation) show virtually all toileting accidents have the same cause: chronic constipation. (Exceptions include type 1 diabetes and certain neurological or anatomical conditions.)
When children delay pooping—a problem that's epidemic in developed countries—stool piles up and stretches the rectum, which squishes the bladder and irritates its nerves. A bladder gone haywire will hiccup and empty without warning and before it's full.
Genetics may play a role, but X-rays show my patients with a parental bedwetting history are constipated—the same as my patients with no parental history. So it may be the tendency toward constipation that is genetic.
As for the "small bladder" theory, bedwetting children do have reduced bladder capacity, but not for developmental reasons. X-rays show their bladders are being flattened by the poop-stuffed rectum. I often see softball-sized clogs that double or triple the rectum's normal diameter.
The "deep sleep" theory is also fallacious. Children with healthy bladders don't need to empty overnight, so deep slumber cannot explain why a child's bladder would spasm at 3 a.m. Why don't these kids wake before peeing? For the same reason constipated kids have daytime accidents: an overactive bladder spasms too abruptly. It's like a sneeze: you can't control it. (Research shows these kids actually sleep less deeply than others, as their overactive bladders disrupt REM sleep.)
Stress and laziness play no role in enuresis.
Truth #3: Bedwetting should be treated around age 4.
Delaying treatment until age 7 is a mistake. The longer the rectum remains stretched and the bladder nerves aggravated, the more difficult it is to fix.
Early treatment is especially important for children who wet the bed nightly and have daytime accidents. These kids are least likely to outgrow their symptoms.
Truth #4: Enemas resolve bedwetting far better than alarms or medication.
Standard therapies for bedwetting are medication and alarms. Medication has a dismal success rate. Alarms can keep sheets dry, eventually, but do zilch to resolve the underlying constipation and bladder hyperactivity.
Permanently resolving accidents requires cleaning out the rectum and keeping it clear for months, so it can shrink back and stop irritating the bladder.
Even doctors who recognize the role of constipation tend to undertreat it. I used to be among them, prescribing endless doses of oral laxatives. But a decade of research and experience has taught me daily enemas work far better.
X-rays showed why. At the start, both groups had an average rectal diameter exceeding 6 cm (normal is smaller than 3 cm). Three months later, the rectums of the Miralax group remained stretched, to 5 cm on average. The enema group's rectums had shrunk to 2 cm.
Even the toughest bedwetting cases can be resolved, but it's a long haul—one that can be prevented if doctors would shift from "Don't worry, you'll outgrow it" to "Let's get you treated!"
Steve Hodges, M.D., is an associate professor of pediatric urology at Wake Forest University School of Medicine and co-author of It's No Accident, Bedwetting and Accidents Aren't Your Fault, Jane and the Giant Poop, and The M.O.P. Book: A Guide to the Only Proven Way to STOP Bedwetting and Accidents. His website is BedwettingAndAccidents.com.