By Steve Hodges, M.D.
My patients who wet the bed have a distinct disadvantage over the children I treat for other medical problems, like kidney infections or hernias: They’re often blamed for their condition.
Nearly every day I hear a parent say, “I’m pretty sure he’s being lazy — he could get up in the night to pee if he wanted to.” Many parents simply don’t believe their children are asleep when they wet their sheets.
So I wasn’t surprised to read a new study, published in the Journal of Pediatric Urology, that found 43% of parents surveyed “reacted with anger” to their child’s bedwetting. In this study, only 33% of parents reacted “positively,” offering comfort and encouragement. About 27% of the parents reacted ambivalently, sometimes comforting their children and other times scolding them.
“In our study, the lack of comfort or encouragement was concerning,” the authors noted. “Lack of encouragement may negatively affect these kids’ self-esteem.”
The survey was based on questionnaires filled out by parents of 93 children ages 6 to 15; the parents were registered for a bedwetting seminar. Though this research was conducted in Taiwan, the results roughly jibe with what I see in my clinic at Wake Forest.
Certainly many parents offer their child only empathy and comfort, recognizing the child cannot control the accidents. And the vast majority of parents who contact me via BedwettingAndAccidents.com don’t blame their children; these folks find us because they know instinctively their child is not wetting the bed on purpose and are in search of a cause and a remedy.
However, a substantial portion of my clinic patients, most of whom are referred by pediatricians, feel certain that if a 10-year-old is wetting the bed, she must be doing it on purpose.
I spend a fair amount of clinic time explaining to parents that bedwetting and daytime accidents are in no way the child’s fault. I think most of them ultimately believe me, especially when I present their child’s X-rays, but I’m pretty sure some don’t. Meanwhile, my young patients sit in silence, hanging their heads. These are the kids who inspired me to write Bedwetting and Accidents Aren’t Your Fault.
Blaming children for bedwetting has a long history, as I explain in It’s No Accident. It’s why Dr. Sean O’Regan was so pleased, back in the 1980s, to have discovered the actual cause of and remedy for bedwetting. (It was Dr. O’Regan’s studies that proved constipation causes bedwetting and that daily enemas resolve it. The Modified O’Regan Protocol, aka M.O.P., is named for him.)
At the time of his discovery, Dr. O’Regan told me in an interview, the majority of his patients were blamed for their problems by their parents and dismissed by their doctors. “These kids were told that it was all in their heads, that they were psychologically disturbed. When you find something new that actually works, that makes a difference, it’s quite spectacular.”
And yet, Dr. O’Regan’s contribution to medicine continues to be overlooked by the medical community.
Yes, many physicians do recognize that constipation causes bedwetting, and blaming children for toileting difficulties is not as common as it used to be. However, bedwetting is still routinely dismissed by doctors as a medical concern. Many of my patients have been told for years they would outgrow the problem or were referred for behavioral therapy. Even physicians who do believe constipation causes bedwetting tend to severely undertreat it, recommending Miralax, Miralax, and more Miralax. (Read “5 Ways to Disagree with Your Doctor About Bedwetting Treatment.”)
The authors of the new Journal of Pediatric Urology study had good intentions: They sought to understand parental attitudes toward bedwetting so physicians can better persuade parents to seek treatment for their children. As the authors note, parents who are “intolerant” of bedwetting tend not to pursue medical treatment. They figure: Since my kid is doing it on purpose, what’s the point? Worse, some of these parents (about 12% in this current study) punish their children for wetting the bed.
Unfortunately, the authors perpetuate the misconception that standard treatments for bedwetting — alarms and medication — are the best treatments. Nowhere in this study is the word “constipation” mentioned, and, of course, “enema” is nowhere to be found.
The authors state that “the causes of enuresis are complex,” and that the causes may differ among children who’ve never been dry, who have experienced periods of dryness, and who have both daytime and nighttime problems. This is untrue. As X-rays in my clinic prove time and again, virtually all bedwetting and daytime accidents have the exact same cause: a severely clogged rectum. Bedwetting is just not a mystery.
When stool piles up in the rectum, over time a large, hard mass forms. This mass stretches the rectum and presses against and aggravates the bladder. Sometimes the mass is so large — imagine a softball or grapefruit — that it nearly flattens the bladder. These kids have no chance of staying dry all night because their bladder has little capacity to hold urine. Compounding the problem, the nerves feeding the bladder are irritated, so the bladder hiccups uncontrollably. The bladder may empty well before it’s filled.
The Journal of Pediatric Urology article encourages measures that “reduce parental annoyance,” like mattress protection and medication. The authors also recommend bedwetting alarms and “behavioral modification” — or a combination of alarm, behavioral therapy, and drugs. They contrast this “standard management” with the treatments parents typically choose: waking the child overnight to use the bathroom (62%), limiting water intake (61%), and “giving verbal warnings.”
As I explain in both It’s No Accident and The M.O.P. Book, none of these methods — neither the treatments recommended by the authors nor those preferred by parents — get to the root of the problem: constipation. The only reliable to way to treat bedwetting is to clean out the rectum and keep it clear every day for months, so the rectum can shrink back to size and stop bothering the bladder. My research and clinical experience tell me that the Modified O’Regan Protocol is by far the most effective way to accomplish this.
I feel like a broken record as I write this! But I will keep doing so until children who wet the bed stop being blamed for their condition and receive treatments that work.
I understand how exhausting and frustrating it can be when a child wet the bed night after night, year after year. This is no small thing for a family to deal with. But it's important for parents not to show their frustration — not even with eye rolls or sighs — because children interpret these reactions as expressions of blame. Children who can't control their bladder already feel terrible about it, and many of them feel they are disappointing their parents. I can't emphasize enough how critical it is to tell your child: This is not your fault. This is a medical issue. Together we will fix it.