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  • By Steve Hodges, M.D.

27 Untruths About Bedwetting


I don’t usually get worked up about kooky advice posted on Facebook. But when the topic is my medical specialty — bedwetting — and when the advice ventures into harmful territory, I can’t let it go.

A Facebook page with a large following recently posted this question from a reader:

My child is 8 years old and still wets his bed at least 4 nights a week. I have tried limiting drinks/liquid intake after 4 p.m., waking him up regularly, etc. Are there any other methods out there I can try?

Last I checked, 584 commenters had weighed in. Suddenly, everyone is a bedwetting expert! Unfortunately, most of the advice was wildly off base, which means lots of children aren’t getting effective treatment for a stressful yet totally fixable problem.

On a positive note, most of the comments urged compassion for the child. That’s huge, as many parents not only blame their children for wetting the bed but also physically abuse them. But love and kindness won’t fix bedwetting.

I’ve filtered out the goofiest advice — “a teaspoon of honey before bed," “consider the fabric softener you use” — and will focus this post on more common misconceptions.

What Really Causes Bedwetting

Let me start with what’s true: Bedwetting is almost always caused by constipation.

I say “almost” because in rare cases bedwetting is caused by serious medical conditions, such as type 1 diabetes or sleep apnea. But in well over 90 percent of cases, the direct cause is simply a clogged rectum.

Here’s what happens: Poop piles up (for reasons explained here) and forms a large, hard mass that stretches the rectum from about 2 cm in diameter to as much as 10 cm. (You can measure this via X-ray.) The bladder gets squished and irritated.

When you clean out the rectum — ideally using enemas — and keep the tunnel clear, it shrinks back to size and stops bothering the bladder. Bedwetting resolves.

All this is fact. The constipation-bedwetting connection was confirmed back in the 1980s in a series of impeccable Canadian studies and is borne out daily in my clinic and countless others.

Take your child to Mayo Clinic, UCSF San Francisco Benioff Children’s Hospital or Nationwide Children Hospital in Columbus or any number of other clinics specializing in pediatric incontinence and you will get the same explanation.

Some doctors don’t realize constipation causes bedwetting and offer lousy advice — one dad told me his son's pediatrician recommended wearing compression socks — that doesn’t make the facts any less true.

OK, I’ve explained what’s factual about bedwetting. Below I’ll list the most common falsehoods posted on Facebook and floating around the universe.

1. Bedwetting is “not a big deal.” ACTUALLY: I have countless patients who suffer — they avoid sleepovers, feel ashamed and left out, blame themselves, and become withdrawn or depressed. Their parents are exhausted from 2 a.m. sheet changes and pinched by the cost of extra-large pull-ups. Entire families are in distress.

2. Bedwetting is caused by a “deep sleep pattern.” ACTUALLY: Deep sleep can explain why a child would not wake up to pee at night but does not explain why a child would need to pee overnight in the first place. That reason: a rectal clog is aggravating the bladder. Your 80-year-old grandpa may need to pee overnight (for other reasons), but not your 8-year-old. Most kids sleep very deeply, but parents don’t notice because most kids don’t have overactive bladders.

3. “He will eventually grow out of it.” ACTUALLY: He might outgrow it, or he might develop even worse problems. My clinic is full of teenagers whose pediatricians preached “patience” year after year. Read, “My 15-year-old still wets the bed” and consider whether waiting sounds like a good strategy.

4. “Sometimes there’s just nothing you can do. It may be something he has to live with.” ACTUALLY: Bedwetting can always be resolved, often within weeks, other times within months. No child should just have to “live with” it.

5. “He has an underdeveloped bladder.” ACTUALLY: Pediatricians love this one, but after about age 4, bedwetting isn’t developmental. The child’s bladder is “small” because it’s being squished or irritated by the clogged rectum.

6. “Try prunes and All Bran Buds.” ACTUALLY: While a fiber-rich, whole-foods diet can prevent constipation and keep a child’s colon clear, once a child is constipated to the point of bedwetting, all the prunes in California won’t dislodge the large, hard lump of clogging the rectum.

7. “Stop all drinks around 6:30.” ACTUALLY: Bedwetting isn’t caused by an excess of fluids. Sure, downing a gallon of water before bed won’t help, but restricting fluids in general can contribute to constipation, the very condition we’re trying to prevent.

8. “Boys’ bladders typically don't catch up to their brains until later.” ACTUALLY: Unless a child — boy or girl — has a neurologic disease, this alleged disconnect between brain and bladder will not exist. All the wires are connected at birth and work fine once children become aware of needing to pee and poop and once the bladder has grown to an adequate size (which it always does unless kids are chronically holding pee and/or poop).

9. “See a chiropractor. When even a tiny part of the spine is misaligned, a child can lose bladder control.” ACTUALLY: In my entire career I’ve never seen a spine misaligned from everyday life to a degree that it can impinge on the bladder nerves and alter their function. Unless your child has suffered a spinal trauma, this should not be a concern.

10. “Consider emotional and mental stressors.” ACTUALLY: Secondary bedwetting — wetting that surfaces after a child has been dry at night for an extended period of time — has been linked to life stressors. But guess what? Every child I’ve treated who had both secondary bedwetting and life stressors also was shown by X-ray to have chronic constipation. Cleaning out the colon fixed them all.

11. “Try bribery. When my sister had this problem, mum rewarded her with a toy if she made it a whole week without an accident.” ACTUALLY: Praise and rewards are totally inappropriate for bedwetting. They imply staying dry is within the child’s control when it’s not.

12. “It could be a UTI.” ACTUALLY: If a urinary tract infection triggers bedwetting (which can happen), the wetting would happen only during the week or so that the infection lasts. Urinary tract infections are a sign of constipation, not a cause of chronic bedwetting. Read "Why 1 Million Girls a Year Get UTIs."

13. “Perhaps the bathroom is too far or too scary at night. Leave a light on or put a potty in his room.” ACTUALLY: Again, a healthy 8-year-old should not even have the need to pee overnight.

14. "Ask your doctor for desmopressin. Fantastic stuff.” ACTUALLY: Desmopressin is not fantastic. It is a drug that tricks the brain into telling the kidneys to make less urine than they should. I will prescribe it in a pinch (camping trips, sleepovers) but it is not an ideal long-term solution because it doesn’t solve the root problem; as I explain in "Bedwetting Medication Doesn't Work," the drug just covers it up. There’s an old saying in medicine: “a dumb kidney is smarter than a smart doctor.” In other words, don’t mess with the kidneys if you don’t have to.

15. “Put him in underwear overnight, so he will get tired of waking up wet at night.” ACTUALLY: Children never wet the bed on purpose, so making them uncomfortable is just mean. Better to do something kind, like read "Bedwetting and Accidents Aren't Your Fault" with him.

16. “Bedwetting alarms work wonders!” ACTUALLY: Alarms work, but like drugs, they don’t solve the problem. They just teach the brain to wake the child up to pee before he wets the bed. The child still needs to pee at night, which is not normal. A young, healthy bladder should be able to hold whatever urine is produce at night.

17. “Could be enlarged kidneys.” ACTUALLY: Enlarged kidneys are no more responsible for bedwetting than are enlarged ears!

18. “His urethra might not be wide enough.” ACTUALLY: His urethra could be could be blocked by a congenital obstruction that was missed by all the child’s doctors, but these children (all of them boys) also have daytime wetting and usually have UTIs (extremely rare for boys). If a doctor didn’t investigate these issues in a boy with these symptoms, find a new doctor.

18. “It could be hereditary.” ACTUALLY: It’s true bedwetting tends to run in families, but it’s the tendency toward constipation that may be hereditary — not the tendency to wet the bed.

19. “Hold in his urine during the day to strengthen the bladder.” ACTUALLY: Holding pee is extremely unhealthy and exacerbates bedwetting. A child who ignores the urge to pee develops a thickened bladder that is more prone to irritation and accidents.

20. “Require him to wash his bedding.” ACTUALLY: Punishment has no place in the treatment of bedwetting. The child can’t control his bladder; sentencing him to manual labor won’t change that.

21. “Children will stop wetting the bed when their body secretes the proper hormones and not one day before.” ACTUALLY: Numerous studies have considered hormonal production in relation bedwetting. I have read them all and have served as a peer reviewer for several. Not one has shown hormonal problems cause bedwetting.

22. "Try cutting out dairy in the evening." ACTUALLY: While intolerance to dairy, wheat, or other foods does predispose some children to constipation, once a child is constipated to the point of wetting the bed, simply avoiding the offending food won’t solve the problem, though it certainly will help prevent a recurrence. The rectal clog needs to be treated aggressively.

23. “See if he can remember anything about dreaming. When I was young I would dream I was ‘going’ out in the woods, in a toilet, on the floor, etc. and had to learn to wake up when I felt the urge. A lot of the time, the answer is in our own head.” ACTUALLY: I threw that one in for comic relief!

24. “He might need his tonsils out.” ACTUALLY: A tonsillectomy may be warranted if a child has sleep apnea (a condition overdiagnosed these days), but even in that case, the surgery won’t reliably resolve the bedwetting. There is a scientific basis for sleep apnea affecting urine output at night: Sleep apnea puts pressure on the heart, leading to the secretion of a hormone that can increase urine output. But I served as a peer reviewer for a randomized controlled trial that found no benefit to tonsil removal.

25. “Limit chocolate and soda because of the caffeine.” ACTUALLY: Caffeine can irritate the bladder, and there are plenty of good reasons to limit a child’s intake of chocolate and soda, but bedwetting is not among them.

27. “He might not be able to feel his bladder, so have him sleep on his stomach, and tape a tennis ball to the back of his PJ shirt to reduce rolling over.” ACTUALLY: This one is really nutty! I left it in for a bit of comic relief, too.

Look, I’m not a certified financial planner, so I don’t offer advice on how to pick mutual funds. I don’t want to lead people astray and make them go broke. I wish folks who don’t have experience treating bedwetting and are not familiar with the relevant scientific studies would similarly refrain from tossing out unfounded advice.

Steve Hodges, M.D., is an associate professor of pediatric urology at Wake Forest University School of Medicine and coauthor, with Suzanne Schlosberg, of It's No Accident, Bedwetting and Accidents Aren't Your Fault, Jane and the Giant Poop, and The M.O.P. Book.

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• Bedwetting and Accidents Aren't Your Fault

• Jane and the Giant Poop

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Feel free to contact Dr. Hodges or Suzanne directly:
shodges@wakehealth.edu
suzanne@bedwettingandaccidents.com

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