By Steve Hodges, M.D.
In the last three days I’ve written letters to two elementary schools on behalf of students threatened with suspension for wetting their pants.
Just yesterday I saw an 11-year-old patient who’s been having pee and poop accidents since age 3.5 — and yet was only now referred to me by his pediatrician. “Our doctor kept telling us he’d grow out of it,” the boy’s mom told me.
And on a prominent parenting website’s Facebook page, I read several dozen misguided responses to a post about a bedwetting 5-year-old. (Among them: “Take him out of pull-ups — he’s a big boy” and “Take him out for ice cream if he doesn’t wet his bed.”)
What all this tells me: I need to do a much better job educating schools, pediatricians, and parents about the real causes of and treatments for bedwetting and accidents.
Following are six damaging yet extremely common myths about children who wet or poop in their pants. When adults buy into these myths, kids miss out on treatments that will actually fix their problems. Worse, children absorb blame and feel shame for medical problems that are in no way their fault. That's why I felt compelled to write Bedwetting and Accidents Aren't Your Fault.
Myth #1: A student who has accidents is “not potty trained.”
Reality: Accidents in school-age children have nothing to do with potty training.
When rationalizing a threatened suspension, schools love to cite school rules requiring students to be potty trained. Then they issue an ultimatum: "If your son is not potty trained by next month, we will have to ask him not to return to school until he is.”
The Arlington, Virginia, preschool that suspended Zoe Rosso insisted Zoe’s mom needed to “work more closely” with Zoe and give her “more one-on-one, at-home attention” so she could master potty training.
Children who have accidents at school don’t need more time and attention to learn about using the toilet! These children are severely and chronically constipated. They need to have their clogged, stretched rectums cleaned out on a daily basis, ideally with an enema-based regimen such as the Modified O'Regan Protocol (M.O.P.).
They also need understanding and compassion from their schools.
Myth #2: Children inevitably outgrow bedwetting and accidents.
Reality: While most children do, eventually, stop wetting the bed, you cannot assume any given child will — without treatment — overcome enuresis or encopresis, and you cannot predict when the accidents will stop.
I have no shortage of patients ages 10, 12, 15, even 18. I see kids who are completely freaked out, for good reason, that they will go off to college wearing adult-sized pull-ups.
Research shows that — without appropriate treatment — a 9-year-old who wets the bed has about a 70% chance of becoming a bedwetting adult. Children who have daytime accidents in addition to wetting the bed are less likely than other children to outgrow bedwetting, as I explain in "Don't Assume Your Child Will Outgrow Bedwetting."
Waiting around for your child to outgrow accidents is like waiting for your stopped-up bathtub pipe to unclog itself, as our artist, Cristina Acosta, brilliantly illustrates in Bedwetting and Accidents Aren’t Your Fault. You’d be wiser to call a plumber.
Myth #3: Positive reinforcement can a help a child stop wetting the bed.
Reality: No amount of ice cream, M&Ms, screen time, or praise will make a difference.
Parents are often advised (by parents who’ve never been in their shoes) to “reward your child for dry nights but don’t punish for wet sheets.” But rewards, like punishments, can be damaging; both assume the child has control over his or her bladder. Rewards simply set up a child up to feel like a failure.
As I explain in The M.O.P. Book, overactive bladders do not respond to the promise of M&Ms!
Myth #4: Children have accidents because they are stressed and anxious.
Reality: Children who have accidents may well be stressed, but typically it’s accidents that cause stress, not the other way around.
Children who poop in their pants or wet the bed get mercilessly teased, feel isolated because they can’t go on sleepovers, and generally feel crummy about themselves. They have plenty to feel stressed about.
But seeking psychological explanations for physiological problems does these children a disservice. When a child poops in his pants, it’s because his chronically clogged rectum has lost tone and sensation. It’s that simple.
Yet it is standard fare for parenting experts, even some doctors, to attribute accidents to stress — to call them “a reaction to heartache” or “a default reaction to a lack of better communication tools.” Bedwetting also is not a reaction to bullying.
Myth #5: Children who have accidents are lazy or have behavioral problems.
Reality: I know it seems impossible that perfectly well-adjusted 5-year-olds or 10-year-olds could pee or poop in their pants, but it is the truth.
I frequently see patients who have been referred by their pediatricians to behavioral therapists for accidents were clearly caused by constipation and easily resolved with appropriate treatment.
The “lazy” myth appears to be pervasive among parents and teachers who have not been educated about the real causes of accidents. “[Teachers] think kids are doing it on purpose to get attention or they’re being lazy,” says Natalie Barganski, a pediatric nurse practitioner at Driscoll Children’s Hospital in South Texas.
An excellent survey of 4,000 elementary-school teachers found only 18 percent of them had received professional training on voiding health. Some 76 percent are, inadvertently, failing to take key measures to help kids who have accidents.
Myth #6: Bedwetting is caused by “deep sleep” or a “small bladder.”
Reality: Deep sleep could explain why a child doesn’t wake up in the middle of the night to pee; it can’t explain why a child would need to pee overnight in the first place. A child with a healthy bladder does not need to pee in the middle of the night.
Most kids sleep deeply! Most kids won’t wet the bed. When a child does wet the bed, it's almost always because a rectal clog is aggravating, even flattening, the bladder. The bladder randomly hiccups and empties, before the child has a chance to wake up and get to the bathroom. These kids have no chance of staying dry all night.
I X-ray all my patients, including those whose parents swear would not wake up even if Mötorhead were giving a concert in their bedroom. And what do these deep sleepers’ X-rays show? Severe constipation.
Another line I hear often: “Our doctor says my son's bladder hasn’t caught up with his brain.” Again, false. The child’s bladder capacity might well be compromised — but only because the stretched rectum is squishing it.
When parents and pediatricians buy into the “deep sleep” or “small bladder” myths, the child usually ends up getting inadequate treatment, such as medication or bedwetting alarms, or no treatment at all.
In the meantime, parents wake up their child to pee in the middle of the night, a strategy that does nothing to resolve constipation but sure leaves everyone exhausted.
I continue to do all can to debunk these myths and help educate the public about the actual causes of bedwetting and accidents.