Teenage Bedwetting: Everything You’ve Been Told Is Wrong

By Steve Hodges, M.D.

Bedwetting in teens is common—and highly treatable.

Editor's note: This post was updated in 2026 to reflect Dr. Hodges' current guidance.

I have a large caseload of teenage bedwetting patients, and I frequently receive emails from teens with enuresis. The common theme: Nothing works. Nobody will help me. How can I go college like this? From a 17-year-old girl: “I cannot feel any urine going out, but I wake up wet every day. My mom thinks I'm stubborn and don't want to wake up at night. I’m a very bright student, I might add. This is the only thing that pulls down my self-esteem. I can’t go to camps, and it’s so embarrassing not even my best friend knows.” From another 17-year-old: “I’ve done special diets, alarms, being woken up at all hours by my parents, limiting drinks after dinner, and desmopressin for a year now. My doctor says I should just ‘get off’ my medication. If only he knew how hard it is. I try to live a life of a normal teen (sleepovers, trips, etc.) yet I'm always nervous to have an accident. Now college is approaching. I just can't give up on myself as quick as others have.”

The other day the mom of a 16-year-old emailed: "I'm still at this 10 years on. I'm starting to panic about sending my son off to college in 2+ years without a resolution."

Doctors commonly reassure teens, ‘Don’t worry, you’ll outgrow it.’ But for many teenagers, that reassurance turns into years of frustration and despair. By high school, it becomes painfully clear the kid is not going to magically wake up dry.

Then what?

If you’re a teen—or the parent of a teen—with enuresis, you may be wondering: Where do we even start? And is it too late to fix this?

No, it's not too late. But the approach most doctors take is exactly backwards.

In my clinic, I start with the Modified O’Regan Protocol (M.O.P.), an enema-based regimen designed to treat the root cause of enuresis: chronic constipation that has stretched the rectum and irritated the bladder nerves.

Once M.O.P. has been implemented consistently, we may add medication—and if needed, bladder Botox. I walk families through the process in the M.O.P. Anthology and in M.O.P. for Teens and Tweens, a shorter, teen-friendly guide to getting started.

Most families are shocked to learn how common enuresis is in older kids. About 2% of teens still wet the bed—roughly 40 to 80 students in a typical big-city high school. And about 30% of these teens also struggle with daytime wetting and/or encopresis (chronic poop accidents).

Most have been wetting the bed their whole lives and expected to outgrow it. But you cannot assume a child will spontaneously stop wetting.

Children who wet nightly, as opposed to sporadically, and those who also have daytime accidents are the least likely to spontaneously overcome enuresis, according to a study of 16,000 children in Hong Kong.

“Our findings challenge the myth that bedwetting will always get better and disappear as the child gets older," the lead author wrote.

Yet pediatricians routinely minimize bedwetting. “A pediatrician said my 7-year-old shouldn’t be concerned until age 11 or 12 because there are such great pull-up-type products available nowadays," one mom wrote. Never mind how 6th graders feel about wearing “pull-up-type products” on sleepovers.

The diaper industry also reinforces the idea that bedwetting is normal and harmless. A A Goodnites campaign portrays preteens with enuresis as late bloomers who simply need “more time” to outgrow the accidents. Most teens who see me have never been told enuresis is usually caused by chronic constipation. So I explain what’s happening: the rectum, enlarged by a pile-up of stool, presses on the bladder nerves, causing the bladder to empty without warning.

I reassure my patients that the accidents are not their fault. They can’t stop them any more than they can stop a sneeze or a hiccup.

Understandably, families are skeptical of the constipation explanation. They've been told the child is a "deep sleeper" or overproduces urine or that bedwetting is hereditary or triggered by stress or anxiety. The child may poop daily, so constipation seems farfetched.

That’s why I x-ray all my enuresis patients. In nearly every case, the image reveals a stool mass filling the rectum. The measurement tells the story: a normal rectum measures less than 3 cm; in children with enuresis it’s commonly 6 to 9 cm.

An x-ray is also valuable because, in rare cases, it will rule out constipation, guiding me to conduct tests for alternative causes of bedwetting, such as tethered cord syndrome or posterior urethral valves, congenital conditions that require surgery.

But these alternative explanations are exceptionally rare. For many families, seeing the x-ray is the “aha” moment and gives us key information to guide treatment. For example, based on what the x-ray shows, I choose the specific M.O.P. variation most likely to work for that child.

I believe that if more doctors x-rayed teens for constipation, children would be spared years of useless tests and treatments. One teen patient had undergone a year of chiropractic treatments and a costly program that instructed his mom to spray him with cold water at night to jolt him awake. She later wondered if she’d “failed him” by not following the program perfectly. Most teens with enuresis actually have a long history of constipation that becomes apparent if you ask the right questions. But because the signs are often subtle and not well known, nobody ever connected the dots.

READ: Even Severe Constipation Goes Undiagnosed in Bedwetting Children. Here’s Why. I treated a boy whose constipation was so severe at age 5 that his parents delayed kindergarten. His poop accidents eventually stopped, so everyone assumed the constipation had resolved. But the bedwetting persisted.

“When he was 14, he wanted to go to Rome with the Latin club,” his mom wrote. “I was so stressed. I sent him with nine garbage bags for the bed.”

Over the years he was diagnosed with narcolepsy, anxiety, and sleep apnea. None of the treatments helped. His mom was stunned when an x-ray finally showed he was still constipated. “I was like, ‘WHAT???’ Our pediatrician never mentioned that.”

It took many months of M.O.P. and medication to get the boy dry. An ordeal that began with delayed kindergarten ended with a gap year at age 18—all because the kid's constipation went unrecognized and untreated.

When bedwetting persists into the teen years, families naturally turn to the Internet for explanations. Unfortunately, most of what they find sends them down the wrong path. Here are the explanations you’ll see again and again—and why they miss the mark.,

•Myth: the bladder is too small to hold urine all night. In reality, the bladder only seems small because it’s being flattened by a chronically stool-filled rectum. Fixing the constipation will restore bladder capacity. •Myth: deep sleep causes bedwetting. Though American Academy of Pediatrics (AAP) describes deep sleep as a "risk factor" for enuresis, this doesn’t hold up. Most teens are deep sleepers; most teens don’t wet the bed. The problem isn’t sleep—it’s a bladder being constantly irritated by a stool-filled rectum.

•Myth: family history means nothing can be done. Family history is real—but what’s inherited is a tendency toward constipation and bladder sensitivity. Treat the constipation, and family history becomes irrelevant. The AAP states: “It is helpful to identify the age of nocturnal continence for both parents.” But it's not helpful.

•Myth: stress or anxiety. The AAP says: "Stress can cause bedwetting; treating the stress can stop the bedwetting." No credible evidence supports this theory. Bedwetting causes stress, not the other way around. Here’s the approach I use with teens:

•Start with M.O.P. to empty the rectum and keep it empty.

•Add medication, if needed, to help kids stay dry while the rectum shrinks back to size and the bladder nerves heal.

•If accidents still persist, consider bladder Botox.

This order matters. Most doctors jump straight to medication or alarms, but those approaches don’t address the root cause.

If accidents persist despite consistent M.O.P. and medication, bladder Botox can be extremely effective—especially for teens approaching college. But Botox only lasts when the rectum is empty, which is why M.O.P. comes first.

READ: Bedwetting Medication: When It Works, When It Doesn't

Healing takes time. A rectum stretched for years won’t bounce back overnight, and irritated bladder nerves need months to settle down. That’s why consistency with M.O.P. is critical.

No teen patient is happy to hear that enemas are the key to resolving enuresis. But in my experience, most kids are so distressed after years of accidents that they're willing to give it a try.

Here's what one teen wrote upon learning about M.O.P.:

"I felt a mix of 'No way' and 'OK.' I pushed myself because I wanted to be cured. Seeing the x-ray of my insides and understanding the treatment helped me a lot. It ended up being much easier than I thought, and after a few weeks of practice, it wasn't even a big deal to go on a sleepover."

Eventually, he started desmopressin to keep his morale up. After 13 weeks, he was able to stay dry without the medication and then slowly tapered off enemas. His advice to other teens who feel hesitant to try M.O.P.: "Just do it. It's not a big deal, and it cured me."

Families who want ongoing guidance can also join our private support group, where I answer questions and help parents troubleshoot treatment in real time.

If your teen is tired of waiting to “outgrow it,” start with the M.O.P. Anthology and a current abdominal x-ray. The path to dry nights is clearer—and more achievable—than most families realize.