By Steve Hodges, M.D.
Nearly every parent who walks into my clinic asks: “All my friends' kids outgrew bedwetting, so why hasn’t mine?”
I also hear this question often in our private Facebook support group. For example, a mom wrote: If bedwetting is caused by constipation, why does it seem that some kids really do grow out of it? I've had so many people tell me that one day, their kid just started waking up dry. My 7-year-old wets the bed and has soiling problems, too, so we are fully on board with M.O.P. But my 5-year-old, who also wets the bed, has consistently soft poops and doesn’t appear to withhold. Would you really recommend doing M.O.P. for her as well? I have hope she will grow out of it, like my friends’ kids did.
I’ll answer her second question first: Yes, I do recommend the Modified O'Regan Protocol for a 5-year-old who does not have obvious signs of constipation. Many chronically constipated poop every day and have soft stool; the soft stuff just oozes past the hard mass that's clogging the rectum.
While it’s true that in most children, enuresis spontaneously resolves, many children aren't so lucky. I don’t believe it benefits a child with enuresis to wait and find out which scenario will play out. With age, enuresis only becomes more challenging to treat.
But I do understand a parent might want confirmation their child actually has constipation, in which case a plain abdominal x-ray will provide an answer.
You can't predict if a given child will stop bedwetting, but one clue is accident frequency. The children most likely to outgrow accidents, research shows, are those who don’t wet every night and who also don't have daytime enuresis or encopresis.
Now for the first question: Why do some kids outgrow bedwetting but others don't?
For one thing, as children mature, their toileting habits mature. They become more comfortable pooping in public restrooms and overall less likely to delay pooping and therefore less prone to accidents. This was my own experience. Though I did not experience bedwetting as a child, I did experience painful pooping and the type of underwear poop smearing that today I recommend treating with M.O.P.
I avoided my school bathrooms at all costs and would often goes days without pooping. I never mentioned this to my parents and thought painful pooping was normal. I was lucky that I did not have a bladder that was sensitive to rectal stretching, because I'm sure I would have developed enuresis.
But then, at some point — I really don 't remember when — I got over my squeamishness and stopped overriding the urge to poop.
When a child has a bladder that's highly sensitive to rectal stretching, I believe, even a modest amount of stool build-up can trigger accidents. I suspect the reverse is true: In some kids, even a modest improvement in chronic constipation can mean the difference between wet and dry nights.
It is never too late to treat a child for enuresis. I have numerous tween and teen patients, and they are able to overcome accidents. But it takes more time and effort to treat enuresis at 15 than it does at age 5. Some older children, whose bladder nerves have been aggravated for years by an enlarged rectum, need bladder Botox, in conjunction with M.O.P., to finally overcome enuresis.
It would have been much easier for these kids, and their parents, if they had been advised to start treatment years earlier, instead of being assured the child would, one day, outgrow it.