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Why Some Kids Outgrow Bedwetting and Others Don’t

Nearly every parent who walks into my bedwetting clinic asks me this question: “All my friends tell me their kids outgrew bedwetting, so why hasn’t mine?”

This week a mom in my private Facebook support group posted the same question:

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 really do recommend the Modified O'Regan Protocol, aka M.O.P., for a 5-year-old who does not have obvious signs of constipation. In fact, I recommend M.O.P. for toilet-trained children age 4 and older.

For one thing, the signs of constipation often are not obvious. Many chronically constipated poop daily and have soft poops, leading parents and doctors to assume all is fine. It’s only when you X-ray these kids, as I do in my clinic, that you see their rectums are stuffed with stool and pressing against the bladder.

Constipation is almost always the cause of bedwetting, even in 4-year-olds. The typical methods doctors use to diagnose constipation — feeling a child’s belly and asking how often they poop — are wholly inadequate. If you’re uncertain your bedwetting child is constipated, an X-ray is in order.

READ: When to X-ray a Child for Constipation

Many doctors advise waiting until a child is 7, 9, even 11, before treating bedwetting. But, in my experience, waiting often backfires.

My clinic is booked with tween and teen bedwetting patients who, year after year, were assured by their doctors that they would outgrow their condition. Ask these patients and their parents if they are glad they waited to seek treatment, and they’ll all tell you the same thing: no.

While it’s true that most children do, eventually, stop bedwetting on their own, plenty do not. I don’t believe it benefits the child to wait and find out which category he or she falls into.

READ: Teenage Bedwetting — Everything You'e Been Told is Wrong

In general, the older kids get, the more difficult bedwetting is to treat. Years of rectal stretching takes a toll. Compared to a rectum that has been stretched for one year by a build-up of stool, a rectum stretched for 5 or 10 years will take longer to shrink back to size and stop bothering the bladder.

Even if a child might spontaneously stop wetting at age 8, why not stop the wetting at 5?

There's really just one reason I can think of, underscored by the mom who posted the above question: the Modified O’Regan Protocol takes time and effort. If you’re already doing M.O.P. with a 7-year-old, as this mom is, I can see holding off for a few more months with a 5-year-old, especially if the younger child is not bothered by the bedwetting and does not wet the bed every night.

The children most likely to outgrow accidents are those who only wet at night and who don’t wet every night. This was demonstrated convincingly by a study of 16,000 children conducted in Hong Kong.

As the Hong Kong researchers concluded, the notion that bedwetting will spontaneously resolve with age “probably applies only to those with mild enuretic symptoms” — in other words, kids who wet the bed infrequently.

Based on their findings, these researchers argued that bedwetting children with severe symptoms should begin active treatments “at a much earlier age.” Based on my own clinical experience and research, I think that age is 4.

Also, I don’t think the symptoms need to be “severe.” I think nightly wetting is enough to warrant treatment with M.O.P.

I’ll now move on to the first question: Why do some kids outgrow bedwetting?

Two reasons: 1.) as children mature, their toileting habits mature; they’re just less likely to delay pooping and therefore less likely to get constipated, and 2.) some kids’ bladders are inherently more sensitive than others when squished by a stretched, poop-stuffed rectum.

There are many reasons a child might become less constipated with age and therefore less prone to bedwetting. Maybe she gets more comfortable using the school restroom or asking the teacher for bathroom breaks. Maybe she’s more willing to eat fruits and vegetables or joins the soccer team and becomes more active.

Whereas most toddlers don’t have the judgment or maturity to listen to their body’s urges (which is why I don’t advocate potty-training toddlers), most older children do.

READ: The Problem with Preschool Potty Training Deadlines

Also, for genetic reasons, some bladders are more sensitive than others to rectal stretching. In other words, one child’s bladder may spasm and spontaneously empty when her rectum is stretched to 4 cm, slightly beyond the maximum normal measurement of 3 cm; another child may not have accidents unless her rectum is stretched to 6 cm and is more severely encroaching upon the bladder.

The child with the less sensitive bladder may stop wetting with minor improvements in constipation that occur as children mature and start going to the bathroom when they need to.

It is never too late to treat a child for bedwetting. I’ve worked with countless teenagers who have been able to achieve dryness and avoid their worst nightmare: going off to college with pull-ups.

However, by the time they get to my clinic, these kids have endured years of stress and embarrassment and typically require the more cumbersome variations of M.O.P. (aka M.O.P.+, Double M.O.P. and/or Super M.O.P. — all described in The M.O.P. Book: Anthology Edition), along with a variety of medications.

I’ve also worked with bedwetting teens who have had to delay freshman year because they just ran out of time to resolve the problem.

Whether bedwetting stops sooner or later, I believe, depends on how much the rectum is stretched and how sensitive the child’s bladder is to that stretch. You can measure the rectal stretching with X-ray, but there’s just no way of measuring the bladder’s sensitivity.

So, I err on the safe side and urge parents to treat bedwetting early and aggressively.

Get Dr. Hodges' updated recommendations for treating bedwetting and accidents!

The M.O.P. Book: Anthology Edition teaches you to implement the Modified O'Regan Protocol with confidence. Get your child on the path to dryness!

Must-read books for kids by Steve Hodges, M.D.

• 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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