About That "Bedwetting Gene"

By Steve Hodges, M.D.,

Does bedwetting run in families?

If so, does that mean there’s a "bedwetting gene”? Does it mean families should wait for the child to outgrow the bedwetting?

These questions surface often in my medical practice, as many of my patient families have more than one child with enuresis. And my private Facebook support group includes numerous parents treating multiple children for bedwetting and daytime pee accidents.

The issue came up again last week when I was interviewed on the Family Looking Up podcast by a mom who came from a family of 6 children, all of whom wet the bed. In her family, it was called “the blue-eyed curse.”

Whoa — what the heck?

The issue is less complex than it seems. In short: Bedwetting is caused by chronic constipation, and the tendency toward constipation runs in families. So does the propensity of the bladder to overreact to a clogged, stretched rectum.

In other words, it’s not a “bedwetting gene” that’s causing the wet sheets. It’s the way the child’s bladder responds when the bladder’s nerves are aggravated by the chronically enlarged rectum.

Loads of children are constipated but do not experience bedwetting or daytime accidents. These are lucky kids! They’ve got bladders of steel, unbothered even when the nearby rectum is stuffed with stool and pressing against the bladder nerves.

My patients are not so lucky!

In many cases, their bladders hiccup and empty at the slightest provocation from the rectum. These kids have to work very hard to keep the rectum fully evacuated every day. As soon as constipation comes creeping back, boom — the wetting starts.

In other families, kids can manage to stay dry up to a certain level of constipation. Only when the hardened mass of stool in the rectum becomes extreme do accidents happen.

And certainly, some kids are far more prone to enuresis than their siblings.

In terms of treatment, the familial connection just doesn’t matter. All these kids, no matter how prone their bladders are to hiccuping, need to be treated for constipation!

The problem with the term “bedwetting gene” is that it suggests treatment is pointless. As in: If a child has the “bedwetting gene,” wet sheets are inevitable, so we might as well just wait it out.

This is a terribly unhelpful approach!

You cannot assume a child will outgrow bedwetting. I have a significant patient load of teenagers, all of them who were assured, year after year, “Don’t worry — you’ll outgrow it. No one ever goes off to college wetting the bed.”

That’s false. Heck, the day after the Family Looking Up podcast aired, I received this email:

All 6 of my kids have wet the bed, the oldest is 18. He just left for college last month and it has been heartbreaking when he calls home and tells us he has had an accident. We were literally out of options… until I heard your podcast. He has ADD, takes Adderall and has struggled with constipation for years. I never knew the 2 were related. Can you give me any tips or tricks to get him the help he needs? For the first time, we feel like there may be hope for this!

Not only is there hope; there’s an effective treatment — the Modified O’Regan Protocol (M.O.P.).

But implementing isn’t a matter of “tips or tricks.” M.O.P. is a process that requires perseverance, experimentation, and time.

And usually, enemas.

The rectum must be fully evacuated every day, so it has a chance to shrink back to size and stop aggravating the bladder nerves. Enemas are by far the most effective method to accomplish that, although even daily enemas will not guarantee complete evacuation.

As I discuss in the M.O.P. Anthology, it’s critical to find the right enema solution and volume that will empty a particular child. For some kids, this means larger volume; for others, it means mini-enemas plus stimulant laxatives. The nuances and variations are covered in the Anthology.

Even when siblings have the same symptoms — bedwetting, daytime pee accidents, encopresis (poop accidents) or any combination — they may need different M.O.P. variations.

Whether you have one child with enuresis or an entire household full, I urge you to treat this condition aggressively and in a timely manner. (And if you do have multiple children struggling with enuresis and/or encopresis, you will find helpful advice in "The M.O.P. Maestro Guide: How to Orchestrate Your Family's Enema Regimen Without Going Bonkers," included in the Anthology.)

Many children who outgrew bedwetting as children nonetheless struggle with constipation and other bowel issues, such as irritable bowel syndrome (IBS) as adults — issues I consider the result of chronic constipation that went overlooked and untreated in childhood.

It’s just not healthy to carry around a belly load full of poop. With a proactive approach, you can save your child from a lifetime of difficulties on the toilet!