Dear Bedwetting Teenagers: Your Condition is 1.) Common, 2.) Not Your Fault, and 3.) Totally Fixable

Teenage bedwetting is common—and totally fixable.

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

By Steve Hodges, M.D.

If your teenager wets the bed, you’ve probably been told some version of: “Don’t worry—he’ll outgrow it.”

By high school, that reassurance rings hollow.

Enuresis is more common than families think, affecting about 2% of teenagers. In any large high school, that’s dozens of students quietly dealing with accidents they assumed would be long gone by now.

Because bedwetting carries such stigma, no one talks openly about it. Teens are left feeling embarrassed and frustrated—while being offered explanations that sound plausible but aren't medically accurate.

Here are explanations my teenage patients tell me they’ve heard from doctors:

•“You’re a deep sleeper," 

•“You have a small bladder. Just pee every 2 hours.” 

•“Your bladder is underdeveloped.” 

•“Your bladder and brain have a disconnect." 

•“You probably have a hormone imbalance.” 

•“It’s probably stress — see a therapist.”

The truth is much simpler—and more hopeful: Enuresis (both nighttime and daytime wetting) is almost always caused by chronic constipation. In plain language: a long-standing pile-up of stool in the rectum.

When kids delay pooping—as they often do for all kinds of everyday reasons—stool gradually accumulates. Over time, the rectum can stretch to two or three times its normal diameter of about 3 cm. An abdominal x-ray shows this clearly.

The enlarged rectum presses against and irritates the bladder nerves. So, instead of sending calm, reliable signals when the bladder is full, the bladder becomes jumpy and unpredictable. It can squeeze and empty without warning, day or night, even before it’s full.

A child can’t stop the accidents any more than they can stop a sneeze or a hiccup.

Once you understand the cause, the solution becomes straightforward: Empty the rectum completely and keep it empty long enough for healing to occur. As the rectum shrinks back to normal size and the bladder nerves settle down, accidents diminish and then stop for good.

This is the foundation of the treatment I use with my patients, the Modified O’Regan Protocol (M.O.P.), an enema-based approach that works far better than laxatives alone.

I explain the process in the M.O.P. Anthology, a detailed guide, and in M.O.P. for Teens and Tweens, a shorter, companion guide written specifically for middle- and high-school students.

Unfortunately, mainstream advice often misses the mark, depriving children of treatment that will actually help.

The American Academy of Pediatrics, for example, lists constipation as just one of many “risk factors” for enuresis—ranking it below “stress” and “deep sleep.” Treatment suggestions focus on alarms and medication, which rarely work long-term because they don’t address the underlying cause. Resolving constipation isn't even mentioned.

Because of this disconnect, teens are steered toward years of ineffective strategies—fluid restriction, alarms, midnight wake-ups, diets, counseling, and medication—while being told they’ll “just outgrow it.”

Worse, the AAP downplays urgency. While acknowledging the emotional toll of enuresis—“Children may get embarrassed, feel anxious, or develop low self-esteem”—the organization advises parents to see a doctor "if bedwetting has not stopped in the late teenage years."

I start treating bedwetting at age 4. Waiting a decade longer does not serve these kids.

READ: The "Wild West" of Bedwetting Treatment: What Your Doctor Didn't Learn in Med School

When I tell families constipation is the cause, I often hear: “But she poops every day—she can’t be constipated.” Pooping every day, even multiple times a day, does not rule out constipation. What matters is whether the child is fully emptying each time they poop.

Traditional ways of checking for a clogged rectum—feeling the belly or using Sitz marker studies—often miss the problem. That’s why I x-ray all my enuresis patients.

Parents are often shocked to learn their child is stopped up. One mom told me her 15-year-old, who'd never had a dry night, had been evaluated for constipation at age 10 and was told he wasn’t constipated. “Honestly, we don’t believe constipation is the cause of his bedwetting,” she said. I suggested an x-ray.

She emailed back: “Turns out his colon is full of poop! I’m so disappointed that in five years of treatment at a major hospital, no one offered us an x-ray.”

Another mom of a teenager told me her daughter never showed signs of constipation. "She was on medication for years with no success. Lots of laundry and self-confidence issues. Her x-ray revealed her rectum measured over 7.5 cm.”

Stories like these are common—and they’re exactly why x-rays matter. An x-ray can confirm constipation as the cause of accidents, or, in rare cases, rule it out and prompt evaluation for uncommon conditions such as tethered cord syndrome or posterior urethral valves. I discuss these rare causes in the M.O.P. Anthology.

So, where do you go from there? Here’s the approach I use with teens:

•Start with M.O.P. Daily enemas (combined with oral laxatives) empty the rectum and keep it empty so it can heal.

•Add medication if needed. Once the rectum is cleared, enuresis medication can help provide dry nights while healing continues.

•If accidents persist, consider bladder Botox. Botox is highly effective—but only if the rectum is already empty.

This order matters. Jumping straight to medication or alarms skips the most important step.

Will teens really do enemas? You might be surprised. Most teens are so tired of accidents that they’re willing to try.

As one mom of a 16-year-old told me: “My son was on board because nothing else had worked. It still shocks me how much resistance we got from everyone — the GI doctor, the pediatrician, the mental healthcare providers, his dad. But we did it anyway—and it worked."

M.O.P. isn’t a quick fix. Healing a rectum stretched for years takes time and consistency, and setbacks are common. The sooner you start, the better.

One mom recently posted about her teen's progress on M.O.P.: "She's only had one accident in three months. Her last x-ray showed she was cleaned out. She leaves for college in two months—and we are so relieved to have found M.O.P. just in time.”