Goodnites' Alarming New Campaign Will Harm Children with Enuresis (Bedwetting)
- Steve Hodges, M.D.
- 4 hours ago
- 12 min read
By Steve Hodges, M.D.
What if your child had a medical condition that caused tremendous stress, embarrassment, and social isolation — but also was highly treatable?
What if an international corporation invested heavily in persuading you to do absolutely nothing for your child’s condition — other than buy a product to make your kid more comfortable while you wait and hope for the condition to disappear?
What if you were a doctor who has spent 20 years successfully treating this condition — while trying, in vain, to inform the universe that doing nothing is a huge mistake?
Welcome to my world!
I’m a pediatric urologist, and the condition I speak of is nocturnal enuresis, aka bedwetting, a misunderstood symptom of chronic constipation.
The corporate entity I speak of is Kimberly-Clark, manufacturer of Goodnites Nighttime Underwear, aka pull-ups.
The advertising campaign I speak of is “It Takes Time,” a troubling new series of 90-second radio spots. The ads portray preteens with enuresis as late bloomers who simply need “more time” to outgrow the accidents.
In the ads, “kids” with AI-generated voices — a bizarre fusion of real children’s and adult voices — liken their persistent bedwetting to late-bloomer scenarios their own parents experienced, such as taking a decade to graduate college or move on from a break-up.
“Some people need more time,” the chirpy, fake voices say. “The only other thing I need are Goodnites Nighttime Underwear.”
No worries, problem solved!
This campaign is insidious. It’s designed, according to Kimberly-Clark's chief growth officer, to “tackle social stigma in a way that is sophisticated and thoughtful,” a worthy aim, to be sure. But what the project actually does is perpetuate medical misinformation and leverage families’ distress for the purpose of selling product.
The mom of one of my enuresis patients, a high school lacrosse player, called the ads “destructive” and “alarming.”
She said the campaign’s “laid-back attitude” captures the nonchalance that prevented her son from receiving appropriate treatment until high school, by which point he had suffered greatly and required difficult, prolonged treatment.
“It is this attitude that could have stopped my kid from going off college,” she said. I have other patients whose belated treatment did cause them to postpone college or to live at home rather than in a dorm.
Another mom, whose son is a high-school football player with enuresis, found the Goodnites ads offensive as well. “The only intent I see here is to normalize wearing a diaper so the company can make more profit.”
(The product’s very name — Nighttime Underwear — works to normalize enuresis. Hey, it’s just “underwear.” No biggie.)
This mom added: “No one should be shamed for wetting the bed or taking a long time to get a degree, but the comparison is mind-boggling. Goodnites obviously did not do their research. If they had talked to a cohort of kids who’ve struggled with life-long wetting, they would have found the only way to combat the shame is to help them understand enuresis is a medical condition that many other children face.”
In the advertising world, the Goodnites campaign seems to be earning high marks. As one analyst observed, the campaign “effortlessly shifts the dial from a narrow focus on the problem to the product.”
Clever. Focusing on the problem (an overactive bladder that spasms and empties overnight) would be “narrow” — that is, unhelpful to Goodnites’ bottom line. But emphasizing the product (extra-large, absorbent pull-ups) — that’s a winner.
Except families lose.
I’m all for children with enuresis feeling comfortable rather than leaking all over their bed sheets. And lord knows I’ve spent my career working to ease the stigma of enuresis.
But Goodnites’ campaign, however well-intentioned, will do damage.
More kids will miss out on treatment that would resolve their enuresis and preserve their confidence and social life. More parents will accept the falsehood that bedwetting children are just late bloomers, second-guessing their instincts as they purchase ever-larger pull-ups and console their increasingly demoralized kids.
And let me tell you: Unlike the upbeat, AI-generated “kids” in these strange ads, actual children with enuresis — my patients — feel tremendous anxiety and, sadly, deep shame, even when assured the accidents are not their fault. Their distress intensifies as they enter middle school and high school and retreat inward for fear their friends will learn their secret.
As the mom of a 15-year-old told me, “Enuresis has basically ruined this kid’s social life and crushed his self-esteem, and I kept listening to ‘Don’t worry, he’ll outgrow it.’”
The dad of a 17-year-old whose enuresis had been brushed off for over a decade emailed me, "The poor kid is humiliated and feels trapped and stressed about going anywhere overnight, including the future he wants in college.”
Many teens with enuresis fall into depression, and some become suicidal, no matter how supportive their parents are. Another mom, devastated that she hadn’t learned earlier about enuresis’ cause and treatment, posted in my private enuresis/encopresis support group: “The longer this goes on, the more havoc it wreaks on the entire family. Even in a positive, loving environment, your child still will endure years of desperate attempts to right the situation.”
Comedian Sarah Silverman wrote an entire musical, The Bedwetter, based on her own suffering as a preteen and teen with enuresis. By age 14, Silverman was taking 16 Xanax a day. It's preposterous to think that all she needed was "more time" and Goodnites Nighttime Underwear.
READ: I’m a Pediatric Urologist. Sarah Silverman’s “The Bedwetter” Is Emotionally True But Medically Wrong
A few facts about enuresis that parents should know but won’t learn from Goodnites:
•Virtually all enuresis is caused by a stool-clogged rectum. When kids delay pooping, as they often do, stool piles up in the rectum, stretching this organ to two or three times its normal diameter. You can measure this on a plain abdominal x-ray. Over time, the enlarged rectum encroaches upon and aggravates the bladder nerves, causing the bladder to hiccup and empty randomly and without warning, day or night. About one-third of teens and tweens with nighttime enuresis also have daytime accidents.
Almost everything on the “What Causes Bedwetting?” page of the Goodnites website is erroneous. Enuresis is not caused by “emotional factors, such as stress and anxiety.” Enuresis does not happen “because the bladder and brain are not yet making the necessary connection.” Enuresis is not caused by a bladder that is "producing too much pee at night.” Enuresis is not caused by a bladder that is “too small,” by “drinking too much water before bedtime,” or by a “hormone imbalance.” (I address all of these unproven/disproven theories in The M.O.P. Anthology 5th Edition,)
The Goodnites website does mention constipation as a “factor” in “some children” but buries this information in a long list of non-causes. In reality, constipation is nearly always the cause. I list the genuine exceptions on page 40 of the M.O.P. Anthology, in a section titled “Medical Conditions That Cause Enuresis in the Absence of Constipation.”
•Resolving the underlying constipation will stop the wetting. Once the enlarged rectum is emptied (a feat more challenging than it sounds) and kept empty on a daily basis for months (also a tough road when the rectum has been stretched for years), it will shrink back to normal size and stop aggravating the bladder nerves. In some cases, like when the rectum is empty but still enlarged, bladder medication and/or Botox injections can bring dry nights sooner. But aggressive bowel emptying, ideally with an enema-based regimen, needs to happen first. (Laxative-only regimens, such as Miralax "clean-outs" followed by daily Miralax, tend to fail.)
•You cannot assume a child will spontaneously outgrow enuresis. Just because most kids eventually stop wetting does not mean all of them do. Left untreated, about 2% of kids with enuresis keep wetting into adulthood — that’s about 840,000 tweens and tweens. A big-city high school with 2,000 to 4,000 students will likely have 40 to 80 students with enuresis. I treat bedwetting at age 4. Even if a child were to spontaneously stop wetting at age 7 or 10 or 12, why prolong a distressing condition you can stop now? Who benefits when families wait? I mean, besides the manufacturers of pull-ups.
READ: Dear Bedwetting Teenagers: Your Condition is 1.) Common, 2.) Not Your Fault, and 3.) Totally Fixable
I have a hefty patient load of teens who were assured, year after year, “Don’t worry, no one goes off to college wetting the bed.” This is patently false. The other day, in a Zoom with my private support group, two moms of high-school seniors spoke of their teens’ panic at the prospect of navigating the freshman-dorm scenario. Both kids’ bedwetting has greatly diminished with a daily enema regimen, the Modified O'Regan Protocol (M.O.P.), in combination with bladder medication, but they're not out of the woods, so their anxiety is warranted. I wrote a note to help one of these teens secure a single dorm room in the fall. Fortunately, these moms are on top of things, and their kids are highly motivated to continue treatment, likely including bladder Botox injections. I feel hopeful both kids will be reliably dry by freshman move-in day.
But none of this had to happen. One of the moms said, “My child spent years being told by the medical community, ‘This will pass,’ and ‘He'll grow out of it.’ I finally had to do my own research, and then we had to go to great lengths to convince our pediatrician to x-ray him. When she finally did, she called to apologize to us because of how badly his colon was full of stool.”
•The kids least likely to spontaneously outgrow enuresis are those with nightly wetting and/or a history of daytime wetting and/or encopresis (poop accidents). As a study of 16,000 children in Hong Kong concluded, the notion that bedwetting will spontaneously resolve “probably applies only to those with mild enuretic symptoms” — in other words, kids who wet the bed sporadically. Left untreated, children with more severe symptoms, they wrote, have a “significantly greater chance of persistent [bedwetting] in adult life.”
About 2% of 10-year-olds are still wetting the bed — the same percentage of adults with enuresis. In other words, contrary to what the Goodnites ads suggest, the odds are poor that a bedwetting middle-schooler, left untreated, will magically wake up dry. One mom, worried her teenager might never stop wetting, briefly joined a Facebook group for bedwetting adults, just to see what might lie ahead for her son. “The stories and suffering I found there were so heartbreaking I had to leave the group,” she told me.
These folks didn’t need “more time to finish bedwetting” when they were younger; they needed (and still need) appropriate treatment.
•For older kids, treating enuresis typically takes longer and requires more aggressive measures. The more years a child’s rectum has been stretched, the harder it can be to empty and the longer it takes to retract to normal size (about 3 cm in diameter).
Treating a 5-year-old with enuresis is usually (though not always) a lot easier than treating a 15-year-old. Older enuresis patients typically need a daily enema regimen for many, many months and, depending on their bladder sensitivity, may still need medication or Botox. Urging families to take no action, besides purchasing pull-ups, does children a huge disservice, though certainly boosts Goodnites’ profits. For every year a child with enuresis continues to wet the bed, the family is buying 365 pull-ups!
But the money spent is the least of it. As the mom of one of my teen patients said, “My son’s condition could have been resolved eight years ago. Instead, he suffered. I’m exhausted. And the prolonged delay only made things worse — his colon stayed packed and rectum remained dilated for all those years.”
•Even severe, chronic constipation in children often goes undiagnosed. A child can poop every day and still be constipated. What matters is not how often the child poops but whether the child is fully evacuating. The methods commonly used to diagnose constipation — a child’s pooping history, palpating the child’s belly, the Rome criteria, transit studies — are not reliable. An x-ray will tell you what you need to know. Unfortunately, many doctors share the laid-back attitude of the Goodnites campaign and don’t x-ray for constipation or treat the constipation aggressively enough, recommending nothing more than prune juice, fiber, and daily dose of Miralax.
Let’s consider the Goodnites’ ad campaign in light of these facts.
In an article analyzing the new radio spots, Campaign magazine, a media outlet that covers the advertising industry, describes the premise behind the ads: “unrealistic social expectations often prevent parents from addressing [bedwetting] or buying products that could help their children.”
But is this true? Are parents actually unwilling to buy pull-ups because they unrealistically expect their kids to achieve dryness earlier?
Certainly, some misguided parents force their kids to sleep in underwear as punishment for bedwetting or as an ill-conceived “incentive” to stay dry. I’ve written plenty about the verbal and physical abuse some children with enuresis endure. One teen emailed me: "My dad screams about how I’m not a little kid anymore. He wants me to sleep in a wet mattress to learn what ‘discomfort is’ and how disgusting I am. He has tried punishments like taking away my electronics and my breakfast."
But that type of parental reaction is the exception, not the rule, and I highly doubt parents with this mindset would be influenced by Goodnites’ perky new campaign.
In my experience, most parents empathize deeply with their children and feel as demoralized by the wet sheets as their kids do. Failure to buy pull-ups is not a widespread problem.
The actual problem is that enuresis is not understood as a treatable medical condition, so parents are buying pull-ups for many, many more years than is necessary. By normalizing enuresis, Goodnites is earning far more money than they would if their message was: Bedwetting is a fixable symptom of chronic constipation. Get your child treated asap!
According to Campaign magazine, the Goodnites ads aim “to take the shame out of childhood incontinence and persuade parents to manage the situation with products like Goodnites, instead of wishing it away.”
But pull-ups do not “manage” enuresis any more than a Band-Aid manages a skin infection. A Band-Aid, like a pull-up, provides comfort and contains bodily fluids — important, sure, but irrelevant to addressing the root of the problem.
Responding to enuresis by purchasing Goodnites and giving kids “more time” to outgrow the wetting is the same thing as wishing the condition away.
Goodnites attempts to present an enlightened, empathetic approach to a condition it badly misrepresents.
The company’s chief growth officer told Campaign: “The world judges people for the ages at which they do things, and parents judge children for the ages at which they wet the bed. I love how this campaign uses this universal truth and takes an adult approach to tackle what many think is a child’s problem. Bedwetting happens, but embarrassment does not have to.”
This statement, like the whole ad campaign, makes no sense.
It’s true, as I mentioned, that some parents judge and shame their children for wetting the bed at an age when these parents believe the child “should know better.” But enuresis that persists at age 10 or 12 (or whatever age the kids in the ads are supposed to be) has literally nothing in common with an extended timeline for earning a college degree, getting over a break-up, or moving out of your parents’ house. In those scenarios, life gets in the way but adults have agency; with enuresis, the child has an underlying medical condition that has gone untreated.
In one of the ads, the AI-generated voice says, “Dad took longer to finish college, just like I’m taking longer to finish wetting the bed.”
The “kid” explains that his dad took 12 years to earn his sociology degree because he met a woman at a party, and they “rode motorbikes around the world,” and then a troupe of Balinese monkeys stole their belongings, and then Dad worked at a restaurant and got married and became a stay-at-home parent, and on and on.
The “kid” concludes: “That’s OK. Some people need more time. And the only other thing I need are Goodnites Nighttime Underwear.”
Heavens, no! What children with enuresis need is a regimen of suppositories and laxatives to heal the rectum and stop the wetting, not a decade of wearing XL pull-ups. Simply wearing Goodnites is devastating for older kids, no matter what the AI-generated voices claim.
In the most cringe-worthy of the three ads, a faux kid offers a convoluted story about how, after 10 years of pining for his ex-girlfriend, her dad finally managed to move on: He ran into her at the drugstore while she was picking up “constipation relief” medication. This repulsed Dad so much — it “relieved him” of all remaining feelings for his ex (ha ha!) — that he was finally able to fall in love with another woman.
Quite the irony: Dad is grossed-out by the very condition that is almost certainly causing his kid’s bedwetting.
I’m no marketing genius, but it’s hard to conjure up an ad that would be more unhelpful to a family dealing with enuresis.
The chief creative officer behind these ads says they are “made specially for the parents of bedwetters, now and in the future.”
But actual parents of enuresis patients find these ads repellent and predatory.
“I’ve often wondered how different my son’s teenage years might have been had we taken action sooner — all the camps, sleepovers, and class trips he missed out on because of his bedwetting," the high school football player's mom told me. "Only now that we’ve found effective treatments has my son started to feel empowered, less shame, and less isolated on this journey.”
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