By Steve Hodges, M.D.
In my capacity as a pediatric urologist, I don’t have much to say about politics. Except this: I wish political operatives and pundits would retire “bedwetting” from their professional discourse.
Political use of the term perpetuates myths about actual bedwetting, enuresis, and contributes to the shame and blame my patients feel.
In politics, “bedwetting” has become such a cliché that the term rates an entry in Taegan Goddard’s Political Dictionary, referring to “excessive worry about a political outcome.”
Political use of the term dates back at least to 1980, when the Modern Legal Glossary defined “bed wetters” as slang for young Congressional Democrats “who panic easily when things don’t go their way.”
Every election cycle, “bedwetting” proliferates in the mainstream media. I know this because I’ve set a Google Alert for “bedwetting” to track public perception of a condition I treat daily.
Mixed in with articles about mattress protectors and child abuse (“Father sentenced to 28 years for beating 3-year-old son to death over bed wetting”) are stories analyzing Democratic and Republican electoral prospects.
Last week, a Fox News contributor referred to the “bedwetting that goes on in the media and Democratic circles every four years.” The week before, a guest on “The Argument,” a New York Times Opinion podcast, conceded he’s “perhaps bedwetting” over the prospect of our country’s deep divisions fomenting civil war.
Google has alerted me to “The Democrats’ Excessive Bedwetting,” their post-2020 “bedwetting phase,” and the GOP’s recent “summer of bed-wetting.”
What’s the big deal? The way I see it, linking “excessive worry” to urinary accidents reinforces the falsehood that enuresis is caused by stress or anxiety and that kids could stop wetting if only they would chill out.
The notion that enuresis, which includes both nighttime and daytime wetting, has psychological roots has persisted for centuries and is pervasive in popular culture. In TV, film, and books, bedwetting portends psychological distress. Inevitably, the kid who wets the bed is the one neglected by Mom! (See: Borgen, Fleischman is in Trouble.)
But pop culture and politics are just taking cues from psychiatry and psychology texts.
The latest Diagnostic and Statistical Manual of Mental Disorders (DSM-5) describes enuresis as “voluntary or involuntary” and cites “predisposing factors” such as “delayed or lax toilet training and psychosocial stress.” The Handbook of DSM-5 Disorders in Children and Adolescents links daytime wetting to “difficult temperament and maternal depression/anxiety” and attributes secondary enuresis, bedwetting recurrence after a long dry period, to “stressful life events,” including parental divorce. And according to Psychology Today’s “Diagnosis Dictionary,” wetting accidents may signal "a child has deep feelings they’re struggling to express or a need for attention and care.”
All nonsense!
The studies cited by mental health texts in support of an alleged psychological link are deeply flawed and misinterpreted, as I explain in “The Mental Health Professional’s Guide to Enuresis and Encopresis.”
In fact, enuresis is not voluntary and is not caused by stress, attention seeking, obstinance, neglect, or divorce. Enuresis is no more a mental disorder than an enlarged prostate and does not belong in the DSM-5 or in political rhetoric.
Sure, children with enuresis experience stress, anxiety, even serious depression. That’s because these kids miss out on sleepovers and sports camps, feel terrified their friends will discover their pull-ups, and fear they’ll never wake up dry. Bedwetting causes stress, not the other way around.
What does cause bedwetting? In most cases, the culprit is chronic constipation. The enlarged rectum aggravates the nearby bladder nerves, prompting the bladder to empty without warning.
But unlike the angst of political operatives, enuresis is entirely treatable. When the rectum is fully evacuated every day, it shrinks back to size. The bladder nerves recover. Wetting stops.
All this was proven decades ago by Sean O’Regan, a pediatric nephrologist who practiced in Montreal and whose research changed the way I practice medicine.
“These kids were told it was all in their heads, that they were psychologically disturbed,” Dr. O’Regan, now retired, told me a while back.
Rejecting the conventional wisdom, Dr. O’Regan published multiple studies proving the rectums of children with enuresis were chronically stretched (to twice the normal diameter) by constipation and that resolving the constipation halted the wetting.
Suggesting that enuresis is psychological, even in part, not only crushes the self-esteem of kids, but it also prolongs their distress. Their parents, having absorbed the myths about enuresis, feel tremendous guilt, too.
“My biggest regret was how much time I wasted thinking my son’s enuresis was behavioral or cognitive or that if I was a ‘better mom,’ he’d stop having accidents," a mom in our private Facebook support group told me.
I try hard to persuade my patients that accidents are not their fault. Every time political operatives scold their party for “bedwetting,” I resolve to try harder.