"I was hoping my son would outgrow bedwetting”: Treat Enuresis Now, Not Later

Waiting for bedwetting to resolve on its own can take a bigger emotional toll than many parents realize.

By Steve Hodges, M.D.

Many parents assume their child will outgrow bedwetting, so they put treatment on the back burner and keep buying pull-ups.

Then suddenly their child is 8 or 10 or 12… and still wet at night.

That’s when parents start asking: How did this happen? Did we wait too long? What should we do now?

It’s no wonder so many families wind up here. After all, doctors typically offer assurances like, “Don’t worry — the accidents will stop” or “No one ever went off to college in pull-ups.” Plus, our culture has normalized enuresis (bedwetting or daytime wetting), a condition that is widely misunderstood.

Since most kids eventually do stop wetting, waiting can seem reasonable. No one thinks their child will be among the small percentage whose enuresis persists into middle school, high school, or beyond.

But from my perspective, as a pediatric urologist who treats many teens with enuresis, nobody benefits from a strategy of waiting and hoping — well, nobody but the diaper companies.

READ: Goodnites' Alarming New Campaign Will Harm Children with Enuresis

In fact, bedwetting is highly treatable, and the sooner you start, the better. Meanwhile, delaying treatment has real consequences.

Kids grow more self-conscious and withdraw from peers, skipping slumber parties, school overnights, and sleepaway camps. Their self-esteem often takes a bigger hit than parents realize. Parents feel the strain, too — emotionally and financially — as the pull-up years stretch on.

If you have a child with enuresis and are wondering when — or whether — to take action, consider the following five facts.

Fact #1: Chronic constipation is the cause of bedwetting — and becomes harder to treat over time

Bedwetting is often attributed, mistakenly, to deep sleep, an underdeveloped bladder, stress, or anxiety — all “causes” that would seem to resolve with age. So, it’s unsurprising that many families simply wait for the wetting to stop.

But in fact, virtually all wetting is caused by chronic constipation — a condition that is often painless, invisible, and easily missed by parents and doctors alike. Even children who poop every day can be significantly clogged up.

READ: Even Severe Constipation Goes Undiagnosed in Bedwetting Children. Here’s Why.

What happens is that the rectum, enlarged by a pile-up of stool, presses against bladder nerves, causing the bladder to “hiccup” and empty without warning, day or night.

A chronically stopped-up rectum, like a clogged drainpipe, won’t spontaneously unclog itself.

Instead, over time, stool accumulates, dries out, and hardens, further stretching the rectum and compromising sensation and tone. The child’s tendency to withhold stool becomes more ingrained.

Halting bedwetting is a three-step process:

1. Fully empty the rectum

2. Keep the rectum empty long enough for it to shrink back to size, so the bladder nerves can settle down

3. Ensure the child responds promptly to the restored urge to poop

   
   

Enuresis is treatable at any age, but the longer constipation persists, the harder all three steps become. Treatment that might have taken a few months earlier can take far longer later on.

Treating chronic constipation early (I recommend around age 4) not only spares children years of accidents — it often shortens the treatment process.

You may wonder: Is constipation the only cause of bedwetting? No, but it’s almost always the cause. Rare exceptions include congenital conditions such as posterior urethral valves or tethered cord syndrome. I discuss these outlier causes in the M.O.P. Anthology, my enuresis treatment manual. (M.O.P. stands for the Modified O'Regan Protocol, the structured treatment regimen I use in my clinic.)

Even severe constipation is routinely overlooked because symptoms are subtle and traditional diagnostic methods are unreliable.

But you can easily confirm — or rule out — constipation with a plain abdominal x-ray (as long as the x-ray is evaluated correctly).

READ: Why an X-ray for Childhood Constipation Can Seem Like a Rorsach Test

Fact #2: After age 9, most children with enuresis don’t spontaneously stop bedwetting.

At age 10, about 2.6% of children wet the bed. At age 11, about 2% do. By age 19, the figure is still roughly 2%.

In other words, if you have a fifth-grader with enuresis, the odds are poor that your child will stop wetting without treatment.

Medical organizations such as the American Academy of Pediatrics often emphasize that “only” 2% of teens wet the bed. This tiny percentage is construed as reassuring — evidence that your child likely won’t be among them. But 2% still represents a large number of adolescents — hundreds of thousands in the United States alone.

You may wonder: If a clogged rectum doesn’t resolve on its own, why do so many children eventually stop bedwetting?

One reason is that constipation has a strong genetic component, as does the bladder’s sensitivity to rectal distention.

In some children, even a slightly enlarged rectum can trigger accidents. Many young children with moderate constipation become less constipated with maturity. They grow more comfortable using public restrooms and more willing to interrupt their activities to respond to the urge to poop. As a result, the rectum shrinks enough to stop aggravating the bladder, and accidents resolve.

But children with a strong genetic tendency toward constipation—especially those who'd developed a strong tendency to override the urge to poop—are unlikely to experience that kind of spontaneous improvement.

Meanwhile, some children can be massively constipated but have a bladder of steel and therefore avoid bedwetting. Some of these children instead develop encopresis, chronic poop accidents. The unluckiest experience bedwetting, daytime wetting, and encopresis, aka the "trifecta."

READ: Treating the “Trifecta” in Children: Bedwetting, Daytime Enuresis, and Encopresis 

The key point: spontaneous improvement often happens in younger children. But once a child is in upper elementary school and still wetting, the odds of outgrowing enuresis without treatment become quite low.

Enuresis fact #3: You can’t predict which kids will outgrow bedwetting

Certainly, there are red flags. Research shows that children who wet nightly and those who have daytime pee or poop accidents are far more likely to experience persistent bedwetting than kids who only wet sporadically and never had daytime symptoms.

However, many children who never experienced daytime wetting or encopresis also end up with persistent bedwetting.

You simply cannot assume a given child will outgrow bedwetting. So why wait around to find out?

If a 4- or 5-year-old is clearly trending toward dryness, then holding off may be reasonable. But if a child is wetting nightly — or still wetting regularly after kindergarten — I would not hesitate to begin treatment.

Enuresis fact #4: Bedwetting takes a bigger emotional toll than parents realize

Many parents downplay bedwetting, saying, “It doesn’t bother my child” or “We don’t make a big deal about it.”'

In my experience, kids are far more affected than they let on. Younger children may not care much, but that changes when they start being invited to sleepovers.

School trips become stressful, and sleepaway camp feels impossible. Kids become self-conscious about wearing pull-ups and retreat inward, fearful their friends will discover their secret.'

Even when children don’t talk about it, bedwetting tends erode confidence over time.

One 15-year-old boy told me, “My accidents make me feel trapped in my own body, like I don’t have control.”

The mom of a different 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 aside emailed me, “The poor kid is humiliated and feels trapped and stressed about going anywhere overnight, including the future he wants in college.”

I could give you hundreds of examples like this. Comedian Sarah Silverman wrote a book and musical, The Bedwetter, about the devastation of teenage bedwetting.

Waiting doesn’t just delay dryness — it prolongs the emotional impact.

READ: Sarah Silverman’s “The Bedwetter” Is Emotionally True But Medically Wrong

Enuresis Fact #5: Bedwetting can affect sleep and learning

Many children with enuresis wake during the night because they’ve soaked through their pull-ups and need to change clothes and bedding. That disruption alone can affect sleep quality.

But even children who sleep through wetting episodes may not be getting restorative sleep.

Though parents often attribute bedwetting to “deep sleep,” research has actually detected less REM sleep in kids with enuresis compared to children who are dry at night. This is likely because their bladders are going haywire all night.

READ: Nope, "Deep Sleep" Doesn't Cause Bedwetting (It's Impossible)

Sleep disruption isn’t just an inconvenience;  many studies link both insufficient sleep and fragmented sleep to compromised brain development, learning and behavior, and mental health.

Research, presented a while back at a meeting of the International Children’s Continence Society (ICCS), showed improvements in attention, learning, and memory after successful bedwetting treatment.

At the time, a Harvard pediatric urologist who was not involved in the study said: “Treatment of bedwetting should help patients achieve more than getting over the stigma of being wet. We now know that treatment can improve cognition and can therefore be expected to improve their school performance, self-image, and their interactions with peers and family members.”

Don’t Keep Waiting

Recently, a mom emailed: “Years ago I bought your book, but I put it aside, thinking and hoping my son would outgrow the bedwetting. Well, he hasn’t — and now he’s almost 12.”

I hear this story all the time.

Parents wait because they’ve been reassured their child will “outgrow it” and because treatment sounds intimidating.

Then they wake up one day with a teen who is still wetting, still wearing pull-ups, and still missing out.

Bedwetting is highly treatable, and treatment tends to become routine pretty quickly. But waiting rarely helps — and often makes things harder.

READ: Children with Encopresis and Enuresis Deserve the Best Treatment, But Most Aren't Getting It

If your child is kindergarten age and still wetting, don’t assume that time will solve the problem. The M.O.P. Anthology explains the treatment approach I recommend.

The sooner you begin, the sooner your child can stop missing out — and the easier the road to dryness is likely to be.