Two Headlines. One Harmful Bedwetting Myth

Society's perception of bedwetting and the medical reality couldn't be more different.

By Steve Hodges, M.D.,

Two headlines this week grabbed my attention:

First: "Fort Worth man accused of beating 9-year-old daughter to death."

Then: "MAGA Rift Erupts as White House Insider Bashes 'Unlikable' GOP Hopeful's 'Bedwetting.'"

At first glance, these stories seem unrelated. One is about politics. The other is about child abuse.

In reality, both reflect the same false assumption: that bedwetting reflects a child's behavior or emotional state rather than an underlying medical condition the child can't control. This bedwetting myth has persisted for generations.

For years, I've collected news stories about children shamed, beaten, “jailed,” even killed, for having chronic wetting or poop accidents. I've also tracked the casual use of "bedwetting" in political commentary, where it's routinely used as jokey shorthand for anxiety or overreaction.

Reading both types of stories in the same week reminded me that our culture still fundamentally misunderstands the causes of bedwetting. And this misunderstanding has real consequences.

READ: Why Threats and Bribes Won't Stop Bedwetting (And What Will)

The thing is, parents absorb society’s messages, often without realizing it. When bedwetting is widely portrayed as something children can control or a sign of emotional distress, it's easy to assume that kids who wet the bed simply need to try harder, “behave better,” or work through an underlying emotional issue.

Bedwetting is a physiological, not a psychological, condition. In almost all cases, it’s caused by chronic constipation; the enlarged, stool-clogged rectum aggravates the bladder nerves. In rare cases, wetting is caused by congenital neurological conditions such as tethered cord syndrome or spina bifida. Encopresis is always caused by chronic constipation.

Yet our culture can’t shake the idea that children could control accidents if they really wanted to.

Obviously, most children with enuresis or encopresis aren’t abused. But even the most patient and conscientious parents—folks who would never come close to harming a child—can become exasperated when they mistakenly believe their child's accidents are voluntary or emotionally driven.

That misunderstanding often leaves children feeling ashamed and responsible for something they cannot control. In response, many children become withdrawn or anxious or behave in ways that confound their parents.

But parents—even some doctors—get this backwards: It’s not that anxiety causes bedwetting; it’s that bedwetting causes anxiety.

READ: Enuresis and Encopresis Are Not “Mental Disorders.” Let’s Remove Them from the DSM-5.

When families believe the problem is behavioral or emotional, they naturally pursue behavioral or emotional solutions—sticker charts, rewards, counseling, or simply waiting for the child to mature.

But, of course, a clogged rectum will not response to art therapy or the promise of extra screen time.

If your child struggles with enuresis or encopresis, don't let society's misconceptions become your own.

In my practice, an evaluation for enuresis begins with a simple abdominal x-ray. (No x-ray is needed for encopresis, since constipation is always the cause.)

In the rare case that a child with bedwetting or daytime wetting turns out to have an empty rectum, we pursue other testing.

The good news is that enuresis and encopresis are highly treatable. If you're looking for a step-by-step guide to diagnosis and treatment, you'll find that roadmap in the M.O.P. Anthology.

The sooner families understand what's really causing the accidents, the sooner children can stop blaming themselves for something they never had the ability to control.

Every child deserves to hear this message: Bedwetting and accidents aren't your fault.