Bedwetting in scientific perspective: Debunking myths and misconceptions

© 2010 - 2013 Gwen Dewar, Ph.D., all rights reserved

Myths about bedwetting? There are several, and they aren't helpful.

Ever heard the claim that kids wet the bed out of laziness?

Or the idea that kids require counseling--talking therapy--in order to break the "habit?"

The worst may be the idea that wetting the bed--also known as nocturnal enuresis--is a sign of anti-social tendencies.

If you know a child who wets the bed, pass the message along. The following claims have been discredited by recent research.

Myth: Wetting the bed is unusual

Reality: As I note in my my evidence-based guide to bedwetting, up to 20% of five-year-olds have yet to achieve night-time dryness, and many school-age children suffer from the problem as well. Bedwetting in young children is common.

Myth: Wetting the bed is caused by laziness or a failure to pay attention to body signals

Reality: Bedwetting occurs during sleep, and research suggests that kids who wet the bed are physiologically different.

They may be harder to awaken at night. In addition, their bodies produce less vasopressin, a hormone that suppresses the production of urine. These traits may have a genetic basis, which would explain why nocturnal enuresis seems to run in families. For the details, see my guide to bedwetting.

Myth: Wetting the bed is sign of psychological maladjustment or antisocial tendencies

Reality: It’s true that bedwetting is sometimes associated with stress. But does a child's failure to awaken before urinating indicate that he is psychologically disturbed? No.

This false claim might originate with Freud, who thought urination was erotic and that wetting the bed was a frustrated sexual act.

Later, in the 1960s, psychiatrist J. M. Macdonald proposed that bedwetting, along with animal cruelty and arson, was a sign that a child was “at risk” for becoming a violent sociopath (MacDonald 1963).

MacDonald’s theory was that these three behaviors, when occurring together, indicate that a child is under substantial stress. And severe childhood stress makes kids more likely to become violent criminals.

But these theories aren’t supported by the data.

Research indicates that wetting the bed is usually caused by relatively benign medical conditions--like a tendency to sleep deeply or overproduce urine at night.

Today, researchers who study crime acknowledge that bedwetting is not linked with sociopathic behavior. And it’s not even clear that kids who wet the bed are particularly distressed by their condition.

Yes, studies indicate that kids suffer lower self-esteem (e.g., Collier et al 2002; Kanaheswari et al 2012). But a number of studies have reported that kids who wet the bed were not more likely to be distressed, depressed, anxious, or antisocial (Wille and Anveden 1995; Shreeham et al 2009; Sureshkumar et al 2009). And when kids have been successfully treated, their self-esteem improved (Longstaffe et al 2000).

Myth: There’s no point trying to cure bedwetting if a child is depressed or anxious. You must treat the psychological symptoms first.

Reality: Some kids who wet the bed are also distressed. But their psychological problems aren’t necessarily preventing them from getting dry, and successful treatment of their bed wetting symptoms may improve their psychological problems.

In a study of children suffering from both psychological problems and nocturnal enuresis, researchers successfully treated the bedwetting problem first (HiraSing et al 2009). Not only did most kids become dry, they also showed less psychological distress after treatment for bedwetting.

Myth: Kids should trained to “hold it in.”

Reality: It seems plausible. If kids practice “holding it in,” they might expand their bladder capacity. And a larger bladder capacity might permit kids to go longer at night without having to relieve themselves.

However, it’s not clear that this approach makes much difference. In a recent, controlled experiments, researchers randomly assigned some kids with nocturnal enuresis to practice “holding it in.” Although the treatment did increase the children’s bladder capacities, it wasn’t associated with substantial reductions in bedwetting (Van Hoeck et al 2008; Van Hoeck et al 2007).

Myth: Parents can ignore the problem. Kids will eventually grow out it.

Reality: Nocturnal enuresis is sometimes caused by medical conditions like constipation, urinary tract infections, obstructive sleep apnea, and diabetes. So if your child is wetting bed, it’s wise to have him screened for underlying medical problems. This is particularly important if your child has suddenly become incontinent after going for at least 6 months without wetting the bed.

More information

Interested in treatment options? Punishment is a bad approach. Offering rewards might be a poor option, too.

Your pediatrician might prescribe medication, but behavioral methods can be even more effective. For more information, check out the Parenting Science guide to the research about kids who wet the bed.



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References

Collier J, Butler RJ, Redsell SA, and Evans JH. 2002. An investigation of the impact of nocturnal enuresis on children's self-concept. Scand J Urol Nephrol. 36(3):204-8.

HiraSing RA, van Leerdam FJ, Bolk-Bennink LF, and Koot HM. 2002. Effect of dry bed training on behavioural problems in enuretic children. Acta Paediatr. 91(8):960-4.

Kanaheswari Y, Poulsaeman V and Chandran V. 2012. Self-esteem in 6- to 16-year-olds with monosymptomatic nocturnal enuresis. J Paediatr Child Health. 48(10):E178-82.

Longstaffe S, Moffatt ME, and Whalen JC. 2000. Behavioral and self-concept changes after six months of enuresis treatment: a randomized, controlled trial. Pediatrics. 105(4 Pt 2):935-40

Macdonald JM. 1963. The threat to kill. Am J Psychiatry 120:125-130.

Shreeram S, He JP, Kalaydjian A, Brothers S, and Merikangas KR. 2009. Prevalence of enuresis and its association with attention-deficit/hyperactivity disorder among U.S. children: results from a nationally representative study. J Am Acad Child Adolesc Psychiatry. 48(1):35-41.

Sureshkumar P, Jones M, Caldwell PH, Craig JC. 2009. Risk factors for nocturnal enuresis in school-age children. J Urol. 182(6):2893-9.

Van Hoeck KJ, Bael A, Lax H, Hirche H, Bernaerts K, Vandermaelen V, and van Gool JD. 2008. Improving the cure rate of alarm treatment for monosymptomatic nocturnal enuresis by increasing bladder capacity--a randomized controlled trial in children. J Urol. 179(3):1122-6; discussion 1126-7.

Van Hoeck KJ, Bael A, Van Dessel E, Van Renthergem D, Bernaerts K, Vandermaelen V, Lax H, Hirche H, and van Gool JD. 2007. Do holding exercises or antimuscarinics increase maximum voided volume in monosymptomatic nocturnal enuresis? A randomized controlled trial in children. J Urol. 178(5):2132-6.

Weatherby GA, Buller DM, and McGinnis, K. 2009. The Buller-McGinnis model of serial-homicidal behavior: An integrated approach, Journal of Criminology and Criminal Justice Research and Education, 3(1).

Wille S and Anveden I. 1995. Social and behavioural perspectives in enuretics, former enuretics and non-enuretic controls. Acta Paediatr. 84(1):37-40.

Content last modified 12/13