Myths about bedwetting: What the research really says© 2010 Gwen Dewar, Ph.D., all rights reserved
Myths about bedwetting? Maybe that word is a bit strong. But there are certainly entrenched folk beliefs and misconceptions about wetting the bed, and these may make it harder for families to cope. The worst of these myths may be the idea that wetting the bed--also known as nocturnal enuresis--is a sign of psychological maladjustment. Ever heard the claim that sociopaths are more likely to wet the bed? Or the idea that kids require counseling--talking therapy--in order to break the "habit?" If you know a child who wets the bed, keep in mind that the following claims have been discredited by recent research. Myth: Bedwetting is uncommonReality: As I note in my my evidence-based guide to wetting the bed, up to 20% of five-year-olds have yet to achieve night-time dryness. Bedwetting in young children is a normal.Myth: Bedwetting is caused by laziness or a failure to pay attention to body signalsReality: 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 vasopression, 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 tendenciesReality: It’s true that bedwetting is sometimes associated with stress. But does bedwetting indicate that a child is psychologically disturbed? No.This false claim might originate with Freud, who thought urination was erotic and that bed wetting as 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 bedwetting 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—which is surprising if you consider that some kids must doubtlessly feel embarrassed about their condition. A recent Australian study found that kids with “severe” nocturnal enuresis (meaning kids who virtually never have a dry night) were no more likely than other kids to have emotional stressors or social concerns (Sureshkumar et al 2009). Other studies have reported similar results--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). 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 in fact the causation might work the other way. Kids get upset because they wet the bed. Fix the bed wetting, and they feel better.In a study of children with psychological problems and nocturnal enuresis, researchers successfully treated the bed wetting 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 informationInterested 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. ReferencesHiraSing 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.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 5/10
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