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
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
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
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.
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.
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
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;
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
Wille S and Anveden I. 1995. Social and behavioural perspectives
in enuretics, former enuretics and non-enuretic controls. Acta Paediatr.
Content last modified 12/13