By Steve Hodges, M.D.
Nearly every parent who walks into my clinic asks: “All my friends' kids outgrew bedwetting, so why hasn’t mine?”
I also hear this question often in our private Facebook support group. For example, a mom wrote: If bedwetting is caused by constipation, why does it seem that some kids really do grow out of it? I've had so many people tell me that one day, their kid just started waking up dry. My 7-year-old wets the bed and has soiling problems, too, so we are fully on board with M.O.P. But my 5-year-old, who also wets the bed, has consistently soft poops and doesn’t appear to withhold. Would you really recommend doing M.O.P. for her as well? I have hope she will grow out of it, like my friends’ kids did.
I’ll answer her second question first: Yes, I do recommend the Modified O'Regan Protocol for a 5-year-old with enuresis who does not have the "traditional" signs of constipation. Remember that enuresis itself is a red flag for constipation. And many chronically constipated poop every day and have soft stool; the soft stuff just oozes past the hard mass that's clogging the rectum.
While it’s true that in most children, enuresis spontaneously resolves, many children aren't so lucky. I don’t believe it benefits a child with enuresis to wait and find out which scenario will play out.
With age, enuresis only becomes more challenging to treat. A rectum stretched for years, along with bladder nerves that have been stretched and aggravated for years — well, the situation is not easily reversed. And teenagers, understandably, can be highly resistant to the aggressive treatment needed to reverse course: M.O.P.x (one daily enema plus daily Ex-Lax) or Multi-M.O.P. (two liquid glycerin or docusate sodium enemas daily).
Recently several several parents of older teens posted in our private support group of their frustrations.
"My 18 yo boy is so resistant and pissed and hopeless," one mom wrote. "I am having trouble getting him to believe that anything will work. I sure wish I had not believed people when they said he would grow out of this, and I had pushed more to fix this when my son was more likely to cooperate."
Another mom commiserated: "I wish I had done something when he was much younger instead of listening to his pediatrician and assuming he would outgrow it. When I think about him and what he has to go through, I feel so incredibly down, sad and hopeless."
In truth, these situations are not hopeless. My teen patients do well with the more intense variations of M.O.P. and, in some cases, bladder medication followed by bladder Botox. But a teen's feelings of despair are indeed obstacles. Progress is inevitably slow, and I totally understand why a teen would feel like giving up.
That's why I so strongly urge parents and pediatricians to take bedwetting seriously when a child is 5. Treatment is a lot easier to deal with in kindergarten than in high school.
READ: Dear Bedwetting Teenagers: Your Condition is 1.) Common, 2.) Not Your Fault, and 3.) Totally Fixable
It is especially important to start treatment if a child wets the bed every night and/or has daytime accidents. The children most likely to outgrow accidents, research shows, are those who don’t wet every night and who also don't have daytime enuresis or encopresis.
However, this does not mean that a child who "only" has nighttime wetting is guaranteed to outgrow it. I have plenty of teen patients with nighttime wetting who never experienced daytime accidents. I would not delay treatment in a 5-year-old whose sole symptom is nighttime wetting.
Now for the first question: Why do some kids outgrow bedwetting but others don't?
For one thing, as children mature, their toileting habits mature. They become more comfortable pooping in public restrooms and overall less likely to delay pooping and therefore less prone to accidents. This was my own experience. Though I did not experience bedwetting as a child, I did experience painful pooping and the type of underwear poop smearing that today I recommend treating with M.O.P.
I avoided my school bathrooms at all costs and would often goes days without pooping. I never mentioned this to my parents and thought painful pooping was normal. I was lucky that I did not have a bladder that was sensitive to rectal stretching, because I'm sure I would have developed enuresis.
But then, at some point — I really don 't remember when — I got over my squeamishness and stopped overriding the urge to poop.
When a child has a bladder that's highly sensitive to rectal stretching, even a modest amount of stool build-up can trigger accidents. The reverse is also true: In some kids, even a modest improvement in chronic constipation can mean the difference between wet and dry nights.
It is never too late to treat a child for enuresis. But in my experience, families are much better off if they start treatment early rather than wait and hope that the child be among the lucky ones who spontaneously, and permanently, wake up dry.