By Steve Hodges, M.D.
With school starting up again, the British tabloids have gone whole hog on bedwetting:
“Back to school anxiety linked to increased bedwetting in children, study finds,” the Daily Star declared.
“Half of parents say their children’s bedwetting gets worse within the first week of going back to school,” announced The Sun.
“Four in ten kids who wet bed more likely to suffer in first week of school,” blared the Mirror.
All three stories stem from a disconcerting campaign by Pampers to market its Ninjamas Pyjamas Pants.
The campaign deploys manufactured “data” to normalize nocturnal enuresis, aka bedwetting, by perpetuating the myth that emotional stress, such as back-to-school anxiety, can cause this condition. (Spoiler alert: Enuresis causes anxiety, not the reverse. Enuresis is actually caused by chronic constipation.)
The Ninjamas campaign aims to reassure families that activities to ease school-related stress, offered in a free “Confidence Building Journal,” can help resolve the problem.
In the meantime, parents and children alike are to feel comforted that Ninjamas Pyjamas Pants (which offer “100% all-night leak protection or your money back”) will keep sheets dry.
This Pampers product may indeed offer excellent leak protection — I have no idea. But I do know this campaign will steer parents away from seeking appropriate treatment for their children’s enuresis and the underlying constipation. So, kids will lose out.
Let untreated, nocturnal enuresis can linger for years, even into adulthood. I have a hefty caseload of teenage patients, all of whom were assured they would outgrow accidents. So Pampers’ campaign, while intended to ease children’s anxiety, may actually contribute to their stress by prolonging their bedwetting.
READ: Dear Bedwetting Teenagers: Your Condition is 1.) Common, 2.) Not Your Fault, and 3.) Totally Fixable
Let’s take a closer look at the “study” trumpeted by the British press, which is actually a poll of 1,000 parents that Pampers paid a PR firm to conduct.
On its website, the publicity firm touts its capacity to “power your PR with data-led storytelling” and “generate attention-grabbing headlines.” (No doubt, the firm delivers!)
Now, it’s unfortunate when earnest academics use flawed methodology to conclude that emotional stress is a predictor of bedwetting. (Case in point: a recent Ethiopian study published in a medical journal.) But it’s worse when huge companies gin up “data” to generate splashy headlines that transmit this myth to the general public.
Also regrettable: media acceptance of this bunk. No reporter sought comment from any source not paid by Pampers, and the articles use terms such as “confirms,” “reveals,” and “reports,” as if the statistics were generated by rigorous research.
In reality, no legitimate studies show emotional stress causes bedwetting. By contrast, careful research demonstrates the root cause of most enuresis is an enlarged, stool-clogged rectum — in other words, chronic constipation. The stretched rectum aggravates the nearby bladder nerves, triggering random and forceful bladder contractions, day or night. Without warning, the bladder suddenly empties.
Research, along with my two decades of medical practice, also shows that when you clean out the rectum and give it time to shrink back to normal size, the bladder stops spasming, and accidents cease.
A regimen of enemas and laxatives will achieve this. Breathing exercises, hugs, and coloring activities won’t. Yet the Ninjamas campaign makes no mention of constipation, instead drawing a direct line from school-related anxiety to bedwetting.
Pampers has paid a pediatrician, Dr. Ranj, to underscore this purported connection: “When your child is nervous or overly excited it can cause feelings of stress which can result in bedwetting, Dr. Ranj is quoted as saying in The Sun. “Therefore, helping to manage these feelings will help to prevent a possible cycle of bedwetting.”
The word “therefore” does some heavy lifting in that sentence!
It’s flat-out irresponsible to say that stress “can result in bedwetting” or that managing stress can help prevent accidents.
However, I’m not saying the school environment plays no role in daytime or nighttime enuresis — quite the contrary.
School restroom policies, unclean bathrooms, bullying, and other school related factors certainly can contribute to a student’s constipation and therefore exacerbate enuresis.
For example, students are often prohibited from using the restroom during class time or are incentivized by prizes to avoid doing so. Many children are intimidated or grossed out by school restrooms or fear that using the toilet during class time will displease their teacher.
For plenty of reasons, children avoid pooping at school, so even more stool accumulates in the rectum, further compromising rectal tone and sensation. In addition, many students avoid or delay peeing during the school day, a practice that can further aggravate an overactive bladder.
It’s not uncommon for enuresis (or encopresis, chronic poop accidents) to develop or worsen at school, especially in kindergarten, when students may receive fewer reminders to use the toilet than they did in preschool or at home or may, for the first time, be required to walk down a hallway to the restroom.
Back during the covid pandemic lockdowns, many of my patients reported improvements in daytime and nighttime wetting. Without all the school-related barriers, they used the toilet more and could more easily manage their schedule of laxatives and enemas.
Pampers misunderstands the school-enuresis connection.
According to the Ninjamas survey, 64% of children “are worried about being separated from their parents and carers,” 55% “get anxious about following instructions from the teacher,” and 60% “get nervous spending time with children they are not familiar with.”
All that may be true (or not — the “data” is based on parents’ perceptions of their 4- to 7-year-olds, not interviews with children). However, there is no basis for suggesting school anxiety causes enuresis.
What concerns me is that Pampers is sending families down the wrong road.
The campaign urges parents to download the Ninjamas 21-day “Confidence Building Journal” designed by a child psychologist “to support children in feeling confident during the back-to-school transition and periods of bedwetting.”
Of course, I’m all for boosting children’s confidence at school. The exercises in this booklet seem terrific for helping kids feel secure at school. But suggesting that confidence will help resolve bedwetting is harmful in multiple ways.
What happens when families spend time completing 21 days of activities, and the child’s bedwetting persists? Will parents assume that their child still lacks confidence and needs additional help from a mental health counselor?
This happens so often that I wrote a free guide for therapists and school counselors explaining that emotional stress does not cause accidents but rather accidents cause emotional stress.
READ: Kids Shoulder Shame and Blame for Bedwetting and Accidents: How Therapists and Counselors Can Help
Pampers is confusing the anxiety that many 5-year-olds experience when heading off to school with the anxiety children experience due to enuresis and encopresis. Affirmations and hugs may ease the former; a regimen of suppositories and laxatives will ease the latter.
In my opinion, the “Confidence Building Journal” has the potential to leave children and parents alike feeling like failures. No amount of confidence at school will stop a child’s overactive bladder from spasming and emptying at 2 a.m.
Children with enuresis need treatment for the underlying constipation, not affirmations like “Mummy knows that my teacher will take good care of me.”
While super-absorbent pull-ups will help reduce a family’s laundry load and a child’s discomfort, Ninjamas are no substitute for the confidence that comes from resolving enuresis for good.
Countless parents have told me how their children’s confidence soared after accidents resolved. For example, one mom in our private Facebook support group told me that prior to treatment, her daughter was in a “very, very dark place.” With treatment, this mom posted:
She went from up to 10 soiling accidents a day to none. She had severe, debilitating abdominal pain daily. It’s gone. I would get called 3-4 times a week to fetch her from school. Haven’t gotten a call since starting. She had severe negative self-talk to the point where the doctors were wanting to start anti-psychotics. It is completely gone. She had severe anger outbursts. Gone
While most of the content in the “Confidence Building Journal” is innocuous, the guide includes erroneous information about the causes of bedwetting.
The guide posits that in addition to anxiety, three other scenarios can cause enuresis: an underdeveloped bladder (“your bladder is young”), a lack of connection between bladder and brain (“Your bladder needs to learn how to talk to your brain”), and sleep deprivation. “School can be a really tiring time, particularly at the beginning of term,” the journal states. “This can mean we go into such a deep sleep that our bodies don’t wake up in time for a wee-wee!”
All three explanations are false, as I explain in detail in the M.O.P. Anthology. Worse, all three send the message that medical treatment is unwarranted because that the child will inevitably outgrow the bedwetting.
Oddly, buried at the end of the “Confidence Building Journal” is a link to ERIC's Guide to Night Time Wetting. ERIC is a UK-based charity that assists families who are dealing with constipation, enuresis, and encopresis. As an organization, ERIC emphasizes the connection between constipation and enuresis.
In fact, the ERIC booklet that Ninjamas links to literally says: “Constipation can, in other words a bowel full of poop, can make your bladder misbehave” and “A full bowel can press against your bladder [and] . . . can make you have wee accidents,” daytime or nighttime.
It is a fact that Pampers’ campaign overlooks entirely, to the detriment of the families it is marketing to.
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