© 2013 - 2021 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 that kids require counseling -- talking therapy -- in order to break the "habit?"
Or how about the idea that wetting the bed is a sign of psychopathology?
If you know a child who wets the bed, pass the message along. The following claims about wetting the bed (also known as "nocturnal enuresis") have been debunked.
Myth: Wetting the bed is an unusual problem
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 by 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.
These children may have more difficulty awakening at night in response to the signal of a full bladder (Nevéus 2017).
In addition, their bodies may produce less vasopressin, a hormone that suppresses the production of urine (Doscche et al 2016).
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 a sign that your child is psychologically disturbed, or predisposed to violence
Reality: It's true that bedwetting is sometimes associated with stress. And kids with certain behavior problems are more likely to experience bedwetting.
But does a child's failure to awaken before urinating indicate that he or she is psychologically disturbed? No.
This false claim might have originated with Sigmund 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 past the age of 5, 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, occurring together, indicate that a child is under substantial stress. And severe childhood stress makes kids more likely to become violent criminals.
Does it sound plausible? Maybe. But the evidence isn't supportive.
Yes, there is a link between bedwetting and attention deficit hyperactivity disorder (ADHD). Children who have been diagnosed with ADHD are more likely to experience bedwetting (Mahjani et al 2021).
In addition, there is evidence supporting the idea that bedwetters are more likely than non-bedwetters to suffer from disruptive behavior disorders (Niemczyk et al 2015; Park et al 2013.).
But most children who experience bedwetting don't have these behavior problems.
And it doesn't appear that these kids are at higher risk for serious emotional problems, like depression or clinical anxiety (Wille and Anveden 1995; Shreeham et al 2009; Sureshkumar et al 2009).
Mostly what I've found are studies indicating that children suffer from lower self-esteem, which makes sense, given the social stigma associating with wetting the bed (Wille and Anveden 1995; Longstaffe et al 2000; Shreeham et al 2009; Sureshkumar et al 2009; Phung et al 2015).
The bottom line?
Modern psychologists have rejected the hypothesis that wetting the bed is a red flag for future violent behavior.
As forensic psychologists note, "bedwetting is neither violent nor voluntary" and there is "little or no empirical support" linking it with psychological maladjustment (Parfitt and Alleyne 2018).
Myth: There's no point trying to cure bedwetting if a child is depressed or anxious. You need to 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 be trained to "hold it in."
Reality: It might seem 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, based on the studies I've found, it's not clear if this approach makes much difference. In 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 of it.
Reality: In many cases -- especially in cases where kids have no other symptoms -- kids do usually grow out of it (Jain and Bhatt 2016). But these children may nevertheless benefit from therapies. And other children may have problems that require intervention.
Sometimes bedwetting is related to treatable medical conditions, like constipation, urinary tract infections, allergies, sleep-disordered breathing (snoring) and sleep apnea (Hsiao et al 2020; Lin et al 2013; Kaya et al 2018; Sun et al 2019; Nevéus et al 2020).
So if your child is wetting bed, it's wise to consult with your doctor and have your child 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 about bedwetting in children
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.
Copyright © 2006-2021 by Gwen Dewar, Ph.D.; all rights reserved.
For educational purposes only. If you suspect you have a medical problem, please see a physician.
References: Debunking bedwetting myths
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.
Dossche L, Walle JV, Van Herzeele C. 2016. The pathophysiology of monosymptomatic nocturnal enuresis with special emphasis on the circadian rhythm of renal physiology. Eur J Pediatr. 175(6):747-54.
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.
Hsiao YC, Wang JH, Chang CL, Hsieh CJ, Chen MC. 2020. Association between constipation and childhood nocturnal enuresis in Taiwan: a population-based matched case-control study. BMC Pediatr.20(1):35.
Jain S and Girish Chandra Bhatt GC. 2016. Advances in the management of primary monosymptomatic nocturnal enuresis in children. Paediatr Int Child Health. 36(1):7-14.
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.
Kaya KS, Türk B, Erol ZN, Akova P, Coşkun BU. 2018. Pre- and post-operative evaluation of the frequency of nocturnal enuresis and Modified Pediatric Epworth Scale in pediatric obstructive sleep apnea patients. Int J Pediatr Otorhinolaryngol. 105:36-39.
Lin SY, Melvin TA, Boss EF, Ishman SL. 2013. The association between allergic rhinitis and sleep-disordered breathing in children: a systematic review. Int Forum Allergy Rhinol. 3(6):504-9.
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.
Parfitt CH and Alleyne E. 2020. Not the Sum of Its Parts: A Critical Review of the MacDonald Triad. Trauma Violence Abuse 21(2):300-310.
Mahjani B, Koskela LR, Mahjani CG, Janecka M, Batuure A, Hultman CM, Reichenberg A, Buxbaum JD, Akre O, Grice DE. 2021. Systematic review and meta-analysis: relationships between attention-deficit/hyperactivity disorder and urinary symptoms in children. Eur Child Adolesc Psychiatry. 2021 Feb 26. doi: 10.1007/s00787-021-01736-3. Online ahead of print.
Nevéus T. 2017. Pathogenesis of enuresis: Towards a new understanding. Int J Urol. 24(3):174-182.
Nevéus T, Fonseca E, Franco I, Kawauchi A, Kovacevic L, Nieuwhof-Leppink A, Raes A, Tekgül S, Yang SS, Rittig S. 2020. Management and treatment of nocturnal enuresis-an updated standardization document from the International Children's Continence Society. J Pediatr Urol. 16(1):10-19.
Niemczyk J, Equit M, Braun-Bither K, Klein AM, von Gontard A. 2015. Prevalence of incontinence, attention deficit/hyperactivity disorder and oppositional defiant disorder in preschool children. Eur Child Adolesc Psychiatry. 24(7):837-43.
Parfitt CH and Alleyne E. 2020. Not the Sum of Its Parts: A Critical Review of the MacDonald Triad. Trauma Violence Abuse 21(2):300-310.
Park S, Kim BN, Kim JW, Hong SB, Shin MS, Yoo HJ, Cho SC. 2013. Nocturnal enuresis is associated with attention deficit hyperactivity disorder and conduct problems. Psychiatry Investig. 10(3):253-8.
Phung P, Kelsberg G, Safranek S. 2015. Clinical Inquiry: Does primary nocturnal enuresis affect childrens' self-esteem? J Fam Pract. 64(4):250-9.
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.
Su MS, Xu L, Pan WF, Li CC. 2019. Current perspectives on the correlation of nocturnal enuresis with obstructive sleep apnea in children. World J Pediatr. 15(2):109-116.
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 4/2021
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