When you’re a dad, parenting questions often come up that you struggle to find an answer to. Since other parents are the worst and Google will send you down a rabbit hole of paralysing, paranoid terror, we’re here to help by putting those questions to the experts. This is “Basic Dad,” an advice column for dads who feel stupid about asking for basic advice.
The Very Basic Concern
I know this sounds wrong, but I’m pretty sure it’s not “normal” for my 14-year-old to suddenly start peeing his bed for no good reason. What I mean is, there’s no crazy new stress going on at home: There’s no divorce or recent deaths or anything like that. The internet tells me that my kid is either diabetic, sexually abused or a sexually-abused diabetic, and I’m pretty sure (I hope to God, at least) that he’s none of those things.
My worry aside, the worst part about this is seeing just how ashamed and embarrassed my son is. The last thing he wants is for anyone to find out about this, including a doctor. I’ve explained to him that we need to see someone to figure this issue out, but he just can’t bring himself to agree to it and it feels wrong to force him. This has been happening for a few months now, and while my son is convinced it’ll just go away on its own, I’m not so sure.
Basically: Why is my teen wetting the bed?
The Expert Advice
Steve Hodges, pediatric urologist and co-author of It’s No Accident: The way I usually explain this to patients is that I give them the three major purported causes of bedwetting, and then I follow that up by saying, “And here’s the real cause…”
The “real reason” we’ve found is that many kids wet the bed due to constipation. Now, that doesn’t mean not pooping every day. What it means is, not pooping when you’re supposed to. Like if a kid is embarrassed to go or he goes to a school that might have weird restrictions on using the bathroom.
See, holding their poop causes a stretching of the colon that can cause residual backup, which can cause bladder overactivity. The reason why this happens is because the nerves that go from the brain to the bladder come out of the bottom of the spinal cord. They go around the end of the colon and are very sensitive to stretching, and this stretching gives the bladder the sensation that they have to pee.
Now, that doesn’t mean that you can just give your kid a laxative and they’ll get better. When a kid is so backed up that they’re wetting the bed, this isn’t sufficient. You need to diagnose it, and aggressively treat it until their rectum is back to normal size.
Some doctors think if you poop every day, you can’t be constipated, but the only way to know for sure is with an X-ray. What we do is, when we have teenagers who come in who wet the bed, we give them an X-ray, and if the X-ray reveals that they’re backed up, we clean them out and they do a lot better.
My message isn’t to wait: Paediatricians often say that a kid will outgrow it and they treat it as a developmental issue, but we believe it’s medical. Even in the kids I’ve treated who had this issue due to abuse, they also had an underlying medical issue too. Any kid over four who is wetting the bed should be evaluated and treated, and I’d say a urologist is the place to go.
Charles Schaeffer, clinical psychologist and sleep specialist: After you’ve ruled out any biological issues, you should begin to consider if it might be a psychological issue. Bedwetting with teens usually signals overwhelming stress, trauma or anxiety that hasn’t been addressed. A lot of times, it may also be related to sexual trauma or abuse.
I believe that it’s best to bring the child to someone who specialises in treating anxiety or trauma. Some believe that this behaviour manifests itself this way because it’s regressive, which means someone is returning to a behaviour inappropriate for their age developmentally. People can regress when they’re under tremendous stress, and if a teen is bedwetting regularly, it’s something that’s worth bringing to a professional.
In particular, I recommend bringing them to a clinician trained in interpersonal therapy, cognitive behavioural therapy or eye movement desensitization and reprocessing. These approaches are the best at treating kids and adults with trauma and the anxiety surrounding that.
One thing I will say for the parent of a bedwetting teen, is to be gentle, open and kind toward your child during this difficult time. It’s already a scary situation, so they need your support. Being punitive adds shame on top of the fear, which may worsen the symptoms and add to the child’s feeling of being unsafe.
Veronica Acevedo, clinical social worker: For a teenager who is wetting the bed, I’ve found it’s often caused by one of three things. First, it could be a medical issue related to the urinary tract. Second, it may be regressive behaviour indicating a change in the child’s environment, such as a new baby brother or sister, divorce or a physical or psychological trauma. Or, it may be behaviour to gain attention.
For one teen I treated, his family had gone through years of relational discord that ended in divorce. During this tumult, the boy’s mother would allow him to sleep with her, thinking she was providing comfort. As the years continued, so did the sleeping arrangements, except now the child was growing into a young adult and sleeping with the parent was no longer acceptable. When the mother set boundaries, the child began consciously bedwetting as a means of getting back at his mom.
While we were unable to resolve this issue before the family terminated their treatment, I hope that they continued to discuss the issue in therapy with someone else, as I believe addressing these problems is the only way to resolve them.
Michelle, former bedwetter: At the age of 26, I awoke one morning to a California king-sized bed soaking wet in my own urine. I had no idea what to think except to slink out of bed and find a towel. I was lying next to my then boyfriend and in his very large, very expensive bed that I had just ruined. I was able to quietly walk to the bathroom and get a towel that I placed on the mattress. I was mortified, and all I could think about was how I was going to clean this up without him knowing? Realising I couldn’t hide it, I decided to tell him what had happened, and to my surprise, he was only concerned about me and not the bed. As the day progressed, I continued to wonder why now, at this age, did I wet the bed? I really had no idea.
Over the next few years, the behaviour would often reappear, and I started to worry something was wrong. I never went to a doctor and I wondered if it might be psychological, as I wasn’t in a happy relationship at the time. But I brushed off the thought and ignored the issue. Several years later, at age 32, it started again. At this time, I’d gone through a big change by moving away from home to attend graduate school.
Despite my embarrassment, I decided to see a therapist to find out what was going on. Going to therapy allowed me a safe place to recount some childhood trauma and abandonment issues that I’d never dealt with earlier. Through therapy, I was able to start to process the complex and lasting impact these events had on me. Over time, as I dealt with my issues and my personal life settled down, I found that the bedwetting went away.