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Dr. Hodges' approach to treating toileting problems is grounded in published research, including several studies conducted by pediatric nephrologist Sean O’Regan, M.D.

It was Dr. O'Regan who demonstrated that virtually all cases of enuresis, encopresis, and recurrent UTIs in children are caused by chronic stool withholding and that daily enemas resolves these problems.


Based on results in his clinic and his own published research, Dr. Hodges has modified Dr. O'Regan's regimen — hence the "Modified" O'Regan Protocol.

Dr. Hodges' research focuses not only the treatment of bedwetting and accidents but also a related question: Why are so many American children constipated? One answer suggested by his research: because they are toilet trained too early — at an age where they are prone to becoming chronic holders.

Dr. Hodges discusses his study, published in Research and Reports in Urology, that found children toilet trained as toddlers had triple the risk of developing daytime wetting later on.

Selected studies by Dr. Hodges:

Daily Enema Regimen Is Superior to Traditional Therapies for Nonneurogenic Pediatric Overactive Bladder

– Hodges SJ, Colaco M. Global Pediatric Health, 2016, 3: 1–4


The association of age of toilet training and dysfunctional voiding

– Hodges SJ, Richards KA1, Gorbachinsky I, Krane LS. Res Rep Urol., 2014 Oct 3;6:127-30.


Occult megarectum — a commonly unrecogized cause of enuresis.

– Hodges SJ, Anthony EY. Urology, 2012.


Altered perineal microbiome is associated with vulvovaginitis and urinary tract infection in preadolescent girls.

– Gorbachinsky I, Sherertz R, Russell G, Krane LS, Hodges SJ., Ther Adv Urol. 2014

Selected studies by Dr. O'Regan:

Relevance of constipation to enuresis, urinary tract infection and reflux. A review.

– Yazbeck S, Schick E, O’Regan S., Eur Urol, 1987


Constipation, bladder instability, urinary tract infection syndrome.

– O’Regan S, Yazbeck S, Schick E., Clin Nephrol, 1985

Constipation a commonly unrecognized cause of enuresis.

– O'Regan S, Yazbeck S, Hamberger B, Schick E.,  Am J Dis Child, 1986

Constipation and the Urinary System

Pediatric Urology, 1997; part Five, Chapter 16, Third edition, edited by Barry O’Donnell and Stephen A Koff.

Sean O’Regan, Salem Yazbeck and Eric Schick, pp 197-199

After 16 years of managing urinary tract dysfunction in children, I would hypothesize that the number [of cases caused by constipation] is closer to 90-100%. Using a prevalence of 50% can cause gross under treatment.

– Angelique Champeau, director, Children's Continence Clinic at UCSF Benioff Children’s Hospital, in an editorial comment published in the Journal of Urology 

Angelique Champeau, director, Children's Continence Clinic at UCSF Benioff Children’s Hospital
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