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  • By Steve Hodges, M.D.

Don't Be Afraid to Give Your Child an Enema

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When I first realized that bedwetting and toileting accidents are almost always caused by a poop-stuffed rectum, I started giving MiraLAX out like crazy. I was on a mission to defeat pediatric potty problems, and I had just the tool to do it.

Years later I can say that while I think MiraLAX is an OK way to clean out a child’s colon, I don’t love it anymore.

I love enemas.

For reasons we detail in It’s No Accident, MiraLAX often doesn’t do the job. Here’s what I’ve learned from treating thousands of children and reading their X-rays: Enemas are the single best way to empty out the rectum and keep it empty.

Yet parents hate them.

When I prescribe enemas to help a child who wets the bed or has daytime accidents or recurrent urinary tract infections, I often get a two-word response from Mom or Dad: “No way.”

I find this frustrating because it suggests that folks still don’t see toileting problems as real medical problems. I can tell you this: If enemas were found to fix any other pediatric medical condition, like asthma or a peanut allergy, parents wouldn’t refuse to use them.

Here are the anti-enema arguments I hear most frequently from parents, along with my responses.

Argument #1: “But my child will never allow it.”

I’m a firm believer that the cure should never be worse than the disease, but if children suffer with chronic bedwetting, encopresis or infections, at some point you have to take charge and say, “So here’s what we’re going to do.”

You may not get as much resistance as you expect. Children are more embarrassed by toileting problems than many parents realize and often gladly cooperate with a treatment, however not-fun it may be, that will fix their problem. I’ve had countless parents report that their child actually said, “Thank you, that wasn’t so bad, and I’m so happy I’m not wet anymore!”

Our children’s book, Bedwetting and Accidents Aren’t Your Fault, has a pretty darned brilliant and unthreatening illustration of the enema process. If you are considering enemas, I highly recommend reading the book with your child.

Argument #2: “But my child will become addicted.”

Untrue! This is addressed in our book in detail, but briefly: If the rectum is stretched out and empties poorly, chronic enemas will help it shrink back to size. There is no downside. Only if you continued to use enemas in the presence of normal bowel function (Lord knows why anyone would) could you cause dependency.

Argument #3: “The enemas will disrupt my child’s electrolytes.”

Doctors often propagate this myth, but I can assure you they are unfounded. Yes, Fleet enemas contain phosphorous, an electrolyte that gets absorbed into the body. But if you use no more than one enema a day (the most we prescribe), the increase is negligible.

The regimen we use for enema therapy has been used in countless children for decades. If children have normal renal function (and virtually all do), they will simply pee out the extra electrolytes. If your child doesn’t have normal renal function, talk to a doctor first. If your child’s renal function is normal but you can’t help but worry, you could always use saline enemas, but they are a bit less effective.

Enemas are safe even for young children. For example, a review of 39 studies that looked at complications from phosphate enemas over 50 years — from 1957 through 2007 — found a total of 15 cases of electrolyte imbalance in children ages 3 through 18. Over 50 years.

So there you go: You have no reason not to use enemas. In my experience, all the toileting problems we cover in our book are solved with this simple tool.

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Must-read books for kids by Steve Hodges, M.D.

• Bedwetting and Accidents Aren't Your Fault

• Jane and the Giant Poop