If there’s one word parents at my clinic don’t want to hear, it’s “enema.”
When I explain that enemas are the express route to solving bedwetting, pee and poop accidents, and UTIs — more effective than MiraLAX and Ex-Lax and infinitely better than fiber gummies (which don’t work at all) — I get three responses:
1.) But aren’t enemas dangerous for a child?
2.) But can’t we try MiraLAX first?
3.) But my kid will never allow enemas!
Here are the short answers:
1.) No, enemas are not dangerous — as long as you limit them to once daily and your child is otherwise healthy.
2.) Sure, you can try MiraLAX first, but it won’t work as well and may not work at all.
3.) You’d be surprised; kids want the wetting to stop, and will generally do what it takes.
Parents are particularly horrified when I spell out the enema regimen that works best to unclog a rectum: nightly for a month, every other night for another month, and twice a week for a third month. (The regimen is called M.O.P., the Modified O'Regan Protocol, and I explain it in great detail in The M.O.P. Book.)
But you know which of my patients get better fastest? Those who follow this regimen!
Do you know which of my patients end up the happiest, freed from belly pain and the stress, embarrassment, and hassle of wetting their pants? Those who follow this regimen.
This is the protocol tested by Dr. Sean O’Regan, the Irish doc whose irrefutable published studies are the basis of It's No Accident, The M.O.P. Book, and basically my entire medical practice and mission in life.
How We Know Enemas Fix Toileting Problems
Many constipated children lose so much sensation in their stretched-out rectums that they cannot detect an air balloon the size of a tangerine.
Back in the 1980s, while I was watching “Back to the Future” with my 8th-grade buddies, Dr. O’Regan was making a breakthrough contribution to the scientific literature. He first tested this regimen on his 5-year-old son, who was wetting the bed multiple times a night. The child’s rectum was so stretched out from a rectal clog that the boy could not even detect the presence of a tangerine-sized air balloon in his bottom. (Want to find out for sure how stretched-out your child’s colon is? That’s the test to request! It’s called anorectal manometry.)
After one week of nightly enemas, the boy’s wetting diminished. After three months on the step-down regimen, the boy had stopped wetting the bed completely and Dr. O’Regan had stopped getting grief from his wife. Dr. O’Regan then tried the regimen with his own patients and had so much success he conducted formal studies.
In one investigation, Dr. O’Regan tracked 47 girls with recurrent UTIs and severe constipation and toileting problems. By the end of the regimen, 44 of the girls stopped having UTIs. Among the 21 patients with encopresis (poop accidents), 20 stopped having accidents. Of the 32 patients with enuresis (pee accidents), 22 stopped wetting. What about the girls who didn’t improve? Their parents admitted to not following the enema regimen fully.
Building on Dr. O'Regan's studies, colleagues and I at Wake Forest University conducted our own research on children with daytime accidents, comparing his regimen with the standard Miralax therapy so many doctors recommend. Our study, published in Global Pediatric Health, found that after three months, 85% of children with enuresis stopped wetting, compared to 30% who used Miralax and other traditional therapies. As I explain in The M.O.P. Book, I have slightly "modified" Dr. O'Regan's protocol — hence the "Modified" O'Regan Protocol — and get excellent results.
Yet pediatricians and pediatric urologists and GI docs tend to push back hard against enemas, claiming they are "traumatic" or "too aggressive." These are unfounded assumptions, as I explain in "5 Ways to Disagree With Your Doctor About Bedwetting Treatment."
How to Ensure Safety of Enemas in Children
Just this week a patient’s mom reported to me that three different pediatricians told her “no way” when she asked about giving enemas to her son. The boy is 13 years old and has wet the bed his entire life. (These are the same doctors who told her that her son would “outgrow” the bedwetting. Um, when?)
The most common safety concern is that phosphate enemas, the kind typically sold in pharmacies, will elevate certain electrolytes to dangerously high or dangerously low levels. Phosphate is used in enema solutions because it helps draw water into the colon, allowing you to use a much smaller volume of fluid than enemas than with enemas that use pure saline solutions. (Saline enemas are 100 percent safe but need to be administered in large volumes, from a height of two feet above the child, and require cumbersome tubing.)
Are concerns about the safety of phosphate enemas warranted?
Well, if you look hard enough in the medical literature, you will indeed find cases of electrolyte imbalances in children. 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.
In nearly every case, the child had kidney disease or another chronic disease, was severely dehydrated, received multiple enemas in one day, or retained the enema fluid in their bodies — or a combination of those factors. Retained enema fluid is extremely rare in healthy children; it almost always happens in children with chronic medical conditions.
In reality, phosphate solution spends very little time in the colon and thus has little influence on the body’s electrolyte levels.
Here’s how to follow Dr. O’Regan’s protocol safely:
1.) Never perform enemas on a child with kidney disease.
2.) If your child has another chronic disease, seek the guidance of your physician before performing enemas.
3.) Never do more than one enema a day.
4.) Make sure your child empties after the enema is given. If the child doesn’t, just wait; it’ll happen. If, somehow, the child does not poop, DO NOT administer another enema until you’ve run it by your pediatrician. A child who’s that clogged up can have a serious issue going on.
Why Miralax Doesn’t Always Work
One reason Dr. O’Regan’s original protocol involved enemas instead of Miralax is simple: Miralax didn’t exist back then. It was not approved by the FDA until 1999. But even when it did become an option, Dr. O’Regan continued to recommend enemas because they work better.
The fact is, “new” does not always mean “improved.” Remember the New Coke debacle? OK, terrible analogy. For the record, I am not in favor of soda of any kind. But you get the idea.
Sure, it’s much easier to hand a child a glass of water mixed with a powder than it is to insert a tube up his bottom. No argument there!
But MiraLAX often does not fully clean out the child’s rectum. So, the rectum may never shrink back to normal size, regain the tone necessary to fully evacuate, or regain the sensation necessary to signal to the child that it’s time to poop.
Don’t Project Your Fear of Enemas Onto Your Child
Dr. O’Regan’s son would read Winnie the Pooh while waiting for the enemas to work. Most parents I work with assume their child will absolutely refuse enemas. But often they are, pardon the pun, pulling this assumption out of their own bottoms!
In my experience, when you explain to a child, even to a teenager, that this regimen is the ticket to dryness, they are plenty willing to give it a try. It’s typically when parents convey squeamishness or fear that kids pick up on it and become reluctant themselves.
Our children’s book, Bedwetting and Accidents Aren’t Your Fault, is a great place to start the enema discussion with your child. Read the book together, and I guarantee your child will not feel threatened. He or she will likely feel comforted in knowing that plenty of other kids get enemas and that they don’t hurt. Our blog post "11 Ways to Ease Your Child's Fear of Enemas" has some excellent, kid-tested suggestions recommended by the parents in our Facebook support group.
Dr. O’Regan recalled that prior to the regimen, his son was “a cranky kid.” But when he got cleaned out and stopped having bellyaches and wetting the bed, he became noticeably more cheerful. Says Dr. O’Regan: “Years later, he told me, ‘Dad, I thought bellyaches were normal.’”
Parents are often surprised when their children not only tolerate enemas but actually ask for them each night because they feel so better.
Dr. O’Regan noted that he and his colleagues devoted an immense amount of time to their research and that the one hundred or so children tracked for his studies were just a small fraction of the patients he successfully treated with the same methods. “When you find something new that actually works, that makes a difference, it’s quite spectacular.”
Nonetheless, within a decade of the publication of his studies, as I document in It’s No Accident, Dr. O’Regan’s research had been buried.
I continue on my mission to resurrect Dr. O’Regan’s protocol. I prescribe it every day in my clinic, and it works.