A medical practice is just that: a practice. We doctors don’t have all the answers, and it is only through research and experience with patients that we are able to keep improving treatments until we figure out what works.
And what works for one patient may not work for another. So we keep tinkering.
I’ve been tinkering with treatments for bedwetting and accidents for about a decade, and I’ve settled on a regimen that fixes these problems in most children.
I call it the Modified O’Regan Protocol — or M.O.P. You can find all the details in The M.O.P. Book and download a free summary of the guidelines on our Downloads page.
How M.O.P. Got Its Name
Dr. O’Regan, as you may know from It’s No Accident, is the genius pediatric nephrologist (now retired) who, while hunting for a solution to his own son’s bedwetting back in the 1980s, made a groundbreaking discovery: Childhood toileting problems are caused by chronic and severe constipation.
It was also Dr. O’Regan who discovered that a three-month enema protocol will fix most cases of dysfunctional elimination by allowing the rectum to shrink back to size and regain its tone and sensation. His studies found the protocol successful for resolving bedwetting, pee accidents, poop accidents, and recurrent urinary tract infections.
All of Dr. O’Regan’s studies, conducted at a Montreal hospital, involved the same regimen: nightly enemas for one month, followed by enemas every other night for a month and enemas twice a week for a third month.
Depending on the condition and the study, Dr. O’Regan had long-term success rates of 80 to 95 percent.
I’ve been prescribing Dr. O’Regan’s protocol for over five years now, and I, too, have found tremendous success with it. But I’ve always been troubled by the small percentage of children who don’t achieve dryness with the regimen.
What could I offer them?
The answer I’ve settled on: daily enemas for a longer period before tapering.
In virtually all cases, even my patients who don’t completely succeed on the O’Regan protocol improve to some degree. This tells me we’re on the right track. Some of these children just need more aggressive treatment and more time for their rectums to heal.
And so, I have modified Dr. O’Regan’s protocol in one regard: I recommend daily enemas not just for 30 days — but for as long as it takes to resolve the enuresis (wetting), encopresis (poop accidents), or recurrent UTIs.
Only when a child has completed the 30 days of enemas and achieved dryness for five nights do I recommend tapering to every other night.
In other words, if your child is dry starting on day 25, finish out the 30 days and then taper to every other day. If your child is not dry by day 30, keep going.
Some children relapse after 30 days of enemas, in which case I recommend returning the daily routine until dryness is achieved for at least 5 days. (I know — not fun!) Some children simply need 60 to 90 days of consecutive enemas to achieve total dryness.
Yes, this sounds a bit nuts. Your pediatrician’s eyes might bug out upon hearing about M.O.P., but do not accept "That's too extreme" or "That's crazy" or "That's harmful." Instead, read "5 Ways to Disagree with Your Doctor About Bedwetting Treatment."
I have found no adverse effects from M.O.P. — there is simply no harm in following this program. And as I explain in The M.O.P. Book, you need not worry that your child will become dependent on enemas to poop.
I can say with certainty that M.O.P. is more effective than MiraLAX at resolving toileting problems for good. M.O.P. also blows away bedwetting medication and bedwetting alarms, neither of which even address the root cause of bedwetting and accidents.
So far, virtually all my patients and (based on emails and posts) the children of our Facebook and blog followers have succeeded with the extended regimen.
But there are always outliers — those tough cases who follow exactly what I recommend and simply don’t get results. I always feel terrible when that happens, especially because these families typically have suffered the longest.
However, there is always more we can do. With the rare child who has not seen progress with M.O.P., we start using large-volume enemas, sometimes containing stimulants. I have a few other tricks up my sleeve as well. The toughest cases may need a special pump, such as the Peristeen pump, designed to empty the colon.
Eventually, these kids succeed, though it can take a long time.
The bottom line: for toileting problems to resolve, you need to get the colon empty by hook or by crook. You also need to keep it empty. No matter how much a child poops, you can never assume her colon is empty until you have proven so by X-ray or the child’s problems resolve.
Parents are always shocked when their child has been doing enemas for weeks, even months, and they are still not empty. But this is not uncommon.
“Enemas? My Child Would Run for the Hills!”
Even if you are sold on the idea of M.O.P., or are at least willing to give it a try, you may feel certain that your child will not agree to having liquid squirted up his bottom.
As a parent, I understand your concern! But as doctor, I also know most kids will come around if approached in a way that respects their intelligence and feelings — and perhaps includes a dash of humor. "11 Ways to Ease Your Child's Fear of Enemas" includes some terrific, parent-tested strategies, most of them suggested by members of our Facebook support group.
Since the publication of our first enema guide, we have heard from more than 200 parents who have used our protocol with their children. Many of these parents struggled to get their children on board; others found far less resistance than they expected — or none at all.
As one mom wrote: “After the first enema, my son told me how his belly felt better than it ever had. He is happy to do this daily — shocking from a kid who won't take Tylenol without a fight. After a week and unprompted, he told me how great it feels to get all the poop out of his body. I had no idea he was even constipated, as he poops daily.”
In The M.O.P. Book you will find
•detailed information about how and why enemas work
•advice on purchasing enemas
•a discussion on enema safety
•details on administering enemas to a child
•tips for getting your doctor on board
And much more! Check out the complete table of contents for The M.O.P. Book.
As always, I welcome your feedback!