By Steve Hodges, M.D.
I’m kind of obsessed with “buried treasure found in cave” stories. You know: a lost wallet turns up six decades later. Or twins separated at birth find each other after 78 years. Or scientists discover a tropical bat species last seen in 1890 and presumed extinct.
To recap briefly (and to shortchange an awesome story): While performing surgery on a 6-year-old girl, Dr. Hodges found a grapefruit-sized lump of stool in her rectum that, despite all the usual tests, had gone undetected. Putting two and two together, Dr. Hodges realized virtually all cases of bedwetting, accidents, and recurrent UTIs are caused by constipation. He immediately declared himself a genius, at least to his wife.
Only when Dr. Hodges went digging in the medical library did he find his “discovery” had already been discovered — 30 years earlier by Dr. O’Regan, a pediatric nephrologist practicing in Canada.
Dr. O’Regan’s research, inspired by his own son’s bedwetting and conducted at hundreds of children at a Montreal hospital in the 1980s, proved Dr. Hodges’ theory conclusively. In addition, his studies found that clearing the rectum with nightly enemas resolved these problems in dramatic fashion, by allowing the rectum to shrink back to size.
In awe of his research, Dr. Hodges tracked down Dr. O’Regan, who had moved to Arizona and switched to treating adults. In 2011 we both interviewed him. Dr. O’Regan told us that at the time of his discovery, he felt pleased he could help so many children who’d been blamed by their parents and shrugged off by their doctors.
“These kids were told that it was all in their heads, that they were psychologically disturbed,” Dr. O’Regan recalled. “When you find something new that actually works, that makes a difference, it’s quite spectacular.”
Alas, as we trace in our book, Dr. O’Regan’s research went ignored, and when we interviewed him, he expressed skepticism that our book would have any impact among doctors. He said, essentially: Good luck with that!
Well, I am pleased to report that the value of Dr. Hodges’ lucky find is finally getting recognized.
Exhibit A: Dr. James Sander, a pediatric urologist in Texas’ Rio Grande Valley.
Dr. Sander, who completed his medical studies, residency, and fellowship at Baylor College of Medicine, began practicing as a pediatric urologist in 2014.
Like Dr. Hodges a decade earlier, he dreaded working with bedwetting patients because the standard treatments — medication and bedwetting alarms, maybe some of Miralax — were so ineffective.
“I used to think: What am I going to do? It was obvious that what we were doing wasn’t working.”
By chance, through a former resident of Dr. Hodges’, Dr. Sander learned of Dr. O’Regan’s research. Intrigued, he started ordering KUB X-rays (short for for kidney, ureter, and bladder) of his patients.
“When I saw how much their rectums were distended, I realized enemas were the only thing that would make a difference,” Dr. Sander says. “As soon as I started trying Dr. O’Regan’s protocol, I found it worked radically better than anything I’d been doing.”
But he encountered a problem: pushback from pharmacists and pediatricians. Pharmacists would call him to question his prescription of 30 enemas. Pediatricians were telling patients to stop the nightly enemas.
Eager to get his local medical community on board, Dr. Sander set up a presentation at his hospital, Doctors Hospital at Renaissance. Twenty pediatricians came.
“The idea was to educate them so they could understand my recommendations were coming from a place of evidence,” Dr. Sander says.
At the talk, he presented Dr. O’Regan’s studies and his own results, including dramatic before-and-after X-rays of four patients. He also showed the group our books, It’s No Accident and Bedwetting and Accidents Aren’t Your Fault, and handed out our infographics and our guide to M.O.P. (the Modified O’Regan Protocol).
Dr. Sander reports that his audience was generally receptive, though he did encounter some skepticism.
One doctor questioned the use of X-rays, suggesting that pretty much any child will appear to have stool in his colon.
“I said, ‘Yes, but I can often measure the rectum is 6 or 7 centimeters wide, and that is in no way normal. A normal rectum does not store stool and therefore will not be enlarged on a KUB.”
A few doctors questioned the regimen’s safety, wondering whether daily enemas for a month could result in dehydration or an electrolyte imbalance. Dr. Sander pointed to the research cited in the safety section of our packet, How To Give a Child an Enema in Five Easy Steps: A Reluctant Parent's Guide to the Modified O'Regan Protocol.
Another physician asked him the question we hear most often: “Don’t you think this is just too aggressive?” Dr. Sander responded the way we do:
“I guess this is aggressive, but when you factor in what the family goes through — school issues, sleepovers, doing laundry all the time, waking up in the middle of the night, buying new mattresses — the level of aggressiveness corresponds to how big an issue this is.”
What about Dr. Sanders’ patients?
Naturally, he says, kids are not excited about daily enemas, and their parents are downright shocked by the prospect. But, he says, he keeps an enema around the office and seeing it makes his patients less fearful. “They’re usually expecting it to be bigger than it really is.”
As for the skeptical parents, he tells them: “Just try it for a month and give me a chance. Nothing else is going to get your child better.”
When presenting M.O.P. to families, Dr. Sander says, what helps the most is the confidence he now has in offering a treatment that works. “This protocol takes all the stress and frustration out of treating these patients. I know my confidence rubs off on the parents.”
Dr. Sander, of course, isn’t the only doctor who has taken Dr. O’Regan’s research to heart. We are in contact with many others and even get emails from parents who say, “Our doctor told us about Dr. O’Regan’s studies.”
But we’ve highlighted Dr. Sander because he’s the first physician we know of who has formally presented Dr. O’Regan’s studies to other doctors.
When I interviewed Dr. O’Regan in 2011, I asked if he was surprised that his studies had been unearthed after so many years. He said he was not. “It’s the rediscovery law of medicine: Things are often lost and recovered again.”
We hope one day M.O.P. will replace medication and bedwetting alarms as the standard therapy for bedwetting and accidents. Families dealing with the stress, exhaustion, and embarrassment involved in toileting problems deserve a treatment that actually works.
In the meantime, we’re pleased that contrary to Dr. O’Regan’s prediction, his long-forgotten studies are finally making an impact.