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  • By Steve Hodges, M.D.

Resolving the Toughest Bedwetting Cases

I’ve spent the better part of five years advocating daily enemas as the most reliable and lasting way to resolve bedwetting, pee accidents, and poop accidents. The regimen I believe in — the Modified O’Regan Protocol (M.O.P.) — is based on the research of Sean O’Regan, M.D., and my own clinical experience. I’ve essentially staked my reputation on M.O.P.

Yet several times a week I receive emails saying: “M.O.P. isn’t working. Maybe constipation isn’t the reason for my child’s bedwetting. What now?”

I share these families’ frustration. A daily enema program is no small commitment for parents and children; to follow M.O.P. diligently and get no results is monumentally discouraging.

But here’s the thing: A stretched, stool-clogged rectum is almost always the cause of enuresis (daytime or nightime) or encopresis. A lack of progress on M.O.P does not change that fact.

What I am finding is that in about 5 percent of my clinic cases and 30 percent of families who correspond with me via my website, pediatric enemas simply aren’t up to the job. Lack of progress means it’s time for a more aggressive strategy.

I call this strategy M.O.P.+. It is described in great detail in The M.O.P. Book.

I know it seems impossible than a child could remain constipated after 30 consecutive days of enemas, but it happens, especially to children to have been severely constipated for several years.

M.O.P.+ involves “large-volume” enemas with a different type of solution (usually saline plus glycerin and/or castile soap) than is found in store-bought enemas. You can’t buy these larger enemas ready-made, the way you can with pediatric enemas, so following M.O.P.+ takes more work. The trade-off is that these enemas more effectively clean out a stubbornly mucked-up, stretched-out rectum, allowing the rectum the shrink back to size. Homemade enemas are also far less expensive than store-bought enemas; the solution costs virtually nothing, and you can reuse the equipment.

I know: “Large-volume” enemas sounds scary, like you’re going to be spraying a fire hose up your child’s bottom. But in reality, these enemas are gentle. They don’t cause discomfort to children, and my patients on this program tend to get on board quickly. They’re relieved to know there’s a next strategy to try.

Chapter 6 of The M.O.P. Book is for families who have tried M.O.P. but are either a) not seeing any progress or b) not seeing enough progress to justify continuing with daily store-bought enemas.

In this chapter, we cover:

•When to switch from M.O.P. to M.O.P.+

•Whether you need an X-ray before starting M.O.P.+

•Supplies needed for M.O.P.+

•How to administer a large-volume enema

•What to do if you're not seeing progress on M.O.P.+

M.O.P.+ is a process. If one solution doesn’t work, we offer another option. If that doesn’t work, we give you something else to try. Eventually you will hit on a formula that works. Be patient! Keep in mind that your child’s rectum didn’t get stretched overnight; it won’t shrink back to size overnight, either.

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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


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