By Steve Hodges, M.D.
Let’s say your child is learning to read. You expect she’ll be able to decode “cat” before she can read “flower” and well before she can work out “thorough,” right?
We all accept that learning to read is a process — one that happens in fits and starts and that each child experiences differently.
Well, resolving accidents is a process, too!
That’s just not how children’s physiology works.
I often hear: "Enemas didn't work for us," or “M.O.P. isn’t working. It’s been 30 days and my son is still wetting the bed.”
But when I probe further, I learn the child has no longer has stomachaches or rushes desperately to the bathroom and his daytime pee or poop accidents have diminished.
This is major progress!
With toileting problems, the early signs of progress can be subtle. These include:
•less frequent need to pee
•less urgency to pee
•fewer underwear skid marks
•improved sensation of the urge to poop
•more spontaneous pooping (other than after an enema)
After that, we tend to see more dramatic progress — and in the following order:
•Poop accidents diminish and then stop
•Daytime pee accidents diminish and then stop
•Bedwetting diminishes and then stops
Why does bedwetting typically clear up last? Because it takes less severe constipation to trigger bedwetting in the first place than it does to cause poop accidents or daytime pee accidents.
A child who has poop accidents is so severely clogged up that even small improvements can make a dramatic difference. But it takes a much more substantial reduction in constipation, and for a longer period of time, to resolve bedwetting.
Keep in mind that the rectum did not stretch out overnight; it won’t shrink back instantly, either. When the nerves feeding the bladder have been chronically irritated, it may take months for these nerves to settle down, even after the rectum is persistently clear.
I can’t guarantee your child’s toileting issues will resolve in the order listed above, nor can I provide you with a timeline.
But I can tell you that in my practice at Wake Forest Baptist Health, about 95 percent of bedwetting patients see significant progress within 30 days on M.O.P., and many completely resolve in the first month. (For children who present with poop and daytime accidents in addition to bedwetting, resolving the whole shebang takes much longer.)
As for daytime wetting, my published research shows that 85 percent of children on M.O.P. will have their daytime symptoms resolve completely within 90 days. (The remaining 15 percent need M.O.P.+, the large-volume enema protocol, described in detail in The M.O.P. Book.)
In my practice, almost all poop accidents completely resolve within a month.
However, I’ve noticed that the success rate among families who contact me via BedwettingAndAccidents.com seems to be considerably lower. Best I can tell, about 70 percent of children who wet the bed see progress within 30 days. The remainder need to move on to M.O.P.+.
Why the difference?
Probably because our website attracts the most difficult cases, whereas my practice includes a random sampling of children referred by pediatricians in Winston-Salem, North Carolina. The folks who find us via our website have searched for solutions for years and have “tried everything.” Or, they’ve simply tried waiting.
When a parent reports “no progress” after 30 days of diligently following M.O.P. — a frustrating prospect, for sure — usually this means one of three things:
1. The child has shown signs of progress that have gone unnoticed.
2. The child isn’t holding the enemas long enough.
3. The child needs to switch to large-volume enemas.
Because it can be hard to tell which of these applies to a given child, I recommend tracking your child’s M.O.P. experience in some detail. A plain old calendar or piece of paper, or you can use our M.O.P. tracker (available as part of our Do-It-Yourself package).
Each day I suggest recording the following:
•how many minutes your child held the enema (10 minutes is the goal)
•the child’s laxative dosage
•any developments relating to the subtle signs of improvement listed earlier (stomachache, urinary frequency, and so on)
6 Things You Can Learn From Tracking M.O.P.
Tracking these specifics will help notice patterns and decide on next steps. Here are 6 ways taking notes can help:
1. You can notice subtle signs of improvement. As I mentioned earlier, dry sheets aren’t the only measure of progress.
2. You can make sure the child is holding the enema long enough. It can take practice for a child to hold enemas for the recommended 10 minutes. Children who can only hold for 2 or 3 minutes may not be getting the full benefit of the enema.
3. You can use the results to adjust your child’s laxative dosage. Whether you’re using Miralax, a prescription laxative such as Lactulose, or something else, tracking your child’s daily dosage can help you make adjustments until you hit that sweet spot — poop that’s mushy but not runny.
4. You can make sure you’re following the protocol. Given our busy lives — with school, after-school activities, family time, homework, and so on — it can be tough to remember whether you did the enema and took Miralax every night. An occasional missed night won’t matter, but skipping enemas frequently may compromise your results.
5. You can see when it’s time to taper from nightly enemas. I recommend tapering from daily enemas only after a child has been accident-free, day and night, for 5 to 7 days. Some families, in their excitement to finish M.O.P., taper too soon, and the child relapses.
6. You can decide when to move on to a more aggressive protocol. For stubbornly constipated children, over-the-counter pediatric enemas may not do the job. These children may need enemas with more oomph, the way you need a more powerful spray to dislodge crusty food remnants from a dinner plate. They may also need a solution with stimulants, such as glycerin or castile soap.
Many parents think it’s impossible for a child’s rectum to remain clogged after 30 consecutive days of daily enemas. But it happens fairly often, and a X-ray can confirm it.
If you find yourself frustrated by your child’s slow progress, please keep in mind that resolving accidents is a process.
Some kids, for whatever reason, become dry almost overnight, the way some kids learn to read with lightning speed. Others require more time and a number of different strategies. Please be patient as your family works to resolve these difficult issues.