By Steve Hodges, M.D.
Parents ask me all the time: How can I get my child on board with enemas? She’s terrified.
Or, they’ll say: I get that enemas are the best treatment for bedwetting and accidents, but there’s NO WAY my child will agree to them. What alternatives should we try?
Or: We did one enema, it did not go well! My child said it hurt and won’t try it again. Now what?
First off, no one is excited about the prospect of daily enemas — that’s a given!
Upon learning of the Modified O’Regan Protocol (M.O.P.), which involves daily enemas, pretty much all parents assume their child won’t go for it. Enemas seem so extreme and invasive, that they dismiss the idea outright, often before even consulting their child.
Only when the accidents persist and life for the family gets more miserable do they warm to the idea.
I don’t push folks into doing enemas — families need to come around in their own time. However, I also don’t recommend “alternatives” to M.O.P., because no treatment is anywhere near as effective.
A rough start with enemas does not warrant giving up altogether!
I want my patients to get better, so I stick with what works, even if it’s not what’s easiest. And actually, plenty of families will tell you M.O.P. is easiest — certainly much easier than dealing with the mess that Miralax can make and the years of continual accidents.
In this post I offer 13 practical ideas for easing a child’s fear of or discomfort with enemas. Most were suggested by parents in our private M.O.P. support groups. These folks know what they’re talking about! You can find additional suggestions in the 4th edition of The M.O.P. Book: Anthology, our detailed guide to the protocol.
The best advice from experienced parents: Don’t run the show. Instead, work with your child to find a solution to his fear.
“For M.O.P. to work, you have to address your child's concerns and engage his cooperation,” one mom posted. “Recognize your child is a partner in this treatment.”
Minor adjustments —a shift in the child’s body position, a different enema tip or solution, a new reward — can make a major difference.
You won’t know what works until you try. The problem may be something you hadn’t even considered.
“It turns out my son hated the glove I was wearing to apply the Vaseline to his bottom for extra lubrication,” one mom wrote. “It took a while for us to figure that out.” Once she ditched the glove, her son found enemas to be no big deal.
Yes, no big deal! Parents are often surprised how quickly enemas become routine for their children. Many children on M.O.P. actually request their nightly enemas, because getting cleaned out makes them feel so much better.
“My daughter’s entire demeanor has changed after 36 days on M.O.P.,” one mom emailed “She’s a happy kid again. Now she sings, ‘I just can’t wait for my enema’ to the Lion King song!”
Another mom was flabbergasted that her 7-year-old with autism, who is minimally verbal, came to her after the third enema and said, “Bum.” She continued: “I actually found him trying to open a Fleet enema and use it on his own.”
Yet another mom posted a photo of her 4-year-old son “playing constipation” with his marble run. She wrote: “The commentary was hilarious: ‘Look at all of this hard poop. This colon is clogged. It's constipated! But that's okay, I'll just give it an enema!’”
If your child is fearful, take a moment to consider whether you might be projecting your own fears onto your child. That's happened more than once!
"If I'm going to be honest," one mom told me, "I was the one who was scared, and I think I was making things worse for my daughter."
If your child’s first enema doesn’t go well, team up with your child to figure out why, and give it another chance when the child is ready. Your kid just might end up being the one who plays “enema” try his marbles in the living room.
1. Compare the enema tip to a typical poop. Constipated kids poop out giant logs and jumbo sausages; heck, one mom described her niece’s stools as “cantaloupe-sized.” Any child can understand that their stools are much, much wider than a pencil-sized enema tip. Point out the difference!
“One trick I use with hesitant kids is to have them show me the average diameter of their stools,” says Erin Wetjen, PT, a physical therapist who specializes in pediatric incontinence and worked for several years at the Mayo Clinic in Rochester, Minnesota. “Then I pull out the enema and show them the small tip in comparison to the large circle they make with their hands.”
With some perspective, Erin says, enemas don’t seem so scary.
2. Offer a reward. Screen time, treats, toys — whatever works. I think any child unlucky enough to have to undergo M.O.P. deserves a prize.
“We started with Starbursts, and then we moved on to iPhone use, which my daughter seems to love,” one mom wrote.
Said another: “My daughter asks every day, ‘Can we do my bum medicine?’ because she gets to watch a show while sitting on the potty.” Another mom reported offering her son $1 for each large-volume enema (part of the M.O.P.+ protocol, explained in The M.O.P. Book: Anthology Edition).
One mom throws her son a “super pooper party” after each enema: “He gets a cookie or other small treat with a candle in it. We sing, ‘You're a super pooper’ to the tune of happy birthday. It's ridiculous, but it works."
Another mom struck a deal with her 7 ½-year-old to buy him a Lego set in exchange for 30 days of enemas. “We got a calendar to hang on the wall, and by the end of the first week, it was no big deal. And after the month was over, he got his Lego set, and we kept doing enemas. He never said, ‘You only said 30 days.’ I was amazed at how quickly it became part of his normal routine.”
3. Acknowledge your child’s fear. Instead of saying, “Don’t be afraid — it won’t hurt,” empathize.
“We did lots and lots of talking beforehand about how lots of kids are so scared they cry and how I was scared when I had to get one before my colonoscopy,” one mom posted. “The discussion, plus some iPad time, made all the difference. “Now we are on day 14 and the enema doesn’t faze her at all. Like, not one bit. And the enemas have helped SO MUCH.”
4. Appeal to your child’s inner scientist. Many kids are fascinated by the workings of an enema. One mom said her son was resistant to switching from M.O.P. to M.O.P.+ because the large-volume enemas required more of her son’s focus.
But she found a solution: “We switched to a clear bag, and watching the fluid draining out fascinated him. He has a keen interest in science and anatomy, so that's helped us in working together on the treatment.”
Another mom did a variety of clever demonstrations. “The inspiration came one morning at breakfast,” she wrote. “There was a large, hard lump of sugary flavoring at the bottom of my son's instant oatmeal packet. I told him this is what his poop is like in his colon: hard and dry and hard to break up. I asked him to try to squish it, and he couldn't. I placed it in a bowl, and then poured water over it. While it dissolved, I told him that's what happens when we use the enema.”
She has also used a sugar cube and a syringe of water, as well as a soft peppermint and water. “The peppermint worked especially well because it took a few squirts to start getting mushy,” she said. “Now he has a concrete visual for why we are doing M.O.P.”
5. Give yourself an enema. Yes, you! What better way to show solidarity and offer a scouting report? Children greatly appreciate this gesture.
“I did it on myself, and my daughter watched and saw it didn’t hurt,” one mom posted. “Worked wonders!”
Another mom wrote: “When I did one in front of my son to show him that it doesn’t hurt and is no big deal, that tipped the scales to get to try it.”
What you learn from self-administering the enema may also help your child. “One thing I learned when doing it on myself is that it helps tremendously if you bear down like you’re pushing out a poop,” one mom posted. “That will relax the muscles and make it pretty effortless.”
Another wrote: “The first time went really poorly for my 6-year-old daughter because I was so nervous, and I had no idea what it was like. I had my daughter on the wrong side, and she freaked out, saying it hurt.” After giving herself an enema, this mom understood how how much more comfortable it is when you’re lying on your left side.
Sometimes simply offering to try enemas yourself can influence a child.
"I found some pediatric store-brand enemas and picked up a couple plus an adult size," one mom posted. "Casually showed them to the kids after school. 'Nope. Nope. Nope.' was the response. I said, 'I’ll try it myself this weekend. We’ll see how it goes.' Bedtime rolls around and the younger one says, 'I want to try the enema.' I was shocked. After half the bottle, she said, 'That’s enough for tonight.' And then: 'It feels better. My tummy feels empty. I want to keep doing the enemas.' She reports to big brother, who then says, 'When do I get to try the enema?'"
"I was NOT expecting to go from adamant refusal to completely on board in less than 4 hours!"
If you’re going to offer to self-administer an enema, just be prepared to follow through!
6. Let your child give YOU an enema! I have to admit: I had never considered this idea until a mom posted about it in our support group.
After the first enema was painful for her daughter, this mom wrote: “I asked her if she wanted to give me an enema first, and if it did not hurt, would she be willing to try it again? She is an only child and likes to do what adults do. She said yes. That did it for us!”
7. Plant the idea, and give it time to take root. Few kids will respond well to, “Hey, guess what we’re going to do tonight? An enema!” But they may be receptive if you introduce the concept over several weeks and explain that lots of kids have enemas.
Bedwetting and Accidents Aren't Your Fault, one our children's books, emphasizes how common these conditions are and explains that many children need enemas.
“We read Bedwetting and Accidents Aren't Your Fault together before we ever began M.O.P.,” posted the mom of an 8-year-old. “I had mentioned several times that we might go that route.” When laxatives and high-dose cleanouts did not resolve her son’s encopresis, he was well prepared for enemas.
You never know: With enough exposure to the idea, your child might even ask for enemas! The mom of a 7-year-old wrote: “My daughter and I read Bedwetting and Accidents Aren’t Your Fault several times when she was just on Miralax, and she suggested trying the enemas herself.”
8. Add lubrication to the tip and/or your child’s bottom. Countless parents have told me that adding copious amounts of KY jelly, Vaseline or Aquaphor to both the enema tip and the child’s anus made all the difference.
“We use a glob approximately the size of the Death Star,” one mom wrote. “We go through a lot of Vaseline, but my kid doesn’t protest enemas, so that’s fine with me.”
“I don’t think there is such a thing as too much lubricant,” another mom wrote. “We use Vaseline and KY together.”
A third posted: “I mean, really grease it up! It helps to prevent the anus from getting irritated, and it helps your kid not to feel it as much going in. Even though the enemas come pre-lubricated, it is not enough for us.”
9. Experiment with different types of enemas. If your child feels a burning sensation from store-bought enemas, in which the active ingredient is phosphate, try liquid glycerin suppositories (LGS) instead.
They are gentler and have a smaller tip, though they may not be as effective (in which case large-volume saline or glycerin enemas, described in The M.O.P. Anthology, might work better). “My 8-year-old preferred liquid glycerin suppositories to pediatric enemas because of the smaller nozzle, so I alternated them," one mom wrote.
Other kids have the opposite reaction: “The liquid glycerin suppositories make my son nauseous and throw up or at least cause a need to gag and spit.” The child has no problems with phosphate enemas.
Still other children are more comfortable with large-volume enemas (which are reusable and therefore less expensive). “My oldest used to complain sometimes that enemas hurt but hasn’t since we switched to MOP+.,” one mom posted.
10. Have your child try a different position. The most popular position is lying on the left side, knees bent, as described in the M.O.P. Anthology. But some kids feel more comfortable in downward position described by this mom:
“I have my kiddo lay down on his forearms, butt in the air, and we sing "Put your butt in the air like you just don't care" while he's watching the iPad. I then put the tube in the anus at the same angle of his body.”
11. Explain why enemas work better than oral laxatives. Kids in grade school can get the gist of my published study comparing enemas to Miralax: Only 3 out of 10 kids got better on Miralax, but almost 9 out of 10 got better with enemas. Explain that the lump of poop is stuck at the very end of their colon, near where poop exits; Miralax comes from the top down and can’t do as good a job cleaning out the hardened mass at the bottom.
12. Let your child take charge. Taking an active role in the process, including self-administering the enemas, helps many children feel less apprehensive.
“Our approach was to have our daughter do the insertion herself," one mom posted, "so we talked through the sensations, had her 'practice' with her own finger first (trimmed nails and clean!).”
Children as young as 5 or 6 may be able to insert the enema tip on their own; others may prefer that you do it for them. Ask your child’s preference, and check in often to see if he or she still feels that way.
“My 5 year-old was scared the first time I had her administer the liquid glycerin suppository herself, but she thought that the penguin on the box and the little suppositories were so cute. I just told her practice sticking it in — no pressure — and I would check to see if it was in the right spot and not touch her at all. Giving her the control made all the difference. She got really comfortable with LGS."
Children who are too young to insert the enema tip can still take charge, with small acts like opening the packaging themselves. “My 4-year-old really likes taking the cap off and holding the bottle before we do it,” one mom posted. “I think it gives him a sense of control.”
You can maintain this sense of control by narrating the process, step-by-step, and asking for feedback. “I listen carefully to my son as we're doing the enema,” one mom wrote. “I wait to insert the nozzle until he is breathing deeply and is in the correct knees-to-chest position. I apologize if I poke him accidentally. I praise him for participating in every step.”
13. Help your child relax. When your child’s bottom muscles are relaxed, the enema tip will slide in easily, so encourage your child to take deep breaths, like blowing out birthday candles or blowing up a balloon.
“My kids hug their knees and breathe out,” one mom posted. “We call it our cleanse and yoga breathing.”
Simply holding the child’s hand can help.
“The first week was rough and my son held my hand while Dad did the enema,” one mom wrote.
Another posted: “My 4-year-old wanted big sister to hold her hand.”
Make your child’s environment as comfortable as possible. Many parents place a soft mat and towel on the floor. One mom uses a portable heater in the bathroom “to keep it cozy warm.” In addition, her son asks to be brushed prior to the enema, using the Wilbarger brushing technique commonly used in occupational therapy.
“Brushing really helps [him relax],” she wrote. We're only five nights in, but after nearly giving up all hope, I'm so pleased with how it's going.”
For some kids, the iPad serves more as a relaxation tool than as a reward.
“The key for the first time is to let the kid watch enough to get zoned out,” one mom posted. “I got the iPad out for my 5-year-old and put on a video of the thing he found the funniest, classic Chip and Dale and Donald Duck. He was so into it that he hardly budged when I administered the enema. They don't call TV the ‘boob tube’ for nothing.”
The parents in our Facebook support groups are always posting new ideas. As one mom wrote: “Reading what other parents are doing was a game changer — it gave me the confidence to try enemas again.”
I hope some of these ideas will give you the same confidence.