Shoulda, woulda, coulda. If I had known 10 years ago what I know today about treating bedwetting and accidents, I could have saved countless families from anxiety, frustration, and embarrassment, not to mention tons of laundry.
But you can’t dwell on your mistakes. You can only learn from them, adjust accordingly, and pass on your knowledge.
That’s what I remind parents who beat themselves up over their children’s bedwetting struggles. Plenty of parents have told me: “I can’t believe all the useless treatments I wasted time on. My daughter could have been dry a long time ago.”
As one mom of a bedwetting teen emailed me, “I am beside myself with guilt, as this has been going on for years. I knew something was wrong, but didn’t do anything."
To parents like these I point out: At least now you know what to do! That alone puts these families way ahead of most, given how poorly the medical community serves kids with enuresis (wetting) and encopresis (poop accidents).
In this post I will share a list of mistakes commonly made in the treatment of bedwetting and accidents. Some are mistakes I, myself, have made; other items on the list come from parents of my patients or parents in our private Facebook support group.
I take the term “medical practice” seriously. The way I approach accidents today is radically different from — and more effective than — the approach I advocated 10 years ago. It’s even different, in more subtle ways, from how I treated the condition a year or two ago.
You can’t resolve a child’s bedwetting and accidents overnight, but by avoiding these mistakes, you can save your family months, even years, of distress.
Mistake #1: Waiting too long to treat bedwetting and accidents
Doctors routinely tell patients it’s “normal” for a 5-year-old, even a 7-year-old or a 10-year-old (!), to wet the bed. Year after year, they’ll tell a family: “Don’t worry — she’ll outgrow it.”
Fact: While it is quite common for elementary-age children to wet the bed, “common” is not the same as “normal.” Children with healthy bladders do not wet the bed (no matter how deeply they sleep!) or have daytime accidents. Enuresis signals that a child’s bladder has gone awry, almost certainly because a stool-clogged rectum is pressing against it. In other words, the child is chronically and severely constipated. Waiting around for this rectal clog to resolve on its own can be as fruitless as waiting around for a clogged bathtub pipe to magically fix itself.
I strongly recommend treating bedwetting at age 4 — especially if your child wets nightly and/or also has daytime accidents. These are the kids least likely to outgrow the condition, as I explain in detail in “Don’t Assume Your Child Will Outgrow Bedwetting.”
If a child is struggling to potty train or starts having accidents post-training, that, too, is a red flag and signals treatment is warranted. Physicians may dismiss the accidents as “a normal response to stress” or “developmental,” but that’s just not the case. My booklet “7 Super Important Rules for Potty Training Success: A Guide for Parents” addresses what to do about accidents.
I understand how difficult it is to defy your doctor’s advice, but as a parent, you sometimes need to do your own research and heed your instincts.
Mistake #2: Not treating the underlying constipation aggressively enough
This is a universal mistake! And it’s the number-one mistake I made early in my career. While I knew constipation is almost always the cause of bedwetting and accidents, I did not remotely grasp the size and severity of the rectal clogs triggering the accidents. It wasn’t until I started X-raying my enuresis patients and measuring rectal diameter that I understood why oral remedies — so popular with doctors — are so inadequate compared to enemas.
When I wrote my first book, It’s No Accident, back in 2011, I was still advocating a Miralax clean-out followed by a daily dose of Miralax as reasonable (though less effective) alternative to a daily enema regimen. But more experience and research led me to change my mind. I now strongly recommend parents bypass the oral approach and make a beeline to an enema-based regimen such as the Modified O'Regan Protocol (M.O.P.) (Oral laxatives do play an important role in M.O.P., but only as an adjunct to the enemas.)
Parents don’t want to hear this! Understandably, they will do anything to avoid giving enemas to their children. Heck, I recently got a 1,200+-word email from a mom (it was so long that did a word count) in which she recounted the trauma caused by her daughter’s pee and poop accidents and the countless remedies they had tried. She was hoping not to have to “resort” to enemas and asked what she could do.
My advice: when a child has enuresis or encopresis, enemas are not a last resort! They are the go-to treatment, no matter how strongly your doctor may disagree.
The reason oral remedies fall short: the culprit is not the poop clog itself but the rectal stretching caused by chronic clogging. The rectum must be fully cleared out daily to allow the rectum time to shrink back to size, stop bothering the bladder, regain sensation, and restore enough tone to fully evacuate stool. Not even one of those pre-colonoscopy mega clean-outs can accomplish that, as I explain in “Why Even the Nuclear Option Can’t Replace Enemas.”
Even the strongest oral laxatives may not even make a dent in the crusty, hardened, impacted stool that builds up over time. Instead, the soft stuff just oozes around the rock-hard mass, leaving the child with, ironically, both diarrhea and constipation.
I understand it can take time to work up to the idea of enemas, and that’s fine. Both you and your child must be on board before you start a regimen such as M.O.P., and you should not push. If your child is hesitant, read Bedwetting and Accidents Aren’t Your Fault over and over again. In many cases, after reading the book, the child has been the one to suggest enemas the parent! Also, “11 Ways to Ease Your Child’s Fear of Enemas” can help.
Just know that if you cut to the chase, you will get your child on the path to dryness faster.
Mistake #3: Stopping enemas too soon.
Families tend to stop M.O.P. for one of two reasons: either they got incredibly quick results or got no results at all.
Sometimes a child who has never received any constipation treatment will respond so well to M.O.P. that accidents cease in the first week or two. The family will get so excited that they assume the ordeal is over and stop the enemas.
In this scenario, the child is ripe for relapse! The holding habit dies hard. Even if a few weeks of powerful clean-outs allows the rectum to stop pressing against the bladder, the rectum is likely to fill right back up, because it is still overstretched and because the child is still in the habit of withholding poop.
It’s important to follow the entire M.O.P. protocol. So, if your child gets lucky and has 7 consecutive dry nights starting on 12, you still need to complete the 30 enemas, followed by another month of enemas every other day and a third month of enemas twice a week.
The second reason families quit M.O.P. prematurely is the child had zero dry nights after 30 consecutive days of enemas. They’ll throw up their hands and say, “Well, I guess this treatment isn’t going to work, either.” They may even assume constipation was not the cause of their child’s accidents, after all.
But this is a faulty assumption! Hard as it is to believe, some children remain fully clogged after an entire month of enemas. I see this fairly often on follow-up X-rays. These kids’ rectums are just so filled hardened, crusty stool that more powerful enemas are required to achieve a clean-out. When M.O.P. doesn’t do the job, the answer is not quitting enemas; it’s switching to a different type of enema. Different kids respond to different solutions and sizes, and sometimes more powerful enemas are needed.
It can a while for parents to realize this. Some families have quit M.O.P. two or three in times frustration, only to come back and stay the course with good results. As one mom in our support group posted:
“What I wish I had known, or at least let sink in, when I started M.O.P. was this: It usually takes time. I was 100% on board and knew to not let my doctor continue to convince me the bedwetting was normal. But I thought that once we started the enemas, we would be through this in a few weeks. I just could not imagine how old, hard poop could resist a daily enema for weeks. Now I know better. Once I let go of my anxiety that this be taken care of yesterday, we were all more relaxed.”
Mistake: #4: Persisting with a version of M.O.P. that is not working
Some parents are so excited to learn about M.O.P. — “Finally, a treatment that makes sense!” — that they push forward even when their child is getting nowhere. Yes, this is the opposite response of the parents I wrote about in #3, who give up completely.
I will get emails that say, “We’ve done M.O.P. for 180 days and my daughter is still wet every night. What is going ON?”
Whoa!! My intention is not for folks to stick with a dead-end approach. That is depressing and pointless.
One of the key tenets of M.O.P. is this: If you’re not getting anywhere after 30 days, make a change.
So, if your child has had 30 days of pediatric Fleet enemas (key ingredient: phosphate) with no improvement, it’s time to try a different kind of store-bought enema or switch to large-volume saline enemas ( the basic M.O.P.+ regimen, as explained in The M.O.P. Book). If that doesn’t bring results, you add a stimulant such as glycerin and/or castile soap to the large-volume enema.
Some families are intimidated by the prospect of doing large-volume enemas, since these enemas are more trouble, so they persist with store-bought enemas far too long. When they realize M.O.P.+ isn’t a big deal — and that many kids find them more comfortable, not to mention more effective — they regret having waited so long to make the switch.
As one mom in our support group posted: “We were nervous to try the large-volume enema with my 8-year-old, but it isn’t as scary as I thought it would be, and my daughter prefers them. There is a huge difference in what comes out afterward. I wish we hadn’t put it off for so long, but you live, you learn — right?”
One way to avoid stalling out on M.O.P. is to monitor your child’s progress, either using a notebook or our download, “My M.O.P. Calendar: A Day-by-Day Enema Tracker.” The packet lists the subtle signs of progress — such as fewer skid marks and less urgency to pee — that can help you decide whether to stick with your current M.O.P. variation or move on.
As one mom in our support group posted: “I would have started using the tracking calendar immediately, so I could have seen we needed to be more aggressive sooner. I could have cut out at least 3 months of pediatric enemas. With the calendar I can see when something is not working and analyze more objectively how things are going.”
Mistake #5: Making Too Many Changes in Your Regimen
This mistake is the opposite of #4! As one mom posted: “I got impatient and would switch to something else within days or weeks rather than being persistent with one thing for a whole 30 days before making a change.” There are many permutations of M.O.P. and M.O.P.+ — different enema solutions, different osmotic laxatives, adding suppositories or Ex-Lax. You can make yourself nuts trying everything.
One mom posted some wise advice: “Have faith in the method, and don’t get discouraged. This can be especially hard with all the comments from the peanut gallery — doctors, family, friends — telling you what you should and shouldn't be doing. But once you commit to M.O.P., keep at it until the problem is fixed.”