By Steve Hodges, M.D.
“How can I convince our pediatrician that M.O.P. is safe?”
“How can I get our doctor to order an x-ray when he’s convinced my child isn’t constipated?”
“Our doctor says enemas are ‘traumatic’ for children, even though my son actually asks for them. How can we get our doctor on board with M.O.P.?”
I get these questions all the time and offer several ideas in my blog post titled “5 Ways to Disagree with Your Doctors About Bedwetting Treatment.” But now I have an even better response: The Physician’s Guide to M.O.P.: Using the Modified O’Regan Protocol to Treat Enuresis and Encopresis. The guide is included in the M.O.P. Anthology.
I wrote this packet specifically for parents to print out and hand to pediatricians, GI docs, pediatric urologists, or other medical professionals who may be skeptical of M.O.P. or interested in learning more about the regimen.
Will this packet change any minds? I hope so! I’ve put forth my best arguments for treating bedwetting and accidents with daily enemas and offered substantial evidence for the safety and effectiveness of M.O.P.
The packet should give parents confidence in bringing up M.O.P. at the doctor's office — and should give any conscientious physician something to chew on. In the packet I invite doctors to call or email me with any questions about the protocol. You can point that out!
The packet includes:
•A “Dear colleagues” letter from me. In the letter, I summarize M.O.P. and explain that it has worked far better for my patients than Miralax, medication, alarms, or other treatments I have tried or was taught in medical school. An excerpt:
Enuresis patients are often told, “Don’t worry, you’ll outgrow it,” but my patient load includes countless tweens and teens whose accidents were dismissed for years. Though we, as physicians, often consider enuresis and encopresis to be relatively minor issues, these conditions are deeply distressing for children and their parents. I have made enuresis and encopresis the focus of my research and clinical practice and am eager to share with colleagues the treatments, however unconventional, that have worked so well with my patients.
•An 11-page document explaining M.O.P.'s origins, basic principles, and safety guidelines. The key section is “Five Lessons from a Decade Prescribing M.O.P.” In this section I explain why it’s important to X-ray enuresis patients and, specifically, to measure rectal diameter, and how we know enemas are more effective than laxatives. I also explain that enemas do not cause dependence or electrolyte imbalance and that they’re not “traumatic” or “abusive.”
•The full text of seven published journal articles. Included are studies demonstrating that constipation is the cause of cause of enuresis and encopresis and that enemas resolve these conditions far better than traditional therapies. One paper — a review of 39 studies on enema safety conducted over 50 years — demonstrates that enemas are safe for healthy children. Another shows that “Don’t worry, you’ll outgrow it” is not something physicians should be routinely telling children who wet the bed.
Why It Helps to Have a Doctor On Board with M.O.P.
Most families following the Modified O’Regan Protocol do so without their doctor’s blessing. Usually this is because their doctors have proclaimed M.O.P. “too aggressive” or unsafe. Or, because parents haven’t even mentioned the protocol, fearing their doctors will respond with hostility or disinterest.
These families either go it alone or join on of our private Facebook support groups, where they can get input from me and from other parents in the same boat.
I admire these families for having the confidence to take on M.O.P. solo, though often it’s not confidence but rather desperation that prompts them to take action. They’re no longer will to wait around, no matter how many times their doctor says, “Don’t worry, she’ll outgrow it" or "Just give him more Miralax."
Most of these families do very well without a local physician on board. If your child is otherwise healthy, you don’t need a doctor to implement M.O.P. It does not take a medical education to give a child an enema.
Still, many families would prefer to partner with their physician rather than do treatments by behind the doctor's back. Also, on a more practical note, you do need a doctor to order an X-ray, get a prescription for lactulose, or take other steps that may be helpful when your child is on M.O.P.
(As I explain in detail in the Anthology, X-rays are not necessary but, when read properly, can be helpful in many ways. Lactulose, a sweet liquid, is an effective alternative to Miralax but is only available by prescription.)
Lately I’ve been fielding more questions from physicians about M.O.P. — a sign that word is getting out. These folks almost always hear about the protocol directly from parents, so I urge you to print out our packet it and hand it to your physician!