top of page
Recent Posts

“Early intervention is everything”: Don’t Wait to Treat Your Child for Enuresis or Encopresis

By Steve Hodges, M.D.

bedwetting must be treated early and aggressively

Doctors routinely dismiss bedwetting and daytime accidents as “normal,” assure parents their kids will outgrow the accidents, and discourage families from pursuing treatment more aggressive than Miralax.

The problem with this advice: It makes matters worse.

In reality, bedwetting and daytime accidents — while certainly common — are not normal, and you cannot assume your child will outgrow these medical conditions.

Enuresis (pee accidents) and encopresis (poop accidents) resolve much more easily when a child is 4 than when she is 14. I know — I have plenty of teenage patients whose obvious symptoms were ignored for years by medical professionals.

The longer a child’s rectum has been stretched by stool back-up, the longer it can take for the rectum to shrink back to size, regain normal tone and sensation, and stop aggravating the bladder.

Among parents of my patients, the biggest regret is that they didn’t start sooner with aggressive treatment, such as the Modified O’Regan Protocol (M.O.P.), a regimen that combines enemas with laxatives. But when your doctor is telling you nothing’s wrong, and accidents are no big deal, why act? It’s easy to keep kicking the can down the road.

Parents in our private Facebook support group — a group of extremely proactive parents! — recently discussed what finally spurred them to follow their instincts rather than their doctors’ advice.

I could write 10,000 words urging parents to aggressively treat enuresis and encopresis. But I think it will resonate more if you hear it straight from parents who’ve walked this road.

As one mom posted, “Trust your gut! You know your child better than any teacher, doctor, or relative.”

As you read their stories, keep in mind that encopresis tends to resolve far more quickly than daytime pee accidents or bedwetting. I explain why in The M.O.P. Book: Anthology Edition — A Guide to the Only Proven Way to STOP Bedwetting and Accidents.

Some children, especially tweens and teens with the more challenging cases, are on M.O.P. or its various incarnations, for more than a year before accidents fully resolve. Even then, these kids may need to take laxatives and other measures for a few years before they are truly out of the woods.

Mom #1: “They told me it was psychological. In my gut I knew it wasn't.”

Her story: I am a former teacher and had several students with encopresis. They didn’t know they had accidents during class until a peer or teacher smelled the incident. Kids (and adults) can be cruel. The younger kids don’t mean to be, but they have no filter, so “pointing out the stinky smell” was never done covertly. The older kiddos didn’t want to be friends with someone who “pooped their pants.” This stigma made it difficult for the kids with encopresis to make and maintain friendships. Field trips and sleep overs were always difficult.

When my own 3.5-year-old started having difficulty with her bowel movements after 6 months of being potty trained, I thought — like most teachers — that it was behavioral. Teachers usually have zero training in the area of incontinence. But after some observation, I began to realize she really couldn't control it. I sought medical treatment, and they told me it was psychological. In my gut I knew it wasn't.

We've been doing M.O.P. for a month now, and there's been drastic improvement. She's only had two poo accidents over the last two weeks, whereas she was having two a day.

Her advice: Early intervention is everything, in all aspects of child development. Treating encopresis or bedwetting is no different. As a teacher, I saw the emotional harm it caused my older students. I urge all parents to try their best to get a head start on the issue before kindergarten if they can.

If you feel that something is off, might as well try treatment, as it is not harmful. If you're wrong, GREAT. If you're right, you've got an early start on treating it.

Mom #2: “Our doctor kept saying she would outgrow it with help from Miralax.”

Her story: My daughter declined a pool party invitation because she was worried about accidents. I hated her missing out on fun with friends. I had read about M.O.P. months before, but our doctor kept saying she would outgrow it with help from Miralax. I did finally feel enough was enough!

Her advice: For someone unsure about starting M.O.P., I would say it’s not going to hurt to try it for a month. You can always stop. But we saw so much improvement in her symptoms and confidence after one month that even though we aren’t out of the woods yet, we’ve persisted and are down to about one accident a week.

Mom #3: “I saw her genuine surprise when she found a big poo in her pants.”

Her story: My 4-year old had on-and-off issues with pooping, withholding, and big, painful poos. It was manageable and seemed behavioral, which I tried to influence with her diet and potty sits. Then, at the beginning of new school year, I picked her up from preschool with poo in her pants three days in a row. She hadn’t notified her teachers to change her. I got frustrated, and I got as low as telling her she will not get the usual school walk-home cookie that she and her sister get, if next time she doesn’t tell her teacher she’s had an accident.

But then, the same day, I saw her genuine surprise when she found a big poo in her pants. When I learned about, it resonated so much. That weekend we started M.O.P., and we have had no poo accidents since! Encopresis was our only issue. We are still on daily enemas, as spontanous poo is sporadic, and I am testing out senna during the weekends.

Her advice: Enemas can be part of a regular and calm routine, and it is so great to know that you might be able to spare your child from a public accident. It is much easier to be patient with the progress when you know it takes time for the rectum to empty completely, shrink back to regular size, and regain sensitivity.

Mom #4: “Our daughter is a different girl. She is so happy.”

Her story: After three years of enuresis and encopresis, my 5-year-old daughter used to pick her ears and they would bleed from stress. She was excluded from play activities at kindergarten and was told off by ourselves and teachers. She wet her pants all day, and she was so stressed and sad.

We saw a urologist and gastroenterologist. We tried everything. Still, we had to fight for an X-ray, which finally showed impaction. Months of oral clean-outs, hospital admissions, countless laxatives — no one cared about her constipation. We had no support from specialists here in New Zealand. We felt so alone, and it consumed our lives. My husband found M.O.P when he was desperately scrolling the Internet at 2 a.m.

We are still on the M.O.P journey, but our daughter is a different girl. She is so happy. She no longer feels ashamed and hopeless. I feel so emotional when I think of the countless times I have scolded her for wetting during the day. It breaks my heart. It’s unbelievable that specialists continue laxative treatment for years on children with no signs of progress.

Mom #5: “We could have taken care of this years ago.”

Her story: We took action when my 9-year-old confided that he was tired of wetting the bed and wanted to stop wearing pull-ups. Our 5-year-old was also still wetting the bed, so we started both of them on M.O.P., even though our pediatrician continually told us it was no big deal for them to still be wetting the bed.

Our 5-year-old has had much better results and has been easier to treat. He's currently on a 3-week straight stretch of being dry, whereas our now-10-year-old is making progress, but it's much slower.

When our 10-year-old was about 3, he was sent to get X-rays because he was having stomach cramps, and they said he was constipated. Our pediatrician just put him on Miralax for a year. I so wish we had known about M.O.P. then! We could have taken care of this years ago instead of now trying to correct six more years of constipation and stretched bowels.

Mom #6: “The emotional toll on him had been more than he let on.”

Her story: Our son was on Miralax for two years, and our pediatric GI had us do weekly oral clean-outs, which meant our son couldn’t eat anything other than clear food for 24 hours. He became resistant to the process, and it was making our lives miserable. We were washing soiled underwear because our daycare would not allow pull-ups. Everything smelled. My son had several poop accidents at school, and one day another mother told me he was bawling. I walked in, and my child was in a time-out. I asked him in front of the teacher, “Why are you in time out?” and he told me it was because he had an accident. I knew right then it was time to do something.

That weekend, as a test, we gave him a liquid glycerin suppository in lieu of the oral clean-out. We made sure to get his buy-in. We told him he could do the “butt stuff” or he could do the clean-out. He chose the butt stuff because he gets to watch his favorite television show.

One day we chose to do a Fleet enema in lieu of liquid glycerin suppository, because he’d had a pee accident the night before. The Fleet took a little longer to work, and my son said, with fear and defeat in his voice, “Am I going to have an accident today?”

The enema worked, and tons of stuff came out. He was so happy and relieved. I knew then that the emotional toll on him had been more than he let on.

I would rather give my child suppositories any day of the week and twice on Sunday than having to clean, disinfect, and wash another pair of dirty underwear.

Her advice: Encopresis is a serious issue. I think our pediatrician and pediatric GI undersold how important it is to get on this. Kids don’t grow out of this. Without serious intervention, you could be subjecting your child to unnecessary bullying, embarrassment and inability to properly socialize with their friends.

Enemas and Miralax are WAY cheaper than new underwear, new clothes, pullups, and your time cleaning them.

Mom #7: “Encopresis is not a phase.”

Her story: Today is my son's 4th birthday. We had a big party for him at a community park by the beach, and it was wonderful. He was the life of the party and had a fabulous time. The best part was: he felt so good about himself! This amazing day would never have happened if we had not been on M.O.P. for the last year.

I remember when he turned 3. We were not thinking about big parties. We were in a state of total desperation. I couldn't take him swimming because of the constant encopresis. His behavior was erratic, and I knew something was wrong.

We took action when we had exhausted our resources regarding local front-line care providers. It seemed clear that something was very, but the remedies offered were totally ineffective.

I can honestly say this is the most stressful thing I have ever gone through in my life. The level of guilt and worry I feel is overwhelming and all-consuming.

Her advice: Encopresis is a medical condition that requires long-term medical treatment. Full stop. It is not "normal." It is not a phase. It is not to be ignored or dismissed. Like many other medical conditions, it is treatable, and your child can have a better life than the life they have without treatment. Parents need to be prepared for the astounding depths of ignorance, dismissiveness, and judgment that will come from the vast majority of physicians they encounter. Parents will feel very alone.

Every day is different on M.O.P. What worked for you one day might not work the next. You will have to be extremely flexible and patient. We have tried to taper multiple times, only to return again and again to daily enemas. When on M.O.P, parents must focus on the long-term progress their child has made. It is so easy to get dragged down by the daily difficulties, especially when treatment seems to be stretching on and on.

My message to parents who have not yet taken action: Where do you want to see your kid a year from now? Still suffering? Dejected and soiled and ashamed? Or living a happier existence and maybe even thriving? I'm not saying things are perfect; every day is a struggle. The bottom line is that in our case, our lives are unquestionably better for making the decision to do M.O.P.

bottom of page