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  • By Steve Hodges, M.D.,

Bedwetting, anxiety, x-rays, withholding — your constipation questions answered!

Based on feedback from parents, we’ve recently added two age-based private support groups for parents of kids dealing with chronic constipation, bedwetting, and/or accidents: a Tween/Teen group (for parents of kids ages 10+) and a Pre-M.O.P./Potty Training group.

If you’re wondering what sorts of questions parents post in our groups, here is a recent sampling. In the answer section, I haven’t included responses from other parents, but input from other folks in the same boat — many of them very well versed in the Modified O'Regan Protocol — may be the most valuable aspect of our groups!

Also, know that members of either of our new groups can gain access to our original enuresis/encopresis support group at no extra charge, as many parents have constipated children in multiple age groups. Our original group has been around for years and is a goldmine of information! So if you have a younger or older child, you might find that group useful simply for search purposes.

Among the useful topics you can search (in no particular order): Miralax, lactulose, Ex-Lax, afraid of enemas, stress, relapse, autism, sensory processing, withholding, LGS (liquid glycerin suppositories), spontaneous poop, olive oil, mineral oil, Castile soap, glycerin, M.O.P.+, Double M.O.P., magnesium hydroxide, magnesium citrate, pullups, behavioral, doctor opposes enemas, frustrated.

And lots more!

From the main M.O.P. group:

Q: Can you comment on this x-ray of my 8-year-old? We had been doing M.O.P. and M.O.P.+ for 4 months, and then 3 weeks ago, his mom did not want to continue with enemas, as she couldn't believe he could still be constipated. I argued that his continued accidents were evidence of constipation, but she wanted further evidence. Now he’s only on Miralax. Before M.O.P., he had daytime pee and poo accidents and bedwetting). During M.O.P. and M.O.P.+, we daytime poo accidents decreased but were not totally eliminated, daytime pee accidents decreased but were not eliminated, and no change to nighttime accidents (last thing to improve, I know). Thank you so much for any insight you can provide!

A: The x-ray shows he has right colon and rectal poop and rectal dilation. You can tell your wife that kids who aren’t constipated don’t have encopresis! So, you know you need to keep going with M.O.P.+. Plenty of kids remain constipated after 4 months of daily enemas, especially those who begin with all three issues: bedwetting, encopresis, and daytime wetting. We could modify your regimen if you don’t think you’re seeing adequate progress, but it sounds like you were heading in the right direction. Miralax alone won’t resolve these issues and can often make encopresis worse.

From the Tween/Teen group:

Q: My 12-year-old has been bedwetting on and off since age 4. As a baby and young child, she struggled with constipation. I now realize she never really resolved that issue. She tried alarms and medication, but the problem would always return. After I read about M.O.P., she started taking Miralax daily and did a phosphate saline enema for two nights but said that it burned. Then we tried solid glycerin suppositories for several nights. But her rectum was sore, so we stopped everything except Miralax. She is now wetting her bed every more than ever. Why would the bedwetting get worse? Also, are the glycerin suppositories sufficient? My daughter has anxiety and takes Prozac daily. Could this be a factor?

A: As we explain in the M.O.P. Anthology, it is not unexpected to see bedwetting worsen with the initiation of a bowel program, because you may be causing more net stretching of the rectum than emptying. If anything, the fact that you’ve seen a change in the wetting should be an encouraging; it confirms that rectal dilation affects bedwetting! It should get better over time, as she gets cleaned out.

Adult Fleet adult liquid glycerin suppositories would be a good option for her. We recommend them over solid glycerin suppositories (LGS), which take longer to work and are harder to time. LGS are also gentler than phosphate enemas and work well for kids who feel a burning sensation with phosphate. It's important to stick with enemas or LGS for 30 days before analyzing whether you're making progress.

Prozac should not be a factor. Anxiety is only an issue if it prevents her from pooping when she feels the urge, especially when she’s out in public.

From the Pre-M.O.P./Potty Training group:

Q: My 2.5-year-old was constipated at 9 months when I stopped breastfeeding and started solids. At 12 months we started Miralax due to an anal fissure. His issue since then is withholding. We’ve tried milk of magnesia, senna, probiotics, Ex-lax, fiber, and Metamucil squares. Nothing works to make him go regularly. He will go 4 to 7 days before he has a massive blowout with soft stool. I read the Pre-M.O.P. book and did 2 weeks of glycerin enemas daily. Then I stopped and have waited 4 days, with no results. I asked him to try to go potty or else he would get an enema, and he refused to try. I asked if he just wanted the enema, and he said yes. Is he just being lazy and wanting the enema? Do you have any advice for a withholder? I'm so frustrated!

A: Just continue with the enemas daily for a while, as we encourage in The Pre-M.O.P. Plan. The important thing is to get him pooping every day and to understand the importance of pooping every day. I wouldn't be in any hurry to stop the enemas. It can take a long time for constipated kids to unlearn withholding behavior.

And don't worry about him being lazy. 2.5-year-olds aren't lazy! Also, we don’t recommend using the enema as a consequence for not trying to go. It's just medicine. It probably makes him feel better, too. Keep up Pre-M.O.P.!

Get Dr. Hodges' updated recommendations for treating bedwetting and accidents!

The M.O.P. Book: Anthology Edition teaches you to implement the Modified O'Regan Protocol with confidence. Get your child on the path to dryness!

Must-read books for kids by Steve Hodges, M.D.

• Bedwetting and Accidents Aren't Your Fault

• Jane and the Giant Poop

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Feel free to contact Dr. Hodges or Suzanne directly:
shodges@wakehealth.edu
suzanne@bedwettingandaccidents.com

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