By Steve Hodges, M.D.
I spend a lot of time explaining to families that toileting accidents are never a child’s fault and are not a sign of stress, anxiety, or behavior issues.
To the contrary, enuresis (bedwetting and daytime wetting) and encopresis (poop accidents) are symptoms of a medical condition, chronic constipation, that has gone untreated.
This is news to many families. Our society treats accidents as if they are psychological in nature, as if accidents signal a child has “unmet needs” or is “acting out.” Typically, movies, TV shows, preschools, K-12 schools, and even psychiatry textbooks assume accidents are somehow rooted in psychological distress.
By the time families land in my clinic, parents and children alike have internalized these assumptions. Children feel shame and blame. Many have been subjected to teasing from peers, along with eye-rolling and exasperation from adults who were taking society’s cues.
Many kids feel left out of slumber parties and sleepaway camps and believe they are the only children their age — whether that’s age 5, 10, or 15 — dealing with accidents.
At the same time, some parents become frustrated over what they call “potty refusal” (“She refused to sit on the toilet and then had an accident 5 minutes later!”) or a child’s reluctance to admit they had an accident. Of course, parents also worry deeply about their child’s emotional wellbeing.
As a pediatric urologist, I’m experienced in treating the chronic constipation that underlies accidents. I have loads of advice on Miralax, Ex-Lax, and every type of enema under the sun — glycerin, phosphate, docusate sodium, Castile soap, olive oil, you name it!
Where I have zero expertise: helping families cope with the emotional fallout from years of accidents and untreated (or undertreated) constipation.
That’s a job for well-informed mental health counselors. I am pleased to report that I have partnered with one of the most astute and knowledgeable counselors on childhood toileting difficulties, Denver psychologist Amanda Arthur-Stanley, Ph.D. Our collaboration, “The Mental Health Counselor’s Guide to Enuresis and Encopresis,” can be downloaded for free here.
The guide is addressed to child psychologists, family therapists, social workers, and school counselors. Parents, too, may want to download the guide and pass it on to counselors they may be seeing.
“As therapists, we can help kids build feelings of self-confidence,” says Dr. Arthur-Stanley, whose private practice focuses on enuresis and encopresis. “Many kids with these conditions experience a devastating loss of self-esteem. Accidents can lead to feelings of embarrassment, hopelessness, anxiety, and depression. Kids wonder: What happens if I have an accident? Where will I change? Who will notice? What will my teachers think? Will my parents be upset with me?”
Parents typically don’t discuss their children’s accidents with other parents — the way they might discuss sleep difficulties or academic challenges — because, as Dr. Arthur-Stanley notes, “they’re seen as sensitive, private issues.” Encouragement and information from therapists can go a long way.
“Removing the blame and stopping the emotional roller coaster is like releasing a pressure valve for parents and kids alike,” Dr. Arthur-Stanley says. “It’s critical for both parents and children to understand that accidents are medical in nature and quite common.”
In Part 1 of our guide, I fill in the gaps many therapists have in their understanding of enuresis and encopresis. Specifically, I discuss how a clogged and stretched rectum wreaks so much havoc on a child’s ability to control their bowels, a topic typically not covered in psychology graduate studies.
I also introduce the Modified O’Regan Protocol (M.O.P.), the treatment regimen I favor for preschoolers and high school students alike.
In Part 2, Dr. Arthur-Stanley discusses the many ways in which therapists can support families who are dealing with enuresis and encopresis, including families who have chosen to implement M.O.P.
Sometimes, even when children understand they have a medical condition, they struggle to comply with the treatment regimen, because, understandably, they’re just sick and tired of the whole thing. Many children have dealt with years and years of ineffective treatments and don’t feel like going down yet another path. Therapists can be quite helpful in this regard.
Therapists also can help parents navigate red tape at school, such as restrictive restroom policies, and can guide families in implementing 504 plans.
I have devoted my career to researching and treating enuresis and encopresis. It is terrific to collaborate with a mental health expert who is equally committed to helping families overcome these distressing conditions.
“This topic is my passion,” says Dr. Arthur-Stanley. “Enuresis and encopresis are common and highly treatable. There’s so much promise for kids when they receive the treatment they need.”