“Lying” About Accidents, Bedwetting Medication, and Treatment Setbacks
- 2 days ago
- 4 min read
By Steve Hodges, M.D.
How should you respond when your child denies having an accident—or begs you to stop talking about accidents altogether? Is bedwetting medication just a Band-Aid? Does one random accident mean you need to restart the clock on your child's treatment regimen?
Below, I address these common questions, recently posed to me by parents.
Q: My 6-year-old used to have 4–6 pee accidents per day, and since starting M.O.P., her accidents have diminished in both frequency and volume. I try hard not to shame or pressure her, but the other day, she yelled at me to stop talking about her accidents. The thing is, she never tells me when she’s had an accident, and she usually lies when I suspect and ask her. So, I don’t feel like I can stop talking about it. Any advice on handling that side of it?
A: I’d focus your efforts and conversation on treatment and drop the talk about accidents. When she says, “Stop talking about it,” she’s telling you she’s exhausted by this, too.
I wouldn’t think of her denying an accident as “lying” in the usual sense. Her signals to pee and poop are on the fritz, and she may not even realize she’s had an accident. Kids can become accustomed to feeling wet and simply not notice. Or she may be embarrassed about her lack of bladder control and desperate to avoid another conversation about it.
Instead, reassure her that treatment is working and that once her insides heal, the accidents will stop.
She’s also the perfect age to read Bedwetting and Accidents Aren’t Your Fault. The book uses clever illustrations to show why her body isn’t cooperating right now. She’ll also learn that loads of other kids deal with the same issues, which may make her feel better.
Q: My 7-year-old’s daytime enuresis stopped months ago, but her nighttime wetting has persisted despite daily high-dose Ex-Lax. (If she were open to enemas, we’d be doing M.O.P.) Her x-ray shows she is still clogged up, but our pediatrician feels desmopressin is the next step. Is medication just a Band-Aid?
A: To some extent, yes. Enuresis medication doesn’t resolve the underlying cause of enuresis, chronic constipation. It just covers up one of the symptoms.
But Band-Aids have their benefits. Desmopressin can be worth a shot, as long as it’s used as an adjunct to constipation treatment rather than a substitute.
Enuresis medication typically won’t stop accidents in children with a full rectum, as I explain in Bedwetting Medication: When It Works, When It Doesn't. The enlarged rectum places so much force on the bladder that medication can’t counteract it.
Given that your daughter’s x-ray still shows significant stool buildup, I wouldn’t expect desmopressin to be a magic bullet. But there’s little downside to finding out whether she’s reached the point where it can help.
Medication tends to work well when the rectum has emptied but remains enlarged enough to aggravate the bladder nerves.
In this scenario, the dry nights achieved with medication—even if they’re a “fake dry,” as one mom put it—can bring a distressed child tremendous relief. Dry nights may also boost a child’s motivation to continue a constipation treatment such as M.O.P.
If the rectum stays empty long enough, eventually it will shrink back to size and stop aggravating the bladder. On medication, however, you don't know when natural dryness has arrived.
So, for children who are able to stay dry on medication, I recommend stopping the drug every few weeks to see whether dryness holds. Once a child stays dry for 30 nights without medication, I recommend tapering the bowel regimen very gradually.
Trying medication can be a useful gauge of how close a child is to natural dryness. If it works—and you’ll know within a few days—you’re probably close to the finish line.
But if medication makes no difference, I’d stop taking it and shift to more aggressive constipation treatment.
Q: My 8-year-old has had encopresis since age 3, with up to 8 poop accidents a day. Four months ago, we started Multi-M.O.P., with two liquid glycerin suppositories (LGS) daily, and soiling almost immediately dropped to 0 or 1 accident per day, with occasional bedwetting. After more than a month accident-free, we were going to start tapering off enemas. But last night, he wet the bed after drinking water before bedtime and not using the toilet. Does that put him back to day 1?
A: Not necessarily. My general rule is not to start tapering until a child has been 100% accident-free, day and night, for at least 30 days. Over the years, I’ve found that the longer you delay tapering—and the more gradually you wean off enemas—the less likely accidents are to recur.
Earlier in my career, I advised patients to start tapering after 7 dry days and nights, but this led to too many recurrences, particularly in children with encopresis.
As you’ve discovered, poop accidents stop quickly with M.O.P. But keeping them away for good requires more work. I explain in the M.O.P. Anthology that accidents stop well before the rectum regains full sensation and function. If you stop enemas too soon, the rectum will refill and accidents will return.
But a random bedwetting episode is more likely to be a fluke than a poop accident, so I wouldn't necessarily reset the clock. I'd maintain Multi-M.O.P. another week or two to confirm the accident was a one-off, and then start the gradual taper.