Quick Answers: Teenage Bedwetting, Why Kids Get Constipated, Tapering Off Enemas

By Steve Hodges, M.D.

Is constipation due to genetics or diet? If a bedwetting teenager won't try enemas, what's the next best treatment? What's the best way to potty train in order to prevent constipation? Do M.O.P. "graduates" continue to struggle with constipation years later? What if two parents disagree on how to treat their child's enuresis or encopresis?

Below I answer all these questions, posed to me last week by parents!

Pediatric urologist Steve Hodges, M.D., expert in treating bedwetting, daytime enuresis, and encopresis.

Q: Which affects constipation more: diet or genetics? Three of my four kids are dealing with constipation, yet they have better diets than I do.

A: My two decades in medicine have shown me genetics plays a huge role in chronic constipation, and diet is less influential than the conventional wisdom assumes.

Parents are constantly told to “just have your kid eat more fiber and less processed food,” but dietary changes rarely help my enuresis and encopresis patients. I have loads of patients with severe constipation who also have terrific eating habits and play high-level sports. I also work with many families, like yours, who have multiple children struggling with constipation, which , for suggests a strong genetic component.

Genetics and diet aren’t the only culprits in chronic constipation. Early potty training, school restroom policies, modern toilets, social norms, busy lives — all play a role, for some kids more than others. See: Why Is Your Child Constipated? Because We Live in the 21st Century.

Q: What’s an alternative to M.O.P. for a bedwetting teen who refuses to do enemas?

A:  I avoid the term “refuses” because it implies the child is willful or obstinate. More likely, your teen just fears enemas will hurt! But to answer your question, the next best treatment is daily senna (Ex-Lax).

Enemas are typically more effective, but in some children, stimulant laxatives will suffice.

Senna is safe for children — see Ex-Lax Safety in Children: Are “Toxicity” and “Tolerance” Legit Concerns? — and worth trying, perhaps in conjunction with an osmotic laxative. Just make sure your teen takes the senna daily and in a strong enough dose (see “Stimulant Laxatives: Options, Timing, and Dosing” on pp. 104-107 of the M.O.P. Anthology 5th Edition)..

If senna doesn’t suffice, continued bedwetting might motivate your teen to try M.O.P. in the meantime, you might encourage your teen to read M.O.P. for Teens & Tweens:The Science Based Way to STOP Bedewtting in Ages 10 to 18, which assures teens that bedwetting is common, not their fault, and highly treatable.

Q: How do M.O.P. “graduates” fare 5 or 10 years down the road? Do they still need occasional enemas or struggle with constipation as adults?

A: Great question. A pediatric urology clinic isn’t like high school, where alumni come back to visit for fun! I don’t typically see my “graduates” unless a recurrence lands them back in my office (which does happen).

But my sense is that most kids who complete M.O.P. are able to head off further struggles with constipation. With age, children tend to become more comfortable with public toilets, and after M.O.P., most kids fully grasp the importance of pooping every single day.  They don’t want to revisit enemas!

Still, some folks are just super prone to constipation, due to genetics or temperament, and need to stay vigilant for years after accidents stop. Needing an occasional enema or Ex-Lax, is no big deal. I feel certain M.O.P. graduates would struggle far more as adults if they’d never implemented M.O.P. to begin with. Many parents of my patients tell me they have struggled with constipation their whole lives and were never properly treated as children.

Q: My older child has struggled so much with enuresis and encopresis that I would do anything to avoid all that misery with my youngest. What advice do you have to potty training to prevent constipation?

A: You’ll find useful suggestions in our free download 7 CRAZY IMPORTANT Rules for Potty Training Success and more detailed guidance in The Pre-M.O.P. Plan: How to Resolve Constipation in Babies and Toddlers. Among my recommendations: 1.) Wait until your child is ready to toilet train (I define “ready” in the book). 2.) Let your child lead the way, 3.) Watch closely for pee holding, and 4.) Provide a tall footstool for pooping. A mom in our private support group followed the Pre-M.O.P. regimen with her youngest and recently posted:

With my 3.5 y/o, we watched output like a hawk. He was on Pre-M.O.P, and toilet trained absolutely seamlessly 6 months ago. Never has even a hint of a daytime accident and is 90%  dry overnight. It has been so nice to experience what it is like to toilet train with a normal, healthy bowel on board. The knowledge we have gained from M.O.P. is invaluable.

Q: What is a good troubleshooting strategy when your child hits a plateau on M.O.P.? Encopresis stopped right away for my son, but bedwetting has persisted for months despite continued enemas.

A: That’s a common scenario, as I explain in our free guide Treating the Trifecta with M.O.P. and in The Long Lag: Why Bedwetting Lasts Longer Than Daytime Wetting. When a child hits a plateau, I recommend an abdominal x-ray to determine whether the child’s rectum is 1.) still clogged (in which case overnight oil enemas and/or Multi-M.O.P. can help) or 2.) empty but still stretched (in which case bladder medication and then bladder Botox would be the next steps).

Q: What if one parent is on board with enema treatment and the other isn’t? Or if the child splits time between divorced parents who have clashing treatment ideas?

A: These common scenarios and are discussed in two sections of the M.O.P. Anthology 5th Ed: Help! My Spouse Thinks M.O.P. is Crazy! on pages 135-136 and Frustration, Guilt, and Family Tension, on page 142. You’ll find advice from parents in our private Facebook support group and insight from Amanda Arthur-Stanley, Ph.D., a M.O.P.-friendly Colorado psychologist.

For example, one mom wrote: “My husband didn’t get on board until he saw the x-ray. It showed our son’s rectum was basically flattening his bladder. Plus, reading the study about how enemas work better than Miralax appealed to his rational side.”