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The Real Reason Potty Accidents Happen

By Steve Hodges, M.D.

I don’t have time to comment on every grossly misleading article about bedwetting or potty accidents, but some published stories are so over-the-top false and harmful that I feel compelled to respond.

This short article, published in dozens of media outlets worldwide, manages to perpetuate three damaging myths about enuresis (wetting accidents) and encopresis (poop accidents).

Myth #1: Kids have accidents because they haven’t “learned” how to use the toilet.

The article states: “If your kid knows how to play on an iPad, they should know how to use the loo.”

In support of this proposition, the story quotes a Swiss “child development expert” who reported having an 11-year-old patient who “wasn’t taught how to use the toilet.”

Fact check: Accidents have nothing to do with a lack of knowledge or training!

When children pee or poop in their pants, it’s because they have developed chronic constipation, and as a result, their signals to pee and/or poop have gone haywire.

Specifically, the rectum, enlarged by a pile-up of stool, presses against and aggravates the bladder nerves. This triggers sudden and forceful bladder contractions — aka accidents. You can see these stool masses plain as day in an abdominal x-ray.

In the case of poop accidents, the stretched rectum loses tone and sensation, so the child cannot feel the urge to poop and does not notice when accidents happen.

It’s not that the kids “don’t know” how to use the toilet. Of course they know! To suggest an 11-year-old, or even a 4-year-old, is having accidents for lack of instruction is absurd.

Yet I’ve had several patients suspended from preschool or elementary school due to accidents and instructed to “go home and get more training.” That's like sending a child with asthma home to "get more breathing instruction."

Kids with medical conditions need treatment, not teaching.

All the training in the world will not stop chronically constipated children from having accidents. What children with enuresis or encopresis need is a regimen to clear out the mass of poop clogging their rectum. Only then can the rectum can shrink back to size, regain tone and sensation, and stop bothering the bladder. Only then will accidents stop.

Myth #2: Wearing diapers causes kids to “lose interest” in using the toilet.

According to the article, “Many tots have become so accustomed to wearing diapers that they lose interest in transitioning out of the convenient but unsanitary method.”

A popular theory is that diapers are a “crutch” — that kids in diapers or pull-ups can’t be bothered to use the toilet because, well, going in their pants is just so much easier. In other words, diapers make kids lazy. Why walk all the way over to the toilet when you can just wear one?

In truth, when kids past potty-training age have accidents or want to use diapers rather than the toilet, there's a reason that has nothing do with convenience. In most cases, they are either not mature enough for toilet training or they're constipated,

At what age are kids ready for potty training? That depends on the child, but for most kids, it’s around age 3, give or take.

Certainly, babies and toddlers can be taught to pee or poop on the potty — there’s no shortage of laudatory media coverage of “potty prodigies” who use the toilet at age 6 months or even 6 weeks.

But managing to pee or poop in the toilet is totally different from possessing the judgement to heed your body’s signals in a timely manner, a distinction lost on advocates of early toilet training.

The article suggests children should potty train between 18 and 24 months of age and that parents who wait longer are shirking their responsibilities. Untrue! In fact, early toilet training often backfires.

My own research shows children trained before 24 months have triple the risk of developing chronic constipation and daytime enuresis. That’s because young children are much more likely to delay pooping and peeing than more mature kids, as I explain here.

But this article doesn’t concern itself with research. Instead, the story glorifies a “TikTok mom” who claims to have potty trained her 6-month-old son.

In reality, many children who were trained early, perhaps to meet preschool potty-training deadlines, end up in clinics like mine, through no fault of their own or their parents. Our culture pushes early training, and the consequences for some kids are severe and long-lasting.

Myth #3: Accidents often signal emotional or behavioral problems.

The article quotes an American teacher who attributes some accidents not to parental laziness but rather to “emotional problems” or conditions such as autism.

Regarding “emotional problems,” this falsehood has become embedded in the psychology literature, with disastrous consequences for children.

There is no evidence showing enuresis or encopresis can be caused by emotional troubles and plenty of evidence to the contrary. Certainly, many kids with these conditions are distressed, anxious, or depressed, but that’s because their treatable condition has gone untreated and because they are teased and blamed.

Accidents cause emotional distress, not the other way around.

As for autism: It’s true that autistic kids have high rates of accidents, but that’s because they have high rates of chronic constipation that goes undiagnosed and untreated.

I have many autistic patients. By the time these kids arrive in my clinic, their encopresis and/or enuresis is typically more severe than in my neurotypical patients because enuresis and encopresis in autistic kids are often brushed off as “part of the deal” with autism.

Also, autistic kids may offer fewer clues they are constipated. They may not be able to verbalize the stomach pain they feel or explain that they can’t sense the urge to poop.

These kids need the same treatment as any child with constipation.

Blaming kids and parents for toileting accidents is easy and convenient but also totally off base and damaging to families, stirring up conflict and feelings of shame.

Enuresis and encopresis are highly treatable. I wish the blame would stop and these kids could get the treatment they need.


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