Treating the “Trifecta” in Children: Bedwetting, Daytime Enuresis, and Encopresis

By Steve Hodges, M.D.

Treating the Trifecta with M.O.P., a free guide, explains how to resolve encopresis, bedwetting, and daytime enuresis.

Among the families that land in my clinic, the most distressed tend to be folks dealing with the “trifecta”: bedwetting, daytime wetting, and encopresis, all at once.

Bedwetting is stressful enough — for kids, who avoid sleepovers and school overnights, and for

parents, who grow weary of vacationing with mattress protectors, buying ever-larger pull-ups, and comforting their demoralized children. Daytime pee accidents ratchet up the anxiety, as families navigate discreet clothing changes and children become fearful of playdates, retreating inward.

But it’s encopresis, on top of it all, that takes the scenario to nightmare territory. I’ve known kids who suffered poop accidents at their own birthday parties, children suspended from school for soiling their pants repeatedly, and parents in despair because, as one mom told me, “trying to stay on top of accidents is a full-time job.”

The trifecta also impacts family dynamics. Children have no idea why they can’t control their accidents, or even feel their bladder or bowels emptying, and fear disappointing their parents.

Baffled parents may suspect their child is “acting out” or “lying” or stubbornly “refusing” to use the toilet.

Parents and kids alike feel mortified when accidents happen in front of friends or

relatives who chime in with uninformed judgments and unhelpful advice. “It’s hard to talk

about, and people who have not been in this situation don’t get it,” one mom posted in our private Facebook support group. “I know it was starting to impact my daughter’s self-esteem, and power struggles were getting worse.”

Adding to the problems, many trifecta kids are referred for behavioral therapy, psychological counseling, or other inappropriate treatments, as school counselors and even some healthcare providers don’t recognize the actual cause of enuresis and encopresis: chronic constipation. Other kids are properly diagnosed with constipation but prescribed inadequate treatments, such

as Miralax “clean-outs” or daily Miralax, only to experience worsening symptoms.

READ: Getting Your Constipated Child Off the Miralax Merry-Go-Round

There is a way out! It’s called the Modified O’Regan Protocol (M.O.P.), an approach that involves daily enemas (such as liquid glycerin suppositories, aka LGS) until accidents stop and then a gradual taper. For some children, treatment may also include osmotic laxatives, stimulant laxatives and/or bladder medication.

The good news: Treating the trifecta with M.O.P. will resolve all three symptoms in virtually all

children. Encopresis will likely resolve within a month, perhaps sooner, dramatically improving your family’s quality of life. Eventually, all of this will end.

The less good news: Resolving the trifecta will take much longer than most parents expect or believe. The process may take a year. It may take longer. No family wants to hear this! But it’s important to have realistic expectations from the get-go. Children with all three incontinence symptoms typically face more challenges, treatment-wise, than kids with one or two symptoms.

Any family tackling the trifecta should prepare for a long haul, periodic setbacks, and plenty

of experimentation with components of M.O.P.

But your family’s effort and patience will pay off. “For all the parents who think there is no hope, I promise there is,” one mom in our support group posted. “My daughter is 8, and we’ve been dealing with all this since she was 3. Nothing worked until we found M.O.P. Was it perfect? No. Was it slow and frustrating? Yes. Does it work? YES!!!! We have been off enemas for 6 months and off Ex-Lax for 2 months with no accidents.”

Folks who’ve endured the trifecta and slogged through the treatment process can hardly believe

it when it’s all over — when a child can confidently take swim lessons, sit all day in class (wearing underwear!), enjoy a stress-free visit to an amusement park, or confidently join the fun at a slumber party. “At times, I never thought we would be here,” another mom posted. “To actually be on the other side of this is unbelievable.”

Another mom posted: ““The strain on our family from soiling and wetting multiple times daily was impacting everyone’s mental health and creating power struggles. This program saved our lives.”

Our Treating the Trifecta guide will set your child on a realistic path to clean and dry underwear, day and night. I offer four critical insights for treating this combination of symptoms, as well as the M.O.P. Trifecta Algorithm, to help guide your treatment decisions and minimize wasted time.

You can download the free guide here.