By Steve Hodges, M.D.
As a pediatric urologist, I know that aggressive constipation treatment resolves bedwetting, daytime wetting, poop accidents, and chronic urinary tract infections.
But could constipation treatment also improve a child’s behavior or mood?
I have no data to support this theory, but I hear it often from parents. Just this week, a mom in our private enuresis/encopresis support group posted that after three years of struggling with encopresis, she and her daughter were “in a very, very dark place.” Life brightened once her daughter began the constipation treatment with the Modified O’Regan Protocol (M.O.P.), the enema-based regimen I recommend:
She went from up to 10 soiling accidents a day to none. She had severe, debilitating abdominal pain daily. It’s gone. I would get called 3-4 times a week to fetch her from school. Haven’t gotten a call since starting. She had severe negative self-talk to the point where the doctors were wanting to start anti-psychotics. It is completely gone. She had severe anger outbursts. Gone.
Another mom in our group, whose son has ADHD, wrote that she, too, noticed "dramatic improvement in mood and behavior” when her son’s accidents stopped, and she posed some good questions:
Do you think physical discomfort was making these kids have mood and behavioral problems? Or was it the shame of having accidents, even if they weren’t consciously aware of the shame? Or is it some brain/gut connection? Some combination of the above?
I can answer all manner of questions about the bladder and the rectum, but this topic is out of my purview. However, I do believe that everyone feels better, physically, when they’re not carrying around a belly load of poop. It's logical that if you’re not in physical discomfort, your outlook and demeanor will improve.
“Debilitating abdominal pain” never brightened anyone’s day, that’s for sure. But I suspect that resolving constipation even helps children who don’t recognize or complain about discomfort. Sometimes, you don’t realize how bad you were feeling until the pain disappears. I think this is a scenario where you can take "lighten your load" literally.
Physical discomfort aside, I do know that many kids feel demoralized by bedwetting and daytime accidents, largely due to the shame and blame they often shoulder, even if they try hard to conceal their feelings. Enuresis and encopresis can be extremely isolating. Many children with these conditions avoid sleepovers, camps, road trips with their sports teams, and other activities with peers. Some kids suffer depression, severe anxiety, even suicidal thoughts.
So, it only makes sense that when accidents stop and kids regain their lives and freedom, they feel liberated and more confident.
For further insight, I asked Amanda Arthur-Stanley, Ph.D., a Colorado psychologist who works with families who are dealing with encopresis and/or enuresis. Dr. Arthur-Stanley also collaborated with me on The Mental Health Professional's Guide to Enuresis and Encopresis, a free guide for therapists and school counselors.
She pointed to several possible explanations for mood improvement: “decreased shame and anxiety around accidents, pride around being able to listen to one's body cues, fewer tummy aches and therefore somatic responses, less stress associated with accidents and needing to plan for a change in clothes, greater sense of freedom in being able to plan trips and do sleepovers and interact socially without fear of accidents, and more, including the brain/gut connection.”
That sounds about right to me.
Reports on behavior and mood improvement often come from parents of children diagnosed with autism spectrum disorder or ADHD. Before their child was treated for constipation, these parents assumed their outbursts, moodiness, and other symptoms stemmed from their child’s autism or ADHD. But as their child underwent M.O.P. treatment, they began to feel differently.
One mom in our support group posted:
We've seen a strong and obvious correlation to increased flexibility in behavior, improvement in expressive language and back and forth conversation, better overall mood. Our daughter can sit still longer and shows more willingness to try new foods. I suspect these things may have to do with feeling much better overall from getting more stool out and not sitting in her system for as long.
A mom who lives Australia emailed me that M.O.P. not only halted her 5-year-old’s encopresis, allowing him to start kindergarten with his peers, but also improved his behavior significantly:
His kinder teachers were amazed. He is type-2 ASD, but once the constipation was solved, his autistic behaviours seemed to moderate. Over the subsequent year, his speech improved from the bottom 1% to the right in the middle of the distribution. He even ended up being top of his class in reading and maths. I personally believe that his constipation held him back and was a huge contributing factor to his speech delay, which is now eliminated completely.
Of course, there’s no way to know whether or how much you can attribute improvements like these to constipation treatment, but I’ve heard enough of these stories to believe there is a connection.
Here’s one more, from a former member of our private support group:
My poor guy had three poop accidents at his 6th birthday party at a park. Yet I kept up with Miralax. . . . He was having daily accidents at school. His doctor blamed it on stress and had me adjust the Miralax dose.
His accidents stopped as soon as we started enemas, and we are now tapering. After every enema, he would let out a huge sigh of relief. His behavior and demeanor are so much better. He used to have anger and behavioral problems that we thought were age related, but now I am not so sure.