Why Kids “Lie” About Accidents, Treating Teen Bedwetting, and ER Visits for Constipation: Parents’ Questions Answered
- 5 hours ago
- 5 min read
By Steve Hodges, M.D.
Why do some children sit in wet underwear and deny they’ve had an accident? How can a child still be constipated after a week of enemas? Do enemas cause dependence or block nutrient absorption? What’s the best way to treat bedwetting in a 15-year-old?
Those are among the questions I’ve recently received from parents via email and our private support group. Here are my answers.
Q: One thing I can’t understand: My daughter doesn't tell me when she's had an accident and even lies about it. We try hard not to shame her, but shouldn’t she feel uncomfortable sitting in wet clothes and want to change? Also, when she says she needs to pee, it’s already an emergency and she often doesn’t make it. She says she didn’t feel the urge until the last second. Is this anything to further investigate?
A: Everything you describe is extremely common in children with enuresis and is physiological, not behavioral. With her enlarged rectum aggravating her bladder nerves, your daughter’s signal to pee is on the fritz. So, she doesn't feel the urge in time to react. Sometimes, the first sensation she feels may come right before her bladder empties; other times, her bladder may “hiccup” and empty with no warning at all.
You’re not the first parent to be baffled by a child’s denial of accidents. Often, children truly don’t realize they're wet. Other times, kids feel embarrassed or stressed and don’t want to draw attention to the accident by changing their clothes. Even in supportive homes, many children worry about disappointing their parents. See my article “Potty Refusal” or “Lying” About Accidents? It’s Physical, Not Behavioral.
As Dr. Amanda Arthur-Stanley notes in the M.O.P. Anthology, my treatment manual: “Even when parents try hard to be supportive and nonjudgmental, kids can be sensitive in ways we never imagined.”
I’d stay focused on constipation treatment and set aside your other concerns. Once your daughter’s rectum shrinks and her bladder nerves calm down, these baffling behaviors will disappear along with the accidents.
Q: My 6 y.o. with encopresis has been on M.O.P. for 6 days, with no accidents since we started. Yesterday he landed in the ER with abdominal pain, and an x-ray showed a large poop ball in his rectum—disheartening after all those enemas. The doctor said the liquid glycerin suppositories we’ve been using aren’t large enough to clear it and we should use a bigger enema, like Fleet, followed by daily Miralax for a year. She gave me a spiel about enemas causing dependence. What do you recommend?
A: Trust me: A single Fleet enema won’t make a dent in that stool mass, and a Miralax-based regimen may actually worsen his encopresis, as I explain in Helping Your Child Exit the Miralax Merry-Go-Round.
Instead, I recommend overnight oil enemas to soften the hard stool mass, along with two glycerin-water enemas daily—the J-M.O.P. regimen detailed in the M.O.P. Anthology. After a week or two, drop the oil and transition to Multi-M.O.P.
And don’t worry: your son is not going to become dependent on enemas. That’s a myth I debunk in the Anthology. Once his rectum fully empties, retracts normal size, and regains full sensation and tone, he’ll be able to taper off enemas just fine.
Abdominal pain is not uncommon in kids who are severely backed up and should subside as his rectum clears out.
Q: My 15-year-old wets the bed most nights. He’s now on board with M.O.P., so we are wondering where to start. I feel like I’m on information overload. He’s currently taking magnesium oxide, and if he doesn’t take it, his stool is firm and large. Should he continue as he starts M.O.P.?
A: He sounds like a classic case of chronic constipation, and Standard M.O.P. (a daily enema plus an osmotic laxative) may do the trick. In that case, I’d continue the magnesium since it’s helping keep his stool soft.
Or, you could start with Multi-M.O.P., a more aggressive regimen I often use with teen patients. Our Bedwetting Algorithm (in the Anthology) lays out both approaches. Most kids on Multi-M.O.P. don’t need an osmotic laxative, but some do. If your son’s stool remains firm on the regimen, you can add the magnesium back in.
I also recommend getting an abdominal x-ray, which will reveal the extent of rectal clogging and enlargement. I x-ray all my enuresis patients and use the images to guide treatment decisions. If your son is especially backed up, I’d start with Multi-M.O.P.
As his rectum empties and shrinks, bladder medication may help him achieve more dry nights while his bladder nerves heal. Medication doesn’t accelerate the healing process, but it can provide a confidence boost and a better night’s sleep. That said, I wouldn’t start with medication yet—it works best once the rectum has emptied. You and your son should also know about bladder Botox, a highly effective treatment for when all else fails.
Make sure your son knows that many other teens are in the same boat. Many of my teen patients feel they're the only kid their age struggling with enuresis—I assure them otherwise!
A good place to start is Dear Bedwetting Teenagers: Your Condition is 1.) Common, 2.) Not Your Fault, and 3.) Totally Fixable.
Q: My 6 y.o. has poor weight gain and is falling off her growth curve. When we started M.O.P. 4 months ago, her appetite improved, but only temporarily. Her doctor seems to think her poor growth is related to her constipation and potentially her treatment. Do enemas prevent the intestines from absorbing enough nutrition? Our daughter has always been small, like both of her parents, but she should be gaining more weight, according to the doctor.
A: No, enemas don’t “block” nutrient absorption. That’s a common fear, but it’s not how the digestive tract works. Nutrients are absorbed much higher up, in the small intestine. Enemas work at the very end of the GI tract, in the rectum, where the pile-up of stool sits.
Many chronically constipated kids eat poorly because they’re packed with poop. You're not going to enjoy dinner when your rectum is stretched out and harboring a load of stool. These kids often feel full after a few bites and some experience stomachaches, bloating, nausea, and poor appetite. Children with these issues tend to regain their appetite after the rectum clears out on M.O.P. I’m not sure why her improvement was temporary.
Constipation is not the only possible explanation for poor weight gain. Some kids are naturally small, but if your pediatrician truly feels your daughter is falling off her growth curve, I would continue investigating other possible causes.
Q: Any suggestions for kids who can’t hold the oil overnight in when trying J-M.O.P.? I used 30 cc mineral oil, and my daughter made it less than 5 minutes before she had to run to the bathroom.
A: Some children have such a full rectum when they begin overnight oil enemas that there’s just no room for the oil. I’d reduce the oil volume, insert it when she’s lying in bed, and have her stay in that position.
Meanwhile, continue with your M.O.P. regimen to keep clearing the stool piled-up. If your daughter has more nights where she can’t hold it long, that’s OK. Keep trying, and eventually it’ll work.
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