The Modified O'Regan Protocol.

This enema-based treatment for enuresis and encopresis was developed in the 1980s by Sean O'Regan, M.D., a pediatric kidney specialist in Montreal, who sought to resolve his own son's bedwetting. Dr. O'Regan's pioneering research demonstrated that incomplete evacuation (chronic constipation) is the root cause of enuresis and encopresis and that a daily enema regimen resolves both conditions. Thirty years later, Dr. Hodges adjusted Dr. O’Regan’s protocol in various ways,. He named it the Modified O’Regan Protocol after the doctor he considers a genius.

Today, M.O.P. is considered a treatment approach, rather than a specific regimen, as Dr. Hodges has developed numerous variations.

All M.O.P. variations involve either one or two daily enemas until the child is 100% accident-free, day and night, for 30 days. At that point, the child gradually tapers off enemas.

Some M.O.P. variations also involve a daily osmotic or stimulant laxative. All the laxative and enema options, plus guidance for timing, dosing, and tapering, are spelled out in the M.O.P. Anthology.

M.O.P. can be implemented at a low cost, with a pack of syringes and a bottle of liquid glycerin.

Yes and yes.

The root cause of accidents is a rectum enlarged by a pile-up of stool. With enuresis, the stretched rectum aggravates the bladder nerves, causing the bladder to “hiccup” and empty without warning. With encopresis, the stretched rectum has lost tone and sensation, so stool falls out of the child's bottom without the child noticing.

Only when the rectum is emptied daily for several months will it shrink back to size, stop bothering the bladder, and fully regain the tone and sensation needed for spontaneous daily pooping.

All this is more challenging than most parents and doctors recognize. Laxatives rarely suffice. The Anthology discusses enema safety in detail.

It’s always helpful to have your doctor’s support. However, M.O.P. does not require prescriptions or medical supervision. Most families who implement M.O.P. do so on their own, following instructions in the Anthology.

Dr. Hodges can provide more individualized guidance via our private support group or 1:1 consultation.

If your medical provider is curious about or skeptical of M.O.P., we recommend sharing The Physician’s Guide to M.O.P., included in the Anthology.

That's what most parents think! But you'd be surprised. Most kids are more bothered by accidents than they let on and are willing to give M.O.P. a try. Before long, enemas become routine.

Children age 7+ (even as young as 5) can give themselves enemas and appreciate the autonomy and privacy of self-administering.

For children apprehensive about enemas, we recommend The Enema Rescue Guide, included in the M.O.P. Anthology, and our children's books:

•Bedwetting and Accidents Aren't Your Fault: Ages 5-10

•Emma and the E Club; Ages 7-12

•M.O.P. for Teens and Tweens: Ages 11+