As a parenting coach and educator, I often meet parents distressed by their children’s potty accidents or bedwetting. They ask: Why is it happening? Will my child outgrow it? What can I do? I recently discovered a terrific resource for answering these questions: Steve Hodges, M.D., a pediatric urologist at Wake Forest University School of Medicine.
“Toileting accidents are really common — I would say epidemic — but in toilet-trained children, they are actually not normal, and parents shouldn’t wait around for these issues to resolve,” says Dr. Hodges. “They are totally fixable.”
Dr. Hodges is the co-author, with health writer Suzanne Schlosberg, of two books: It’s No Accident and Bedwetting And Accidents Aren’t Your Fault. Their website, bedwettingandaccidents.com, offers free downloads on toileting topics. Here are Dr. Hodges responses to some common questions we get at Grow Parenting get around bedwetting and accidents:
Q: What are the biggest misconceptions about bedwetting and accidents?
A: That kids wet the bed because they’re deep sleepers or their “bladder hasn’t caught up to their brain” or because they’re stressed or having “behavior issues.”
In reality, virtually all cases of bedwetting, pee accidents, poop accidents, and recurrent UTIs in young girls are caused by constipation — a chronic pile-up of poop in the rectum.
Q: How does constipation cause bedwetting and accidents?
A: The large, bulging lump of stool in the rectum presses against the bladder, shrinking its capacity and irritating the nerves feeding it.
Poop accidents happen because the stretched-out bladder loses tone and sensation. Poop just falls out, and kids may not even feel it.
Q: How do you know for sure that bedwetting and accidents caused by constipation?
A: Because several excellent studies prove it. Also, I X-ray my patients and show their parents the giant mass of poop stretching the rectum; when we clean out the rectum, accidents stop.
The most rigorous studies were led by Dr. Sean O’Regan, a kidney specialist whose 5-year-old son wet the bed. Dr. O’Regan’s Canadian research team used a test called anal manometry on several hundred children with enuresis, encopresis, and recurrent UTIs. These kids’ rectums were so stretched by poop that the children couldn’t detect a tangerine-sized air balloon inflated in their bottoms. When their rectums were cleaned out with daily enemas, the wetting, soiling, and infections stopped.
Q: So do you recommend enemas for resolving bedwetting and accidents?
A: Absolutely. I’ve been using Dr. O’Regan’s regimen for many years; it’s very safe and far more effective than Miralax for resolving these problems. It’s critical not just to clean out the rectum but also to keep it clear so in time it can shrink back to size and regain tone and sensation.
To accommodate the most difficult cases, I’ve tweaked Dr. O’Regan’s regimen slightly. I spell out the details in a free guide — “5 Easy Steps to Giving Your Child an Enema: The Reluctant Parent’s Guide to the Modified O’Regan Protocol.”
Bedwetting medications and alarms, the most commonly recommended therapies, don’t get to the root of the problem.
Q: Don’t a lot of kids outgrow bedwetting?
A: Yes, but many don’t — I routinely treat tweens and teens. Clogged colons, like clogged drain pipes, generally do not resolve themselves.
Q: Why are so many parents told to wait it out?
A: Because many pediatricians don’t know constipation causes bedwetting, or they
rely on inadequate methods of detecting a rectal clog. They’ll take a patient history and press on a child’s abdomen and call it a day.
In my clinic, well over 90 percent of these kids are shown by X-ray to be severely constipated, though only 5 percent of their parents had a clue. Most of my patients are referred by pediatricians who also missed the signs, which can be subtle. We offer a free download called “12 Signs Your Child is Constipated.”
Q: Why are so many kids constipated in the first place?
A: Our culture sets our children up to be constipated. We feed them highly processed food and potty train them too early because preschools demand it. Then, we send kids off to K-12 schools that restrict bathroom access or reward kids for ignoring their body’s signals. I discuss all this in It’s No Accident.