By Steve Hodges, M.D.
We doctors are a stubborn lot. We’ve spent about a hundred years in school and treated more patients than we can count, and we spend weekends reading long-winded journal articles.
So, we tend to think we’ve seen it all and know it all.
But, of course, we haven’t and we don’t.
I mention this because literally every day I hear from parents frustrated by one of two scenarios: Their child’s doctor 1.) has stubbornly dismissed their concerns about bedwetting or accidents or 2.) refuses to consider our approach to diagnosing and treating constipation.
Parents ask me: Can we follow your program without our doctor on board?
Here are a few excerpts from emails parents have written me:
•”Our 7-year-old has never had a dry night, yet our pediatrician continues to insist bedwetting is normal and she’ll grow out of it.”
•”I liked It’s No Accident, and our GP found it interesting and sent us to a specialist to discuss our son’s constipation. The specialist’s response was ‘Oh, you read a book, good for you.’ Refused to even talk about it.”
•”Our doctor told us that giving our son enemas would be ‘cruel and unusual punishment’ and would turn our 4-year-old into a ‘psycho.’ “
•Our 10-year-old son has had encopresis for 6 years. We have been seeing a pediatric GI for 6 months, and his only solution is MiraLAX and more MiraLAX. We’ve gotten nowhere.”
•”Our 6-year-old-son has been having accidents despite being potty-trained early for preschool requirements. Our pediatrician dismissed the accidents. When we pushed for an X-ray, he put up a big fight (“no need”) but finally caved. The radiologist confirmed constipation, but the pediatrician wouldn’t give us any details.”
In that last case, the mom sent me the child’s X-ray, and let me tell you, her son was stuffed with poop.
If your doctor responds like these doctors did, can you dismiss their dismissals and simply follow the instructions in our book?
Well, you can — and many families have done so successfully — but I don’t advise it.
Why It Helps to Have a Doctor in Your Court
Sure, MiraLAX and pediatric enemas are sold over the counter, so you don’t actually need a doctor to follow our program. Still, every child’s case is unique, and a pediatrician may have insight into your child’s health that could influence how you approach our regimen.
Also, a doctor who’s on board can help you adjust MiraLAX dosages, prescribe alternatives (such as lactulose) for various reasons, prescribe stimulant laxatives (such as Ex-Lax) when necessary, and answer questions about giving enemas. Of course, you need a doctor to get baseline and/or follow-up X-rays.
So, how can you get a skeptical or stubborn physician in your court?
Honestly, sometimes you can’t. Many doctors don’t want to hear new ideas, especially if they come from patients who’ve done research online. They may get annoyed or defensive and dig in.
To some extent, I can understand a doctor’s reluctance to treat constipation aggressively. In many med schools, doctors are taught that bedwetting up to age 7 is normal and at that point, the best therapies are a bedwetting alarm or bladder-calming medications. Doctors may not realize alarms and medication don’t get to the root of the problem and that medication, as a long-term solution, doesn’t even work.
To a large extent, the medical community just isn’t up on the research.
So if your doctor won’t budge, you may simply need to find a new doctor, awkward and time-consuming as that may be. It is, after all, a lot easier to work with your doctor than against him or her.
On the other hand, if you like your current doctor, disagreements over wetting notwithstanding, don’t jump ship right away. Some skeptical docs, when presented with a compelling case, will eventually come around.
The Patient Who Changed My Career
That’s what happened to me. Early in my career, I didn’t grasp that constipation is the primary cause of bedwetting, accidents, and UTIs. I knew a clogged rectum could contribute to urinary problems but didn’t realize constipation alone could wreak such havoc on a child’s bladder.
But then I had a patient, a precocious 6-year-old girl with a history of UTIs, who made me rethink everything I’d been taught.
In “It’s No Accident,” I describe this patient’s story in detail, but here’s the short version.
This patient, whom I call “Ella” in the book, had urinary reflux, a condition that causes some urine to flow back up into the kidneys when the child pees. Constipation is known to exacerbate urinary reflux, so I watched Ella closely for signs of constipation and took several preventive measures. Ella showed no signs of constipation.
After much therapy, she didn’t improve, so I ended up doing surgery to reposition her ureters. I was shocked: When I cut open Ella’s abdomen, I discovered a grapefruit-size mass of poop sitting right behind her bladder and squishing it into a position likely to cause reflux.
That surgery changed my career. Suddenly, I saw how easy it is to miss constipation in a child and just how much damage a mass of stool can cause.
Thanks to Ella, I’m a much more open-minded doctor.
So press your doctor for that X-ray and for aggressive treatment. Perhaps if you keep at it, he or she will come around.