By Dr. Hodges
It makes me nuts when I hear of pediatricians saying, “Don’t worry, she’ll grow out of it” to parents of kids who’ve been wetting the bed for years or parents of potty-trained kids who are having pee and poop accidents.
I’m telling you: Accidents are not normal, they are almost always caused by unrecognized constipation (and, to an extent, holding pee), and the longer you wait to treat them, the longer it takes to fix the problem.
I am going to describe to you just three patients I saw in clinic this week because I think their cases are instructive.
Patient #1. This was a 9-year-old boy whose chief complaint was bedwetting. That’s not so odd, except that he’d been wetting the bed since he was toilet trained, and for the past six years his pediatrician had been telling his mother to ignore it — “he’ll grow out of it.” He was already 9. At what point was he supposed to grow out of it?
Last year, he began having daytime accidents, too — both pee and poop accidents. This worsening prompted his pediatrician to refer the child to me. Before I examine kids with this type of history, I order an X-ray now, so first thing I did when I entered the room was pull up the films. Not surprisingly, his entire colon was completely stuffed with poop, stretched to such an unnatural size that his mom (an untrained eye) could easily see it.
I explained to the mom that her son’s constipation was almost surely the cause of the bedwetting and accidents, and because it had been ignored, fixing the problem was likely to take many months and a lot of work. But at least now that we know what we’re treating, we can get to the work of getting him better.
The mother was shocked; so was her son. Neither of them had any idea he had bowel issues. They wanted to why no one had ever checked this before. They wanted to know how things could have gotten so much worse when things were supposed to improve on their own. But most of all they wanted to know how to get him dry.
Patient #2. The 8-year-old granddaughter of a pediatrician came to my office with a three-year history of urinary frequency — peeing all the time — and constipation. A gastroenterologist had treated her constipation — her poop was now soft, and she was pooping regularly — and had even X-rayed her once. Yet she was still peeing constantly.
I ordered another X-ray. The findings? An extremely stretched-out rectum full of poop. After a daily enema regimen for a month, she came back to see me again. Her symptoms had waxed and waned with the enemas, but another X-ray showed her rectum was still full of poop. She will likely need months of aggressive therapy, including laxatives, enemas, and pelvic floor physical therapy, because this problem was inadequately treated before.
This was a very well-informed family. They had done everything possible to help their child, but the problem was still missed. They were blown away.
Why was this problem missed? Because most doctors think that if children have normal bowel movements that constipation has been treated adequately. Not only do many docs dogmatically claim that kids with normal bowel habits can’t be constipated, but they also refuse to even look for it with an X-ray. I have no idea why.
Patient #3. A 4-year-old child boy on the autism spectrum but highly functioning had been having trouble toilet training for the past year. His mom couldn’t get the child to poop on the potty. Though the kid was pooping every day in pull-ups, his mom had heard about It’s No Accident and nonetheless wondered if her child was constipated. An X-ray showed severe accumulation of stool. Nobody else had even raised the possibility of constipation. All the advice she’d received from friends, family, and physicians, “Be patient — he’ll come around.”
These aren’t unusual cases. They’re what I encounter every day.
Here’s what I’m saying: As parents and physicians, we are missing the boat on this problem and it’s harming children. When I see folks dismissing my research on this topic, as I have seen in some discussions online and have heard from parents who have brought It’s No Accident to their pediatricians, it’s disheartening. I’m not making outlandish claims here. I’m just saying constipation in kids is often missed and is often the direct cause of bedwetting, accidents and difficulties with toilet training.
I don’t mind folks saying they disagree, as long as they’ve looked at the X-rays themselves. But guess what? I’ve never heard disagreement from a doctor who has looked.