What the Chicago Tribune Got Wrong About Bedwetting

Today the Chicago Tribune ran a story about bedwetting that’s totally off the mark.

The piece quotes Dr. Hodges and mentions It’s No Accident — hooray for that! But the whole premise of our book — that constipation is the main cause of bedwetting and a major cause of daytime accidents — gets buried and dismissed as “theory,” despite the substantial research behind it.

Meanwhile, the notion that “most” bedwetting is caused by “a deep sleep pattern” gets treated as fact. This idea may be popular, but that doesn’t make it true. Oy.

Let’s start here:

Wetting issues have become an increasingly common problem, according to pediatric urologists, who say . . .  a deep sleeping pattern the cause of most bed-wetting.

We agree that wetting issues have become increasingly common. But if deep sleeping is the cause of most bedwetting, are we to believe that kids today are sleeping more deeply than in the past? What would be the cause of this deep-sleeping epidemic?

As we explain in the book, constipation among kids is incredibly prevalent and on the rise, thanks to the junked-out Western diet, lack of potty-training follow-up, and misguided school policies and conditions that prime kids to hold their poop and pee.

As we also explain, parents and pediatricians frequently miss constipation because they aren’t look for the right signs. They’re focusing on regularity, yet plenty of constipated kids poop once or twice a day; that’s because poop oozes past the giant mass of poop stuck in their rectums.

The rectum simply stretches, like a squirrel’s cheeks or a snake’s belly, to accommodate the poop mass. Meanwhile, the expanded rectum squishes the bladder and causes the nerves feeding it to go haywire.

Dr. Hodges’ recent study, published in Urology and not mentioned by the Chicago Tribune, followed 30 bedwetters ages 5 to 15. Most of these kids did not have constipation symptoms, and their parents had no clue they were clogged up. It was only by X-raying the kids that Dr. Hodges could show they were stuffed with poop.

When these kids were treated with laxatives or enemas, 83 percent stopped wetting the bed within three months.

As Dr. Hodges freely admits, his study isn’t groundbreaking; it merely confirms the many published studies of Dr. Sean O’Regan and colleagues at the University of Montreal, Hôpital Sainte-Justine.

Dr. O’Regan got even more dramatic results than Dr. Hodges — for bedwetters as well as children with daytime accidents — probably because all of the children were treated with daily enemas rather than laxatives.

The news here isn’t that constipation causes bedwetting: That’s long been proven, despite what the Tribune would lead parents to believe. What parents need to know is that constipation is routinely missed.

I even missed it in my own kid. My son Ian, who was potty trained at 2, started having near-daily accidents around age 3. I was as baffled and stressed. Our preschool was understanding — in retrospect, exceedingly so. The teachers would say, “Oh, don’t worry about it; accidents are normal.”

On Dr. Hodges’ recommendation, I got Ian X-rayed. He was chock full of poop. After an enema clean-out and a week on laxatives, he stopped peeing in his pants. Several months later, he was dry overnight.

Last week, after Ian been taking laxatives for a year, I cut his dose by half. Within a few days, he had started wetting the bed again. We did another massive clean-out. He’s back to being dry.

You can’t tell me Ian’s bedwetting is caused by a “deep sleeping pattern.”

Let’s look at another line from the Tribune:

Pediatricians generally emphasize that bed-wetting can be addressed with simple tips, such as not drinking too much fluid before bedtime, and understanding.

Seriously? Every parent of a bedwetter has tried limiting fluids before bed, along with “understanding.” If these “simple tips” fixed bedwetting, would the Trib even be writing about this topic?

If a rectal poop mass is flattening your child’s bladder, making him stop drinking water at 5 p.m. isn’t going to make a bit of difference. Heck, read this question from the mom of a 6-year-old bedwetter; this mom cuts her daughter off at 4 p.m. and still the girl is drenched every morning.

It’s unfortunate the Trib overlooked the compelling research linking constipation with bedwetting. Also unfortunate: The Trib story’s headline: “Doctors caution against overreacting to kids’ wetting problems.”

Parents should be concerned. Accidents among potty-trained kids are not normal. Bedwetting after a certain point is not normal, either, and at any rate, can be fixed well before age 6. Why wait?

If it takes “overreacting” to get your child X-rayed for constipation, go ahead and overreact.

 

 

 

 

 

February 15, 2012 at 8:04 pm

“Pooping shouldn’t take any longer than peeing.”

Dr. Hodges is happy to answer potty-related questions on this website. Please submit your questions to schlos1@gmail.com.

Dear Dr. Hodges,

My daughter has had maybe three dry nights she since she basically potty trained herself at age 2. She is a hard sleeper. She has nothing to drink after 4 p.m., she pees before bed, and I take her to the potty around 10 p.m. And still, she wakes up every  morning with a drenched pull-up. Our doctor says it’s normal and won’t take action until my daughter is 8. I can’t take two more years of this! I want her to have sleepovers. Also, when my daughter poops it’s a big event. It’s usually twice a day, and she’s on the toilet for a long while. I never thought to two could be connected.

-A frustrated mom in Oregon

Dear Frustrated Mom,

You absolutely do not need to wait two more years!

First, I’m not surprised your daughter is wetting the bed. In my practice, bedwetting is most common among kids who trained before age 3 and especially those who trained themselves. These kids have good sphincter control, which is actually a negative: It means they tend to hold their poop (and often their pee, too).

I’ll bet your daughter’s hard sleeping has no bearing on her bedwetting. All kids sleep hard. It’s just that nobody is trying to wake up non-wetters in the middle of the night.

Although limiting fluids before bed is a good idea, 4 p.m. seems a bit early to stop. Given that her problem surely is constipation, it won’t help to limit her drinking that early.

Waking  your daughter to pee after she goes to sleep also won’t help, although it’s a popular strategy among parents of bedwetting children. In the book I explain why this won’t work.

Clearly, your daughter is constipated, even though she poops twice a day, as many of my constipated patients do. A kid shouldn’t need to sit on the toilet for a while; pooping shouldn’t take any longer than peeing.

I highly recommend you have your daughter X-rayed. If the results show a large rectal stool burden, which I’m sure it will, you and your pediatrician can discuss whether to unclog your daughter with enemas (the most efficient way) or a very high doses of PEG 3660 (MiraLAX or generic). The therapies I recommend are spelled out in the book.

If you follow them, your daughter should be dry in about three months!

February 13, 2012 at 4:17 am

My Daughter Was Suspended from Preschool for Potty Accidents, But We Found Sweet Relief

By Betsy Rosso

As a parent, you know your child better than anyone else. You know when she’s actually ill and when she’d just rather play than finish dinner.

At the same time, you don’t know everything about your child’s body. When a weird rash appears or her cough sounds like a barking seal, you head to the Internet or call your mom, and then you decide if it’s worth calling the doctor at 2 a.m.

So when you are pretty sure something with your kid is not quite right, but everyone says it’s normal, it’s a tough call.

The potty-training process started slowly for Zoe, as we’d expected. We were not the kind of people to let her run around naked all day or have her pee in the backyard. Our house backs up to a busy street and we don’t have a yard to speak of. Still, she seemed to get the hang of it.

But after a few months, Zoe’s accidents became more frequent instead of less so. We attributed it to upheaval: Zoe’s child-care routine had changed. We had gone on vacation. My Grandma had died.

We weren’t happy about the accidents, but we weren’t too worried. But later, we did worry.

We love our pediatrician, and she assured us that accidents were normal in potty-trained 3-½-year-olds. She also told us if the problem didn’t resolve eventually she could refer us to the urology clinic at Children’s National Medical Center.

We did copious Internet research. We learned the word enuresis and tried navigating the scholarly research. We made that appointment at Children’s, but there was a long wait time. So we hadn’t yet been to the hospital when the principal at Zoe’s new school suspended her because she’d had too many accidents. (You can read about it here.)

Though we requested an appointment with a pediatric urologist, we were sent to a nurse practitioner. She was nice. She felt Zoe’s stomach and said maybe she was a little constipated. She recommended fiber gummies and no caffeine. Who gives their three-year-old caffeine?

The NP said no further tests or procedures were necessary. She did say that many other parents had come to her because their children’s preschools also had concerns about too many accidents.

So Zoe’s accidents continued. Oddly, she had no idea they were happening. When I would notice her pants were wet, she would be genuinely surprised and confused. She would use the bathroom of her own accord and then have an accident 10 minutes later. She was mystified, and so was I.

We couldn’t figure out what was wrong, but we were pretty sure something was.

We didn’t know where to turn, so when we learned about Dr. Hodges’ work and read early chapters of It’s No Accident, it was a revelation. Dr. Hodges somehow knew exactly what Zoe’s problem was, and he said he could solve it.

You have to trust your kid, and you have to trust yourself, but it’s such sweet relief when someone else trusts you, too.

February 10, 2012 at 12:16 am

What Poop Should Look Like

By Suzanne

So back in the 1990s, as Dr. Hodges mentions in our book, some folks in England actually stopped listening to good music and eating bad food long enough to produce a pictorial representation of the various forms of poop.

It’s called the Bristol Stool Scale — it was developed at the University of Bristol — and it  has its own Facebook page. You can even buy dishwasher-safe Bristol Stool Scale mugs.

If your kid’s poops look like Types 1 or 2 on the scale, you can bet she has a mass o’ poop in her rectum, no matter how often she poops. Type 4 is a stellar stool. A+!

Anyway, as helpful as the Bristol scale may be, it’s a bit complex for preschoolers. My 4-½-year-olds developed their own poop scale, assigning names rather than numbers, to their poops. They explain it all in the video.

One clarification: As the boys indicate in the video, “thick snake” = bad. But poop shaped like a thin snake is fine.

 

 

February 3, 2012 at 12:57 pm

Why I Wrote “It’s No Accident”

By Dr. Hodges

My first patient yesterday was a 12-year-old girl who’d been wetting the bed her entire potty-trained life. She and her mom had waited and waited for the problem to resolve, as her pediatrician had promised it would.

But the girl kept on wetting the bed, missing out on sleepovers and summer camps all the while. She’d become painfully shy and withdrawn.

Her pediatrician knew constipation could cause bedwetting and that this girl had a history of hard poops, so the doctor recommended a daily dose of Miralax.

Still, the wetting continued. After that, the doctor prescribed bladder-relaxing meds. And still: wet sheets.

I knew in a second what the girl’s problem was, and I ordered an X-ray to show her and her mom: Her rectum was packed with poop. I’m talking a softball-sized mass of stool. This pile of poop was crowding out the kid’s bladder, making it impossible for her to stay dry overnight.

I’ll bet anything this girl will be dry within three months. Now that we’ve identified the problem, it’ll be relatively easy to fix.

This story plays out in my clinic every day. That’s why I wrote It’s No Accident.

Countless children with easily treatable problems — bedwetting, pee or poop accidents, urinary tract infections, incessant peeing — are misdiagnosed or undertreated because parents and many pediatricians, and even many urologists, don’t know what to look for.

Here’s the thing: Back in 1980s, Dr. Sean O’Regan, a brilliant Irish doctor named working at a Canadian hospital, published several studies explaining why constipation in kids is so often missed and how this undiagnosed constipation causes bedwetting and other urinary problems.

Somehow, the medical profession missed all this. I tracked down Dr. O’Regan, who now practices in Arizona, and he said he wasn’t surprised that his research had been ignored.

“If a discovery is made,” he told me, “and the world wants to take notice, they will. But constipation is a distasteful subject. People don’t even want to think about it.”

I’ve spent my career thinking about it, researching it and otherwise obsessing over it. I’d love to prove Dr. O’Regan wrong — to show that when presented with the facts, people really will want to know what’s behind childhood wetting problems and how to fix them.

That’s what my book and this blog are all about. I have a poop-load to say on the subject of potty problems — why these problems are epidemic in our culture and on the rise, why preschools should never require children to be potty trained by age 3, why the usual bedwetting treatments don’t work, and so on.

If you have a child with toileting problems or if you work with kids as a teacher, administrator or school nurse, stay tuned.

 

 

 

 

February 3, 2012 at 12:56 pm