Bedwetting + Accidents

Let's talk about bedwetting and accidents. This is a topic that becomes increasingly taboo to talk about. Even with friends, as our kids get older. In fact, it's a challenge that we have in our house with my background in child behavior and development. I've always viewed this very much as a behavior and emotional challenge. Bedwetting and accidents are often blamed on things like deep sleep and anxiety and behavior and emotional stress than transitions. But my guest today is a pediatric urologist and he has helped me to see the medical side, which I hadn't given consideration to before. And I think it's important for all of us to understand a little bit more about.

Hi, this is Denaye. I'm the founder of Simple Families. Simple Families is an online community for parents who are seeking a simpler more intentional life. In this show, we focus on minimalism with kids, positive parenting, family wellness, and decreasing the mental load. My perspectives are based in my firsthand experience, raising kids, but also rooted in my Ph.D. In child development. So, you're going to hear conversations that are based in research, but more importantly, real life. Thanks for joining us before we get into today's episode, I want to tell you that enrollment for the mental unload is currently open. This is a program that I run three times a year

Focused on De-cluttering your brain and lightening your mental load. In this program, we focus on improving your wellbeing and your partnership. It's a systematic four-step process. If you want to learn more about it, go to simplefamilies.com/unload. Remember, I only run this program three times a year and we're starting the next round on February 11th to make sure you grab your spot right now. That's simplefamilies.com/unload. So let me start this episode off with a little warning, or we're going to talk about poop and pee today. So if you're having lunch or if this just makes you incredibly uncomfortable, then you might want to press pause. However, after learning more about healthy elimination, I feel like every child and adult should know more about this topic. In fact, it probably should be built into our health curriculums within the schools.

My guest today is Dr. Steve Hodges, and he is a pediatric urologist out of Wakeforest university. He specializes in the area of accidents and bedwetting. What I'd really recommend before you listen to this episode is that you click over in the show notes, simple families.com/episode 253. I have a link to a 32nd video from Dr. Hodges website in that 32nd video, Dr. Hodges very simply illustrates the connection between poop and pee and how sometimes our kids can have too much poop backed up inside their rectum, which in fact contributes to pee accidents. Now, when I first heard this, I said, this isn't relevant to me. My kids poop every day. My kids are not constipated. Nope, but I was so surprised to learn that our kids can still be constipated and still be backed up. Even if we have no idea and that backup, which can be in many ways, hidden and invisible to us as parents can contribute, or even cause nighttime pee accidents, daytime pee accidents and poop accidents.

So my goal in this conversation with Dr. Hodges was to really wrap my head around everything that I read in his books, because sometimes the medical side can feel complicated and it can feel overwhelming, especially when we're not familiar with the terminology. So remember, first I would recommend going over to the show notes, simplefamilies.com/episode 253. And watching that quick 32nd video from Dr. Hodges. Now I want to add the disclaimer that I always do, which is not everything that we talk about in this podcast is right for every family. So, listen with an open mind and take away what resonates with you and leave what doesn't thanks again for tuning in. And I hope you enjoy this conversation.

Denaye Barahona: Hi, Dr. Hodges, how are you doing?

Dr. Hodges: Great. How are you?

Denaye Barahona: Good. Thanks for chatting with me today.

Dr. Hodges: Thanks for having me.

Denaye Barahona: So, I want to share a little bit about how I found you, because I feel a little bit like the universe led me towards you. Um so three years ago I have a four year old and a new new seven year old. And three years ago, I had a friend who sent me this text message with a link to your book. And she said, you've got to read this book because we had recently been talking about, we both had four year olds who were still having accidents. And she's like, you gotta read this book it's by a pediatric urologist. And he basically says that all accidents are caused by constipation. And I like pitched posture. And I said, Oh, no, no, no, my kid's not constipated. I don't need that book. And so fast forward three years and my son is still having accidents, daytime accidents, nighttime accidents. And we've kind of gone down every road possible. And I called a PT, a pediatric pediatric pelvic floor therapist, which is a physical therapist also to have him assessed. And she assessed him and said, I think he's constipated. I said, it's just like you need Dr. Hodges book and simultaneously your PR person had been emailing me saying, would you like to have Dr. Hodges on the podcast? And I had been getting emails from your PR person, probably like once every couple of weeks for a couple of months.

Denaye Barahona: And I always, I'm like, Nope, I know that, I know that guy. I don't want to talk about constipation on the podcast.

Dr. Hodges: Oh, he cut me.

Denaye Barahona: I'm like, I'm not doing it, not doing it. And here I am, I'm doing it because I read your books and I thought that they were eye opening and I just, yeah, I have a lot of questions. And I think it's, this is a topic that I think is really good from a medical perspective, because I think a lot of times we look at it from a social emotional perspective. And I know that you have a lot of feelings about the importance of, of looking at it from the medical side.

Dr. Hodges: Oh yeah, for sure. And I mean, all holistically, I guess as well, but yeah, it's, there's a lot to it.

Denaye Barahona: So tell us how you got started in this.

Dr. Hodges: So, yeah, that's a interesting story. I think I'm a pediatric urologist by training. So, that's a surgeon. Primarily we see patients in clinic for surgery for congenital problems relate to the kidneys and urinary tract and genitals. And, but half our clinic is, you know, usually congenital or acquired problems from, from those things. But the other half ends up being, you know kids with accidents P P accident, bed-wetting daytime wedding. And if you go all around the country, most of those kids are seen by physician extenders. So the urologists don't take time to see them because the cookbook therapy for that has been kind of you know, baked in and it's like, it is what it is. If they show up, you just run through this protocol with them. And so physical therapists may be involved, but usually they're seen by PA's or nurse practitioners and they just get this protocol at my practice.

Dr. Hodges: There were, there were no physician, physician extenders. So I was seeing them all, cause my partners had no interest in it. And I was, you know, doing the typical things that they teach us in our textbook to do. And I was seeing very poor results. It's a difficult problem in general to treat, but I mean, these kids were getting like no better. And so I, I thought to myself, that's really, you know, frustrating cause I was, you know, I have nothing to say to them when they come back to clinic. And a couple of things happened all at once, much like you, the universe gave me a a moment of synchronicity. I guess I had a child to operate on that had been treated for constipation and needed surgery for a related issue. And when I did the surgery, she was really constipated when I actually got inside of her insides and I saw she was full of poop.

Dr. Hodges: And so, and these parents were, you know, with it involved conscientious parents, I knew were doing a good job with the laxatives. And so I was like, wow, there's really weird. You know, I went back after the surgery, she taken her mirror locks. Yes, she's pooping everyday. She's fine. I couldn't jive that with what I found in the surgery the next week I went to a meeting in Cincinnati where there were some doctors that were giving us a program. I had to deal with some congenital anomalies of the parent I am that involve, you know, anal, rectal, abnormal abnormalities, probably too much for your crowd, but basically, you know, they have problems pooping. And so these kids need help with surgery and with also enema, their entire lives and to get that enema formula down, right. They would x-ray these kids, they would actually these kids every day until they figured out they were getting in them empty and then they'd send them home on this protocol.

Dr. Hodges: So I said, you know what, I'm going to start x-raying people because they're doing it here. It seems like a reasonable thing to do. And my next clinic, I went back home and I got x-rays and all of these kids that I was seeing for voiding dysfunction and low and behold, they all told me they were pooping fine. They're doing great. And when I got the x-ray, they had, you know, just pounds and pounds of poop at the end of the colon. And so I realized then that there was a disconnect here and I started treating them aggressively and they were getting better. And I was like, Oh man, I'm a genius. I'm gonna win a Nobel prize or whatever. And I went to write it up the first stuff.

Dr. Hodges: And I found that this had actually all been described in like 1980s by Dr. Shauna Regan, who was a nephrologist whose son was wetting the bed at four w if you go to most doctors around the country, no one would even treat them for bedwetting. They'd say, Oh, it's normal. This guy went out. He found out why his son was wetting the bed by looking at the literature. He says, some of it published in 18 hundreds about retro dilation and bladder dysfunction. Then he did an anorectal manometry on his son, which is even crazier. He put a balloon up, his bottom, measured, his rectal tone, found out it was dilated. And then he says, I'm going to give my son enemas. This is all he came up with on his own. I'm gonna get my son enemas every day.

Denaye Barahona: a Guinea pig.

Dr. Hodges: Yeah. I know. A physician in Ireland. And and he said you know, I'll do this. He emptied the rectum and the kid got better. And he started publishing all about this in the eighties. And, and then he kinda got lost to history or maybe people just don't like animals and they stopped talking about it, but it's out there and it's been proven without a shadow of the doubt. So I was surprised as anyone that it kind of wasn't more well understood.

Denaye Barahona: Right. So, I have the same reaction. I mean, we'd been year after year to the pediatrician and just told it's an overactive bladder. It is what it is with no solution. And I have professionally potty trained before. So I feel like I have a lot of tools in my tool belt. I've worked with kids with developmental disabilities, a variety of different kids. So, my kids weren't the first kids that I had potty trained. So being that I was, I've continued to have these problems year after year, as my kids getting older and older, I felt like there's gotta be something else going on. You know, I've tried everything. And then also my best favorite parenting advices when you've tried everything, try nothing. Yeah. So I've done that too. And we're still, we're kind of back at square one and I've been baffled by it year after year as to why. And it seems to be out of the awareness of my kid. So that, can you speak a little bit to, if you could describe, I mean, most of us are not exactly clear on the rectum versus the intestines and the different body parts and How those are all interconnected.

Dr. Hodges: Yeah. So I have, I think I've worked out pretty good theory at which you know, I don't know how you would prove it beyond a shadow of doubt, but what, what makes at least wakes a lot more sense than the current theory of how this all takes place. And it's hard, you know, how, you know, you're professional too. Like, you know, when you speak about something in your field, it's hard to know what people understand and don't, so I'll try to explain it as best I can, but basically if you, if you eat something, you know, it goes your stomach and it goes in your small intestine. And then it goes into your call and your colon is like a question Mark. It starts kind of, and your right lower quadrant where you people know, everyone knows your appendix. Is there, it goes out to your.

Denaye Barahona: Is the colon part of the intestine?

Dr. Hodges: Yeah, it is. It's the large intestine, so, okay. Yeah. So, I just think of it, like the small intestine gets all the nutrients out and then the large intestine just makes poop basically. So it gets in the large intestine kind of moves around your stomach. And then when it gets to the end of the colon, which is the large intestine, there's a thing called the rectum. And the rectum is basically like the bladder for the colon. So, you know, your bladder kind of fills up with urine and you feel it and you go pee. So, the rectum fills up with poop and it stretches and then you feel it, you go poop. So it's not supposed to be somewhere where you kind of store poop. It's supposed to be like a area that once you feel it's full, you empty it.

Dr. Hodges: And then it fills up again later. And that's what it has. That's what it does for every other animal that has a rectum. But as kind of a side effect of evolution, I guess in our large brains, humans have found a way to circumvent that, especially modern kids, so they have to poop. And so and you know, if you're in classroom or you're in clothes or you're playing and you want to go poop, you just squeeze your sphincter. And the urge goes away because you've stopped the urge to poop. And now you don't feel the, or boop again, until you fill up more. And so take that process, which can happen, you know, to every kid pretty much. And you put it forward a few years, you have a very large amount of poop piled up at the end of the colon.

Dr. Hodges: And since the rectum is a muscle, you know, overstretched muscles if you think about it just intuitively probably doesn't, it's not as strong as as a normal size muscle. So it can't empty as well. So they basically develop this incomplete, delayed and incomplete emptying of the rectum. And that's not normal. And with that's going to happen to anyone, right. It can happen to old people too, but what's unique in kids is that they were just infants, not too long ago. Right. And so a one or two year old, how do they pee? If you think about it, they don't think about it. Themselves. They actually just void via reflex. So there's two ways to pee, at least in babies. One is the reflux void where your bladder stretches, it gets full and it sends a signal to your spinal cord. And as fond cord just sends a signal right back to empty. And that's how like a six-month old piece. And so it never actually gets to the brain. Once you're potty trained, that signal goes from your bladder to your spinal cord, up to your brain. You think about it. And then when you want to go, you send it back down.

Denaye Barahona: So I have heard you compare this to peeing and pooping like a horse. It makes perfect sense to me because they just go, when they've got to go, there's like, no. And that's how our bodies are designed. Yeah.

Dr. Hodges: Right? Yeah. And that's the natural way to go. But if you, and let's say you did it perfectly, right. You just peed and pooped normally then you could, you could become potty trained. Like most of us do and you just go to the bathroom. But if you dilate this rectum, those signals that go from the bladder to the spinal cord, they go around the rectum. And those, those nerves don't know what stimulating them. They just do their job. So if the rectum stretches those nerves, it causes a signal to go to the spinal cord that says I got to pee really badly. And then it, since you have this infantile reflex of spontaneous forwarding, it may send the reflex arc, right. Instead of just going up to your brain, it'll just go to the spinal cord, back to the bladder, empty it. And the kid doesn't even know they peed because it never got to the brain.

Dr. Hodges: So that's, what's going. And that explains to me, that's the best explanation. I have a scenes that scientifically sound that explains why this stuff gets better with age, because all these infant reflexes do go away. Right? All these little reflexes kids have eventually, you know, they, they, they have a function, right? Like they're the way they'll turn towards a bottle or whatever. But they go away as you get older. And that's why these problems get better with age. But if you have this dilated rectum, it can persist well into teenage years if you don't address it.

Denaye Barahona: Okay. So let me try to put that into the way that I understand this. And I will tell you that I actually understand this so much better because I read your kids book to my kids by the wedding and accidents, aren't your fault. And I, I learned so much from kids' books and especially you, you do such a great job of taking it from a complex level to a very simplified level that even kids can understand. So the rectum, which is like the last stop before you go before the poop comes out, is holding all this poop. And like, here's an example. Recently we were in the city, we were in New York city and during COVID, I mean, it's hard to find a bathroom there, period, but during COVID, it's impossible to find a bathroom there. And my kid told me that he had to go, he had to poop. And I was like, Oh, crap. Like literally. And so we, I took him and we started like kind of running towards the department store to try to get there as fast as we could. And by the time he got there, I don't have to go anymore. So that, I feel like that's what happens. Right. That signal gets lost. And then that poop, what should have come out, did not come out and there, that adds to the backup.

Dr. Hodges: Exactly. Right. And I do think like and I don't know why but you know, let's say you had to go drive somewhere. You could make yourself go pee, even if you were not have the urge. Whereas kids have a hard time doing that. Like spontaneously, they can't like, just go make themselves go. If they don't have the urge that they don't have good control of that. And I really can't explain that, except that maybe they just don't know how to use their pelvic muscles, but yeah, I've read it. The rectum. It's supposed to be a sensing organ, not a storage organ. So exactly what you said, it's supposed to sense and empty, not store poop, and you have a good example of it right there. And you're, you're an experience.

Denaye Barahona: Okay. So with it, now tell me why so many kids are dealing with this now. Why are so many kids constipated and how do we, if they're pooping every day, how can they still be constipated?

Dr. Hodges: Yeah. Okay. So the I'll do the first one for the second one first. So basically what the problem is, is not. And I guess I get myself in a lot of trouble by calling it constipation because it's not really constipation, but I don't know a better word for it, but what it really is, is not pooping on time and not emptying completely. And so I remember when I, my first phone call with Dr. Regan, he said, it's not constipation, Steve, it's incomplete emptying of the rectum. And, and, and that's the best way to put it. You just can't say that. Right. And yeah, exactly. So that's what the issue is. So if you know that, so if, you know, if your rectum is really full, you can poop 10 times a day and everyone thinks you're pooping. Okay. But you're never actually emptying. And so you're just kind of letting a little bit out each time.

Denaye Barahona: I'm still stuck in there. .

Dr. Hodges: Exactly or it's not even like, it's not even like some people do say think of it as like a one blockage, like, okay, when the blockage has gone, well, I'll be better. It's that? It's that whatever percentage of poop that's in there, you're getting only a small amount of it out each time. So there may be new poop in it every time, but you're not more's coming in and coming out or you're just not effectively emptying it. Or another relation. I thought it was like a big, big, you could have like a six lane highway. There can be traffic moving through that highway at a good rate of speed, but that's a lot more traffic than a two lane highway. Right? You, you want it to shrink down. You want to have a smaller size, so it won't affect the nerves. Now why kids get constipated?

Dr. Hodges: I think, you know, I've seen, I would never obviously tell someone to not eat a healthy diet. Every kid should eat a healthy diet, but I've been amazed at how little, not that it doesn't affect it, you should have a healthy diet. But most of the people that see me, you know, we're pretty plugged in parents. They're really involved. They're searching on the internet for problems that they're not feeding their kids bad diets. You know what I mean? If they found me there were already like really conscientious. And so even if you have a perfect diet, I think it comes down to personality and genetics. And so what I mean by that is I'll see a kid and I'll be like, Oh, he's really constipated. And I'll see a mom that looks just like him and be like, where are you constipated? And she's like, Oh yeah, totally.

Dr. Hodges: And so something about the genetics and that's probably personality based, but why that developed? I think, you know, like we talked about the horse example, we're like too smart for I'm good. Like it would never occur to an animal to not go poop. Right. your dog, you know, handles it better than, than a kid does, but the kid dog also has a pretty you know right when I say the diet, doesn't matter, I'm going to say it does. And that a kid, a dog, you know, has a pretty routine that same every day, the poops are about the same consistency, same size. There's no triggering response with the little kids, any type of pain with voiding or defecation just, just leads to guarding, reflects where they withhold. And then it becomes a habit. And that can be going from breast milk to a rice cereal. It can be adding dairy. It can be adding a whole a table food. It can be after a viral illness or where you have diarrhea and then go back to solid poop after antibiotics. So any change in the poop consistency can trigger this. And once it started, it's tough to tough to get rid of.

Denaye Barahona: So when the rectum is full, it pushes on the bladder and causes the urine to come out spontaneously. Is that a good summary of the impact that sort of the relationship between constipation and urine accidents?

Dr. Hodges: It's, it's, it's, it's, it's a better kind of model for maybe people to understand, but what's really happening is it's affecting the nerves. So the, the real estate, there's plenty of real estate down there actually, but the it's causing the nerve reflex. So the nerves that go from the bladder to the spinal cord go around that rectum. And when they get stretched, stretched, they send a signal that just tells the bladder go empty. And so it happens without any control, we just, it goes into empty mode and there's nothing you can do to stop it when that happens.

Denaye Barahona: So as with most parts of our body, the bladder and the rectum are not separate, right. They're not separate entities, one impacts the other, which, but that was news to me. I had no idea.

Dr. Hodges: Oh yeah. You know, and all this it goes deeper than that. You know, urinary tract infections painful urination, frequent urination, it's all into the pelvic floor. And there's a lot of interrelated areas with the muscles in the pelvis as well. It's, it's a complicated topic, but you know, if you get it working, right. Things just take care of themselves. So, you know, the process works fine. Like in any other animal, they just pee and poop normally, but we have to have, you know, a kid that's an retentive for lack of a better term, that's actually withholding. And once you withholding and you disturbed that kind of homeostasis, then things go haywire. But I do think it's important to note that yeah, these accents do represent a sign of some kind of abnormality that you can fix. Cause as we all know that, you know, pediatricians will say, Oh, they'd outgrow it. It's not a problem. They'll be dry when they want to. And I disagree with that sentiment.

Denaye Barahona: So I always had the assumption that there was some connection to big transitions, emotional changes in life because I noticed symptoms increase and accidents, frequency increase during times of stress. Like when we moved to a new house, huge increase in accidents just big life changes. And after reading your book, I also started thinking that usually when we're going through big changes as a family, we're also eating like crap for eating like frozen pizza, like cheesecakes ideas, like all these things that are probably contributing to the backup.

Dr. Hodges: Yeah. And that, you know, the cause we have how do I put it? Like I see a lot of kids with like histories of you know, abuse, unfortunately. Right. And there's a lot of stress in their lives for that. And so the, and you know, there's always the, kind of the, the thought, and it's not like a meme, whatever the thought of like, someone's scared, ping in themselves, you know, like really like frightened. And I seen that in animals and I guess in humans as well but w no matter what the, the, the, or associated activity or event at some point there has to be some kind of stimulus going to the bladder to make it squeeze. Right. So always look for like, what caused that stimulus? Was it like, sure. If you're really scared at one moment, you may have a action that we know that from the movies, wherever, but how is this happening all the time? If you have some kind of inciting event, it's probably leading to a series of events that lead into constipation, like you said, you moved, so you thought, well, maybe the move caused stress, but during the move, we, you know, we didn't have anywhere to go to the bathroom. We were eating and properly, we got backed up and then the accidents happen. And it happens a lot with travel as well when kids don't go to the bathroom.

Denaye Barahona: Yeah. Well, not just kids. I feel like that's also a common adult issue too. Right.

Dr. Hodges: That is so weird, I have no idea. I can't explain that. It's totally true.

Denaye Barahona: Yeah. So something I observed, I what let's see, it was almost, it was 10 years ago. I guess I was in China and I observed that there are, and I don't, I'm not an expert in Chinese culture. This is just what I witnessed there. That the kids there, the boys wear pants without crutches, and they just go, they just squat and go. Which feels a little bit like that approach to pooping and peeing, like a horse where when you go, you just go wherever you are. And it makes it a very natural part of the process. And as a result, they start potty training really early. What do you think about that versus early potty training here in the U S what are your, how does that all impact?

Dr. Hodges: Yeah, that's a great, that's a great point. So, cause my, my my journey in this process has been, you know, I mean, I have confidence in myself, but I'm not going to go, this is what we're saying here is going against all the teachings of the whole world. Right. So it's a pretty big statement to be like, I got this right. And everyone else is wrong. And so that's not really my personality. So I'm always looking for like, okay, what am I missing? And so when I first started looking into this, I was like, well, based on this, for sure, you should have problems if you train early. Right. And we saw that in our own studies, the earlier train, you have a kid that doesn't know what they're doing. They're like a year old. They have no idea when they should go pee or poop.

Dr. Hodges: So they're probably going to withhold it. And we did see in our research, the more kids had trouble if they trained early. And so every, when I, there's some kind of, it's almost like a philosophical, political or religious belief in top potty train. Right? If you believe in a certain type of potty training, you send them tend to be pretty passionate about it. And so I got a lot of pushback from the early potty train crowd. And there's actually pretty mean articles out there from the elimination communication people about me, but one of the one of the main points be like when China, that train real early, and I was like, what in the world? That makes no sense. So I looked it up and I found out about the split pants. And I was like, well, that explains it, right?

Dr. Hodges: Because the most natural way to pee and poop as an infant or baby would be to go whenever you want. So if you're in diapers that works, if you're out in the middle of nowhere, like in a very impoverished country, maybe where you can go anywhere that works. But in China, it works because they have these split pants. So I say, that's great for China, but guess what? I don't think America would want people peeing and pooping, like on the playground or in the grocery store, which is what happens. And so that's, that explains it. So the, the moment America is okay with people peeing on the slides at the playground. And I think we could do that. But short of that, the only way we can recreate that process in America is with diapers because otherwise kids are, they're too busy. They're too clothed. They don't have time to get to the bathroom.

Denaye Barahona: Yeah. If you're eliminating an elimination communication practitioner and you carry a potty with everywhere with you, I guess that would kind of replicate this.

Dr. Hodges: But you'd have to really get on it at the time. So, yeah. And you know, what, and I, and I, this is just as kind of an olive branch that I think, and I've learned, I know now that this is all genetic predisposition. So if you have 20 kids and 10 of them got constipated and they don't have the genes for overactive bladder, they will be fine. And so I'm not saying that it's okay to be constipated, but you could train a kid very young. And if they withheld, if you have no history of any problems in your family, they might be okay. But if you're looking at a population-based philosophy to provide the best health in the less accident for everyone, then, you know training them late until they're old enough to know what they're doing is a better strategy. And I just, the thing I worry about that you see, not that people can do what they want. I'm just worried about picking up the cues appropriately, because you know, when you have the people, parents of kids that are constantly, they never knew, right. So they didn't know, they had no idea. So, anytime you're doing that, you can do training however you want. But if you know, there's accents, don't ignore it knows where it's coming from and be aggressive with it.

Denaye Barahona: Okay. So early potty training doesn't necessarily lead to these backup issues later on, but there could be a correlation for some kids, depending on their genetics

Dr. Hodges: Personality and stuff. Well, some kids do great. And so I used to be dogmatic, but I realize, you know, it's not really helpful because it doesn't really apply. And there's, and I don't want to make it seem like I'm explaining a way the outcomes, but there are actual studies, right, where they did in animals and humans, where they did dilation of the rectum to see how it affected the bladder. And it varied per subject. So some people had bladder overactivity, some people peed less, they could hold their pee more. Some people peed the same. So you never know. And I would in general, you know, you want to poop regularly and get it out, but you're not going to condemn your child to actions. If you train them early, it's just a, a risk that you have to be aware of.

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Denaye Barahona: All right, Dr. Hodges, I have a couple of questions from my audience members. Actually. I had a lot of people asking the same questions. The first one is, what do you think is going on with a kid that is a camel and can just hold it for like six, eight, 10 hours and seem perfectly fine.

Dr. Hodges: Yeah, the, you know, that's interesting. So just exactly what I said previously. So we have a condition, which I don't know how it's allowed to be used anymore because it's not very politically correct, but called lazy bladder syndrome, which is not a judgment on a child, but it's just a bladder that doesn't empty very often. And, and I hate almost saying this because people are gonna be like, this guy blames everything on constipation, but the treatment for Lazy is exactly like, and I don't want to be like, you know, when you have a, whatever your hammer, the whole world is a nail, but yeah, there's there's basis on this that if you have if you're one of that subset of the population where rectal dilation leads to less bladder activity, then that can be the cost. So if you have a child that PS voyage rarely and they're constipated, then treating constipation will help with that. And so it's not really a problem to, to avoid rarely unless you're having you know, actions at some point or infections or something, but that is typically associated with it. So they just happen to be in that subset of people that when they get their record violated, it makes their bladder work less.

Denaye Barahona: Interesting. So it might not be a problem, but if you do notice urgency and that sort of thing, then there might be something to check it out.

Dr. Hodges: If you hold it too long, you know, you can have, you know, infections, especially with girls. And some kids will hold it all day and then have bedwetting. So I think it's better if you, if you have a child like that and parents as well, you know what poops are huge. They go rarely, you know, giving them something to help them put more regularly is a good idea.

Denaye Barahona: Okay. So what about the height or the kid who hides to poop and poops and that poops in their pants, or like crutches in the corner of the room, that kind of thing.

Dr. Hodges: That's been associated with constipation in numerous studies. It's a big deal. And it's just, it's a bad sign. And like, and I go back to the horse analogy, you know, like, I think you heard me talk about it where I was horseback riding. A lot, kids in the horses were just pooping as we went along. And I compare that in my brain. Cause I'm always thinking about poop, tickle a kid, you know, like stopping their playing and going in a corner and being, leave me alone. I got to poop and like how much they're in their head. So it's, it's, I would rather have a kid poop, like a horse than poop, like a kid that's hiding. So definitely hiding the poop. And parents will be like, Oh, they, they have good control of their poop. Cause they just asked for their pull up and they go in the corner and they do their business. I'm like, that's, you know, it's okay to like pause what you're doing, but that's a little bit too much in their head if, if they're having to make a a federal case out of it. So I'd rather have them kind of poop without so much so much of their brain involved.

Denaye Barahona: So you think those kids are holding a lot

Dr. Hodges: For sure. They're definitely constipated. It, it hurts them. That's why they're hiding. And if you're in a hurry, you're not going to be it out.

Denaye Barahona: So, and, and that's something I imagine you see a lot is that it hurts to go, so they hold it and then they develop this backup.

Dr. Hodges: That's basically all this in a nutshell, like how, you know, everyone's different, right? I mean, there's a million different personality variations. It comes down to, if your poop hurts, are you going to let it out or are you going to hold it? And what's your threshold. And that varies with every person and the people that let it out. They do find the people that decide. I don't like it. It's going to hold it in, do worse. And, and it can vary along that spectrum as well. How soft does it need to be for your child to poop comfortably? And that varies for every, every child.

Denaye Barahona: Okay. And that's where me relax and that sort of thing. Lexitas okay. So what about the relapses? So I got a question that said my daughter has been potty trained since she was 22 months, but during COVID she started peeing on the floor. I know it's a behavior issue, but my mother-in-law insists. It's a UTI.

Dr. Hodges: So peeing on the floor, I'd have to get a little bit deeper into that. Like this is a child walking around and, and, you know, underwear and then purposefully taking the underwear off in 40 on the floor or are they just having accidents? And so if, if they're purposely peeing, I have a couple kids like this, like they can control it. And they're just not going in the bathroom. That's a little bit beyond my area. That's more of a, maybe a developmental site kind of thing. Like why they would want to go somewhere other than the toilet, but if they can't control it and they're going on the floor, then that ties in exactly what we're talking about. And in kids that develop this stuff late, there's usually a reason, right? They, they potty trained. They were fine for a couple years and then maybe something happened to school environment or preschool dietary changes you know, maybe it's something simple as an antibiotic for an ear infection. And they, they started with holding. It became a habit and they got backed up to cause accidents. And so I'm always rule out that stuff. There's a couple of, you know, significant but rare medical issues that can be behind this, but the vast majority are are, are from constipation.

Denaye Barahona: Okay. So let me wrap my head around that. I'm thinking about the impact of antibiotics, do antibiotics. Cause constipation as a side effect.

Dr. Hodges: What I see mostly is that it's that change in, in texture, right? So it, it, when it goes from firms, so you will have a kid that gets antibiotics, they get like watery diarrhea. What typically can happen with some antibiotic wide area, water diarrhea, and then they stop it. And the next per poop is from, and they withhold. So it's usually for young kids, but it's that change is going from soft poop to hard poop. And that's why adding rice cereal or adding dairy or, or, or table food can precipitate this as well.

Denaye Barahona: Okay. So the change from exclusively breast milk or formula to table food.

Dr. Hodges: Yeah. They, they don't like that change in how it feels. Okay. And some kids, you know, even when they're born, it's funny, there's a condition called dyschezia where right when they're born, they're eating breast milk, their poop is like mustard and they still withhold it. They freak out when they're pooping and eventually they learn, okay, this doesn't bother me and they do fine. But then six months later that you had rice cereal and they start developing, holding again.

Denaye Barahona: Okay. So, and thinking about, you mentioned the transition to preschool that can happen then, and often, I mean, me being someone from the developmental psychology field, I'm thinking about the emotional impact of transitioning to a new environment and how that can have impact on behavior. And I'm thinking about it from a behavioral perspective, but from a medical perspective, it could be that they're holding because they're in a new environment and they don't feel comfortable going.

Dr. Hodges: Yeah. Think about all, that's what I tell parents. Like if you're going to go to a new place, what's the bathroom look like, have you minute, does it have toilet paper? Is there like privacy? Can they lock the door? Are they scared to go alone? Is that, you know, some toilets flush really loud. So there's all these reasons that you may never predict that a kid would not want to go there. And, you know, as you know, most people don't want to poop in public anyway. Right. And there's a whole movie character based on that concept from American pie. And so this is something that I think parents, especially with kids with accidents, need to know every time you have an open house, once we're actually back in school to, to understand where's the bathroom, what's your bathroom policy. Are they clean? Are they well-stocked? Are you comfortable going? Because some kids, you know, we need to make special dispensations for like use the teacher lounge or something more private so they can go because otherwise they just will not go to the bathroom.

Denaye Barahona: Yeah. I actually remember my elementary school bathroom was gross and the toilet paper was gross. Like it was like little Brown squares of toilet paper. It's just not an ideal atmosphere for getting kids to relax and do what they need to do at any time of the day.

Dr. Hodges: I'll tell you a funny anecdote is we have one when our first book is it's no accident. We had a project clean Tom Keating did a chapter on cause he he's basically job is to keep bathrooms clean in schools. That's just like passion. You've been doing it his whole life. And so we let him attack work with us on that because we know how important it is to have good bathrooms in schools. And and the stories he told me were amazing. Some, you know, kids were given like a square of toilet paper at a time. Cause they couldn't, you know, trust them with all the toilet paper. There were no doors, you know? So he seemed really bad bathrooms. And so that needs to be addressed. But we have one other issue of our book. I mean, one other publishing of our book in another language that's in Korean, it's in South Korea and they took that chapter out because they had no understanding of that concept. They're like, what do you mean a dirty bathroom? It's like, doesn't exist in Korea. So they're like, yeah, we don't, that doesn't happen here. So we had to take the chapter up. America has lousy bathrooms.

Denaye Barahona: Okay. So what about the kid who it's an emergency? Like they don't have to go and all of a sudden it has to happen right now. My daughter does this. Like we'll be in the car, driving on the highway and all of a sudden she has to go right now. Like immediately there's no holding.

Dr. Hodges: Yeah. And so I used to you know, early on at the, a lot of the traditional therapy is okay. Kids don't like to pee. They wait till last minute. So make them pee on a schedule. Right? So I would have kids pee every two hours. They would get no better having pee every hour I've had parents have a kid try to sit on the toilet every 30 minutes it's, you know, it's, it's dominating their lives and they would never be. And then they would get up and have an accident. So what you have to think about it is that usually they're not pooping on time, but they're paying at a reasonable time. And what I mean by that is a couple of examples. Like go home right now and hold your pee till you have an accident, do that. And the answer is you cannot do that because you will have such a strong urge.

Dr. Hodges: Your brain will make you go to the bathroom. And so that happens because there's a gradual rise, you feel it. And then it becomes so uncomfortable that you have to go pee. These kids with the constipation issues, that curve of the rise is more steep. So they may have zero urge and all sudden severe urge. So that urge comes on. So suddenly they may not even be able to get to the bathroom. They're more focused on curtsying or squatting or holding it until that urge goes away. And then they don't want to go to the bathroom again. So I've had kids that had horrible behavior. The parents blame them, not paying, not paying and they couldn't do the bowel program. So we said, okay, we'll do a surgery. Right. We jumped to Botox, which is a very effective bladder, relaxing medication if needed. And those kids, when the Botox work, they peed completely normally the next month without any behavioral changes. So that really struck me as like, this is not a brain problem. This is a bladder problem.

Denaye Barahona: Interesting. So what about the denier? Like both my kids will deny it, deny that they have to go and then like, literally I'll have, like, my son will be like, do you have to go? Do you have to go potty? And no, I don't have to go. Do you have to go? No, I don't have to go. And then he could be going and still say, he doesn't have to go. Do you see this a lot?

Dr. Hodges: There are two things that I cannot explain, but I can tell you they're very consistent. I mean, they are literally, I've never not seen it. That is number one, a kid will never say you have to go pee. If you ask them, I've never had a key. So that is so consistent. Like literally it's never happened where I go, where parents says, I told them they have to go pee. And they said, yeah, you know what? You're right, mom, I'll go pee. That never happens. And the other is that, you know, we talked about the accent being the, the bladder spasm happening in the pelvis or doesn't get to their brain so they can't control it. But then once the pees out right. And their clothes they're wet, but they don't know. And I, I can't explain that. Well, other than it's very common. So these kids they'll be walking around and they're soaking wet and the mom will say, you peed on yourself and they'll be like, what do you mean? Look down and see the pee. So it becomes so disconnected from their brain that they don't even notice the wetness, which doesn't make sense. Cause they're, you know, neurologically normal, but it's very consistent. It's just part of the process.

Denaye Barahona: And so that you would recommend they go down your mops route, which we're to talk about. Okay, sure. So I first started off because our PT or pelvic floor therapist said, you need to read, it's no accident. And that's the book that was recommended to me a couple of years ago. So I read that book first and I found it eye-opening, there were so many things from the medical perspective that I hadn't considered at all. But then I found out that you have this newer book and you have the children's book. So I, and then I read the newer book, the mop book, which came out this year, right?

Dr. Hodges: Yep. Well, we do, we kind of update it and that's a great part of having people online is that I'm updating it all the time based on feedback. And it's like having a active clinical trial or, you know, going on in real time.

Denaye Barahona: Good. And I love that the fact that you are open to changing your philosophy as you see changes within your community as well.

Dr. Hodges: Yeah. And the things that work are consistently work it's, it's impressive. You'll see a lot of people repeating the same things over and over again. So it's pretty new.

Denaye Barahona: Yeah. So I read it's no accident. I thought that was kind of more of the why book and this, the mom book is more of the, how, like how you proceed forward. Is that, do you feel like that captures it?

Dr. Hodges: Yeah. Okay. Great way to put it.

Denaye Barahona: Um and I thought both were really valuable. But also the kids book Better winning and accidents are your fault. I thought that was just, it was eyeopening for everybody. And I think just teaching our kids about healthy elimination, I mean, I think every kid should read that book, whether or not they have elimination problems because this isn't something that's taught in health class. I don't ever remember in a health class learning about healthy elimination. And what healthy poop look like versus unhealthy poop. Is that ever taught other than a medical school?

Dr. Hodges: No. No, he's not. You know, even in medical school, like I, I have partners in my own department that do what I do that, you know, don't not that they don't care about it, but they're just kind of, you know, it's just not, I don't know why it gets short shrift, but Dr. Tom Keating, who ha who did the project clean for the bathrooms? He, he had this three E philosophy. And I thought that was pretty, pretty clever. You know, we all know about eating. We all know about exercise, but what about elimination? If you don't have all three, you really can't be healthy. And so it's, it's, I always joke that, you know, I'm, I'm a pretty immature guy. You can ask my wife, I, I don't make very immature jokes or whatever, but for this topic, somehow I can like maturely.

Dr. Hodges: Think about it. Be like, look, you know, we have to, we have to talk about this. We have to take care of this. And, and I've had, you know, really buttoned up scientists, be like, Oh, you're talking about poof, and not be able to even have a discussion on it. So I think as a human, as a humanity, as a nation, we need to be like, okay, look, this is a real problem. We have to deal with it as adults. And not just, and not just a joke about it. Cause even like if kids need enemas, you know, parents were like, Oh, that's, that's a horrible therapy. You know, if it were any other disease process and the animal would cure it, I can't imagine they would be opposed, but because accidents are seen as just like a childish behavior, not a real problem, it kind of gets Ignored.

Denaye Barahona: So, your approach in general, the whole mop approach is viewed as some, by some, including some physicians as extreme. What are your thoughts about that? And what do you recommend if someone wanted to take this approach and their pediatrician or their other physicians didn't agree with it.

Dr. Hodges: Yeah. It's unfortunate if the doctors won't help because I'd rather have a, you know, hands-on physician on board, but I, you know, I would put it to them and say, you know, okay, what's your alternative? You know what, what's the therapy that you recommend because, you know, I don't, I'm not. So caught up with myself if they get better with something else I'm upset. I want everyone to get better. So if they get better with another program, that's great. I just, haven't seen another program work as effectively. And if you take it down to like, you know, Ockham's razor, you know, we have this problem, which the fastest way to fix it straight line, and that's where it is. And so if your Pediatrician offers a better therapy, that works. That's great. But if you're, I had a patient write me, I get a lot of these letters.

Dr. Hodges: It's funny. And I don't mean to make light of it, but they'll say, you know, my, I had, my child had this problem for years. I found your stuff. I did Enemas. They were doing better, but then my mother-in-law or my mom or my doctor said, enemas are bad. So I stopped him. And now he's worse again, what do I do? And I'm like, I think you answered your question, you know? And so I, I do encourage people to work with their family physicians, but if not, you know, we do have a lot of resources online for over the counter therapies that can be very effective with minimal of physician guidance.

Denaye Barahona: Okay. So in your first book, It's no accident, you advocated for an oral laxative clean-out, but since then, since your new book came out, it sounds like you have new evidence that leads you to want to go straight to the enema approach. Is that accurate? The change between the book?

Dr. Hodges: Yeah, for sure. And this whole, this whole kind of journey has been one of me going thinking of a therapy, thinking it may be too much and then not wanting to do it, and then realizing it was the best therapy. And that started with animals early on where for the first book, I was like, Oh no, one's going to do enemas. This is, you know, I'll just try me. And, and that was, it was just new to me. And I was just seeing, you know, I'd cured, like, you know, some neighbors just by saying, take me relax over that, you know, as bypass them on the street. And so I was saying, you know, this is going to be easy. And as I got a larger and larger patient pool from all over the country, all over the world, I was getting these much more complicated cases.

Dr. Hodges: And I realized that, you know, Enemas were more effective and why not use them if that's the best therapy. And the same thing has happened with Ex-Lax too. You know, I was using a lot of mere lacks early on because it's easy and some people oppose MiraLax for various reasons, but I found that to fill up the rectum with, if it's dilated, you have to use a lot of mural X. So sometimes it's better to use Ex-Lax, which can make you empty before you get filled. And and I was afraid to use it, but I met with some, you know, doctors learned how safe it can be and how widely it is used. I've had some good success with that very recently. So that's the most recent change that a lot of Ex-Lax to our chop protocol.

Denaye Barahona: Okay. And I think that this in general, it's just it's can be a fast process and it can be a long process. Right?

Dr. Hodges: Yeah. The main thing is,utwo mistakes parents make one is that they give up too easy to say, Oh, it's not working. And they give up, you want to, you want to,umake sure that you're committed. You know, it's not going to be an overnight, even with, if there's just bedwetting, it usually takes longer than,uone to three months. Uso stick with the program and make sure that you, you,uare doing it correctly. But the other problem is some kids, parents are just start enemas and just not look back. And at six months go by and they're like, well, I've been doing animals for six months. Why am I not better? You can't let too much time go by because just the act of doing the enema does nothing by itself. The way you cure them is by fixing the rectal dilation. So if you're doing animals and you're still have rectal dilation, you've done nothing. So you have to find an enemas composition and type and protocol that's leads to our goal. And it may be a large volume enema, maybe a small volume enema. It may be mere lax. Maybe Ex-Lax every kid's different. And I can't predict who will get better, faster, but I know that if you're doing something and after four weeks you've seen, so you've not seen progress. We either need to change protocol or get an x-ray or both.

Denaye Barahona: So for people who are not familiar with enemas, this is kind of how I envisioned them working. And tell me if this is wrong, this is how I explained it to my husband. So basically it's kind of like if you clean out a kid's ear and you use peroxide or whatever solution, and the solution goes in there and it kind of breaks up the ear wax until the ear wax comes out. So with the, is that what the enema is doing basically on the impacted poop?

Dr. Hodges: Yeah. So it does a couple of things. It causes the influx of fluid. So we're going to have a dried out poop. It's going to make it more moist. It's going to be softer. And then it also causes contract contractions of rectum. So you're making the poop softer. You're making the area around it squeeze. So you're leading to easier emptying. And so, yeah, I think it's essential. You have this blockage I hate say blockage. Since, you have this big mass in the way of a small opening coming up from below is a lot easier than pushing it from behind as mere lax would do.

Denaye Barahona: Okay. So then once the, the backup is removed, then you, it's not fixed necessarily because you still have the rectum, which has been stretched out because of this prolonged period of retention of bowels, so then you have to keep them empty.

Dr. Hodges: That's a two-step process. You said it perfectly, you have to empty and then you have to keep it empty. So there's tone is restored. And so that, that's a little tricky because a lot of parents will be like, well, okay, they're full. I get it. I saw the x-ray, can we just go to the hospital and get me cleaned out? And I was like, well, you know, you could, but that's not fixing it. And there may be a role for that, but that's not going to, it's just going to fill up again as they eat. And they won't feel the urge to poop until it fills up. So you really need to have an enema that, you know, gets them empty every day. And that's the key. Okay,

Denaye Barahona: Good. Well, thank you so much for this. This has been so enlightening. I feel like it's kind of opened up a whole new world of thought for me thinking about bedwetting and accidents from a medical perspective, because like I said, I had always really approached it from an emotional and behavioral perspective, and I think we need to make sure that we're giving it a holistic view.

Dr. Hodges: That's awesome. Thanks for having me. I'm, I'm, I'm really grateful for giving us a platform to spread the word because I think it's important.

Um yeah, I'm talking about poop is probably a hard sell, right?

Dr. Hodges: Yeah, it is. Unfortunately. but it's important.

Denaye Barahona: Thank you, Dr. Hodges. Thank you so much.

Denaye Barahona: Thanks so much for tuning in today. I'm going to put the links to Dr. Hodges books in the show notes at simplefamilies.com/episode253. And remember enrollment for the mental unload is now open. Go to simplefamilies.com/unload to grab your spot. We start on Thursday, February 11th. Thanks again, and have a good one.