Potty Accidents, Bedwetting, and Constipation with Dr. Steve Hodges
00:00:00 Alyssa
You're listening to Voices of Your Village and, boy, do I have an episode for you today. I have not stopped talking about this or thinking about it, to be honest. I've had so many conversations with people in my real life after having recorded this episode. I got to hang out with Dr. Steve Hodges. He's a professor of pediatric urology at Wake Forest University School of Medicine. He's a leading authority on childhood toileting issues, and he's dedicated to debunking common myths surrounding daytime and bedtime wetting and poop accidents. He emphasizes that these issues are never a child's fault. Dr. Hodges, residing in Winston -Salem, North Carolina, with his family, has authored eight books for both parents and children, such as the M .O .P. Anthology and Bed Wetting and Accidents Aren't Your Fault. He shares valuable insights through his blog at bedwettingandaccidents.com. We got to chat about accidents and bedwetting and constipation and I literally was like, oh my gosh, mind blown. And I've been really taking this into my parenting. I share a little bit about Sagey and our experience with Sage, but since this episode, when I recorded it, Mila has now started solids and I have taken everything I've learned from Dr. Hodges in this episode into that journey with her. And it has informed like how I'm approaching her diet and what we're looking at when, you know, she went from pooping every day as a nursing babe to then going a few days and seeming uncomfortable and just trying to figure that out and navigate it. And I'm so grateful to have Dr. Hodges resources and for his knowledge shared in this episode to navigate that now with Mila. I cannot wait to hear your thoughts and feelings and feedback about this episode. Please take a screenshot and share it over on social and come tag me, let's continue the conversation over there at seed.and.sew. Also, if any of this is serving you, please take a minute to rate and review the podcast on whatever platform you're listening to. It helps us reach more folks with free information to navigate the challenges of raising tiny humans. We don't have to do this alone. Thank you so much for being in our village. You're the bomb. All right, folks, let's dive in.
00:02:42 Alyssa
Hey there, I'm Alyssa Blask Campbell. I'm a mom with a master's degree in early childhood education and co -creator of the Collaborative Emotion Processing Method. I'm here to walk alongside you through the messy, vulnerable parts of being humans, raising other humans, with deep thoughts and actionable tips. Let's dive in together.
00:03:04 Steve
Hello. How are you?
00:03:05 Alyssa
How are you, Steve?
00:03:06 Steve
Good, good, good. Great. Let me shut this off here so you don't hear my alerts.
00:03:14 Alyssa
That digging sound we all know.
00:03:17 Steve
Yeah.
00:03:18 Alyssa
How are you doing?
00:03:19 Steve
Good.
00:03:20 Alyssa
Are you from North Carolina?
00:03:22 Steve
Yeah, I'm from Winston -Salem.
00:03:24 Alyssa
You're from there, rad. My brother, I'm from upstate New York, near Buffalo, but my brother and sister -in -law and their three kids moved down to the Wilmington area a couple years ago. And we've been sneaking down in the winter for a couple of weeks the last couple of years when we can't handle being in Vermont anymore.
00:03:45 Steve
It's hard to leave the South if you come down, I hear, just because the cost of living and everything.
00:03:50 Alyssa
Yeah, a hundred percent. Yeah. we started like looking around and we're like, oh, everything's so much more affordable than Vermont. And also you get sun, which sounds great.
00:03:59 Steve
Just don't come down in the summer though. It is humid. Maybe near the water is better, but...
00:04:03 Alyssa
Sure, sure. That makes sense. Well, I'm excited to get to hang and chat. This is, I mean, a topic and just a word I feel like that hits a whole lot of households. I have a three -year -old who's very into poop and pee and all things related. Yeah, and I think a lot of folks can relate. What a wild path as a pediatric urologist.
00:04:24 Steve
I know. It's funny because, you know, it's not something people take seriously, but it's a serious problem. Costs a lot of money, affects a lot of lives, so I appreciate you taking time to cover it.
00:04:35 Alyssa
A hundred percent, yeah. Again, I think it's something that affects a lot of households. I'm hoping that we're gonna hear there's a lot of, like, misconceptions. I think it's something a of people have questions about.
00:04:46 Steve
Oh, for sure.
00:04:48 Alyssa
Most notably in your work, the thing that jumped out at me that I was like, okay, yes, let's have this conversation was the emphasis of these issues are never a child's fault.
00:04:58 Steve
It is, it is. The abuse part of this is horrible. I hate even reading about it. It happens a lot though.
00:05:06 Alyssa
Yeah, I think a lot of people are like, I don't know how to make changes and like there's fear and perception. And I have had folks in our village too where like kids have to be fully potty trained with no accidents in order to go to preschool or to go to this camp or to go to that. And so there's this like pressure, I think, for parents and caregivers to make sure things are all buttoned up and ready to rock by certain ages.
00:05:30 Steve
Yeah. You know, if you have a kid just having frequency, which is a problem related to kind of poop issues too, like, you know, you get peed and like five minutes later, like I got to pee and you're in the car, you're like, 'you just peed, you don't have to go'. I get it, but the kids feel it. They're feeling it for a reason. There's usually a poop reason, but it can frustrate even the most, even keeled parent. If you think that maybe they're playing games or not going when they need to or not doing what they're supposed to, and you know, 'you were just in the bathroom, why do you have to go again?' Or 'you peed on yourself, why didn't you go when you felt it?' It's frustrating. So trying to get that, for parents to see that more clearly is definitely one of our goals.
00:06:10 Alyssa
Yeah, I think that's rad. When we're looking at things like daytime accidents, whether it's pee or poop, can we kind of dive into some things that might be going on here for folks who are on this journey?
00:06:23 Steve
Yeah, I like to say, first off, don't ignore it because a small percentage of kids, if they're peeing or pooping on themselves, have a serious condition, right? Maybe there's something wrong with their spinal cord, their anatomy, how they're built, just physically, and seeing a doctor can rule that out. And if that's all ruled out, great, and then you can start on what we deal with it, which is 99 % of the time, kids have delayed pooping long enough that poop's gotten backed up, backed up, backed up to an abnormal degree, that now it's causing abnormal urine emptying or poop just falling out and they don't feel it. And all those accidents are not sensed by the child, they're kind of happening in the pelvis, they never get to the brain. And so by reversing that and restoring the colon size and function to normal, they typically go away.
00:07:13 Alyssa
Ok. So many questions. Fascinating. Why would we get to that point where we are seeing such constipation where they're so backed up that we're seeing these other trickle downs. What kickstarts the constipation?
00:07:27 Steve
You know, it's, I have my own theories and I used to think it was different things like maybe the age of potty training or diet, whatever. I think it's primarily driven by personality and genetics and so forth. Almost always if I see a kid that's backed up and I see their mom looks just like them, I'm like, were you constipated as a kid? And they're like, yeah, I was. And I've seen kids backed up that are on the cleanest diets you ever imagined. And I'm not saying diet doesn't matter, I'm just saying that you can be doing all the right things and they'll still get backed up. And you have a three -year -old you said?
00:07:58 Alyssa
Yeah, I have a three -year -old.
00:07:59 Steve
Do you have any other kids?
00:08:01 Alyssa
I have a four -month -old.
00:08:02 Steve
Okay. So you've seen kids poop and how it can be stressful and it can be like intense. Maybe you've seen your three -year -old go hide somewhere to poop or just intently try to force it out. But it shows how difficult that process can be, how it doesn't feel right to them, how it's a very natural thing, I think, for modern humans to be uncomfortable with that. And then their easiest solution is just squeeze your sphincter. It's over. Done with. And then in their mind, problem solved. But literally, it's just kicking the can down the road and then it gets more backed up. So they develop this behavioral withholding, and it is just a very human thing. It's just – it happens to people. And I don't know if – I joke in our papers that the brain is too big for our own good. We're too smart for our own good. It wouldn't occur to a cat or a dog or a cow to hold their poop, but we figure that out. And then, you know, the kids are clothed. It's not like they can just poop anywhere. Diet's not, it's not like you're living out in the woods eating raw fruits and vegetables. You're eating regular, processed food, which does have less fiber. But I think, you know, I don't know what in human history led to this, but it's not a new problem. It's been going on for a while.
00:09:14 Alyssa
Yeah. So I taught preschool for a while and I was thinking of this little guy that I had who had a really hard time pooping. He would never poop at school, but then would be constipated and uncomfortable and, you know, wondering how much just like that safety, like sphincter law plays into this of the ability to relax and like, oh, and, you know, we see it in, on our side over here with birth of being able to open up a cervix or that ability to relax. I'm wondering if that, what role that plays here when we're looking at the like kind of psychological aspect, the anxiety, the fear, the like then holding piece.
00:09:50 Steve
Yeah, there's definitely people that have high tone pelvic muscles. So if you go back far enough, they used to think that there was actually blockages in the sphincters, like urologically speaking back in the 60s, 70s, 80s. So a lot of people that were having accidents would get bladder neck dilations because of this. When they would scan them peeing, they would see what's called the spinning top urethra. So then urethra, bladder would open, the urethra would narrow down like that. They said, oh, there's a blockage there. That's why this kids having accidents or infections, they would go dilate it. And then in more modern times, if, you know, they go scope these kids never saw a stricture, so they were like, what are we dilating? And so they thought, to your point, that people are not relaxing or paradoxically tightening the sphincter when you should be emptying. So, like, one big misconception we'll see is a lot of kids are having accidents, so people will say, even doctors will say, well, you know, do Kegel exercises. The sphincter is usually overactive in these kids, so it's not their ability to hold it, it's that the bladder is emptying inadvertently. What I've seen is that yes, there's a pelvic floor component, but if you put all the right pieces in place, it just happens. And I'll give you an example. Some kids, you know, just don't like pooping, right? And so they'll, if they sit to poop, they won't relax their sphincter. They're scared. Maybe it hurts. And if you've ever had a hard poop, I have, you have to will yourself through it.
00:11:08 Alyssa
Sure. You have to mind over matter.
00:11:10 Steve
Yeah. You have to relax. So what we find is if we get the poop soft enough, certain kids will go and then they realize, okay, it doesn't hurt and they'll go. Other kids are just, it's ingrained in the brain, they won't go. And so we have to overwhelm that with like ex-lax. But if you get a strong enough urge where it's coming, the sphincter's like, it doesn't have a role anymore because the poop's just coming and they have no choice. So the body kind of does what it's supposed to do. So yeah, I think there's a role for physical therapy, but also a role for the kind of laxatives. And I think without both of them, you kind of, you don't treat it well.
00:11:41 Alyssa
Just like flushing the system
00:11:43 Steve
Yeah, and just getting an urge strong enough that you have no choice like it's coming, to overwhelm almost their ability to hold or so the guarding reflex isn't as a big a deal And it's definitely a problem I see with parents trying to reason with their kids that you can't reason your way through how to pee or poop. You have to feel it. That's why like kids who are having accidents, like just go pee every two hours doesn't work that well because they're not having the proper urges and so it's an artificial system, but if you can make the colon, if you can shrink the colon down so it functions normally and then therefore the bladder functions normally, everything works great.
00:12:19 Alyssa
Incredible. Okay, I'm just very intrigued. So if your kid is refusing to poop on the potty or they are doing the clenching, what's a parent's next step there?
00:12:30 Steve
So if you just have a child pre -potty training that's withholding, we have a book on that, it's called The Pre-M.O.P Guide. Pre-M.O.P is the plan we came out with prior to kids needing M.O.P, which is our treatment for incontinence, to help prevent incontinence from developing. And basically, it's some type of osmotic laxative, like magnesium or Miralax or lactulose, every day. And on days they don't go or they're struggling, it doesn't have to be every day, but you want to be going regularly. Especially if you catch them struggling, you can just pop a little solid suppository or liquid in there to help it out. And then you add a little more laxative until finally you kind of get the dose up to a level where they poop normally. And the goal for pre -toilet training kids is that the pooping should be a non -event. They should just be walking, stop, poop, keep walking. You know, it should be that easy. They shouldn't have to hold on to a railing or go hide somewhere. And that's how you know you're doing it well. And if you do that, then potty training should be a lot easier.
00:13:30 Alyssa
Yeah. Okay. Fun. Okay. My little guy potty trained, I like don't even like to talk about it because they feel like it's not the norm, so easily. Yeah. He had one, like started to pee accident at the very beginning and then like caught himself and went to the bathroom and finished. And I was like, nobody look over here because this is, I've potty trained so many kids in preschool--
00:13:52 Steve
Yeah.
00:13:53 Alyssa
And that has not been my experience. He has a really sensitive interoceptive system. So he is like when he can tell you when he's starting to get a little bit hungry, he gets real hangry and he starts getting a little tired, he gets real tired. And his internal body cues are heightened. He's really aware. He can say like, my heart's beating so fast and he's been able to say that since before he was two. Like he's really clued into those like internal cues. And so I kind of always chalked it up to that of like, he's really aware of those feelings and he can notice them and then build the skill set to able to like pause what he's doing and go. But I'm curious about that, like that interoceptive awareness piece when we're looking at the eight sensory systems, like what role that plays and for kids who might have low interoceptive awareness, if they're not getting those kind of body cues internally sent to them, how that might play into their ability to notice when it's time to go.
00:14:51 Steve
I think what happens is how you respond to the cues initially. So let's say that there's a kid that's, you know, fresh out of the womb, whatever, everything is working perfectly, like God intended, and they get the urge to pee or poop, may feel some of the peeing, but a lot of the peeing happens as reflex at that age, as very young infants. The pooping though, they definitely feel that more, and I don't know, I think, again, something we should do like personality tests and profiles later on. Something in some kids lets them go, I'm just going to let this out, and other kids say like, I'm going to fight this with everything I have, and so then, and then how they respond to different levels of needing to poop, right? Some kids may not care. Some kids are very sensitive to it and hold right away. But once you stretch out the colon to a certain degree in susceptible populations, again, the amount it stretches and how that affects the bladder or the colon varies. But once you get that beyond what's supposed to be like physiologic, then you lose a lot of the sensations. So all of a sudden, they don't get to your brain or you just have bladder reflexes. It's almost like someone's coming to hit your knee with a reflex hammer. Why are you kicking your leg? And like, well, you know, I'm not trying to.
00:15:59 Alyssa
Sure.
00:15:59 Steve
Same reason. Why are you peeing? Well, I didn't mean to. I didn't know it was coming kind of things. I think what you said is correct, but also at some point it's beyond that and they've lost all control.
00:16:09 Alyssa
Sure. What age -ish should we be looking at seeing like, oh, daytime accidents start to decrease and they have that awareness and can pause and go?
00:16:18 Steve
Yeah. So I think potty training at various ages is possible. Whether or not they make good decisions again is something parents should maybe keep track of. If you get a potty, kid that happens to potty train early, that's good in terms of your life and expenses, but you do want to make sure they poop regularly and don't hold it. But I think that -
00:16:38 Alyssa
Can I ask you a question? When you say poop regularly, how often would people be looking at that?
00:16:44 Steve
I definitely like daily. I mean, the moment I say daily though, some mom's going to be real upset if they don't go daily. So if 36 hours is fine, but you know, you don't want them to be, I think if they're not going enough, you're going to see it, right? You're going to see that you're going to find them in the corner hiding with the red face. So that's a bad sign. But yeah, so if you have this infant voiding reflex that is present in babies, they just pee, they don't even know it. And then at some point there are transitions to the brain being involved with an adult voiding pattern. And that, I don't think that one turns off, one turns on. I think it's a transition. The persistence of the infant pattern is probably what causes incontinence, and that may persist differently in different people, but definitely constipation makes it persist. You don't have enough of that adult pattern plus the awareness until after three in my experience, but some kids are different. So three and a half is usually a good number for me because I know three might be too early for some people. Four, everyone should be potty trained if they're developmentally normal. So I usually say three and a half, but obviously that's everyone's a little different and there can be factors that affect that.
00:17:47 Alyssa
Sure. Yeah. Yeah. We were very much to like take his lead. In fact, he started to want to poop on the potty just before he turned two, but it was frankly inconvenient for me. It was like winter in Vermont and I was like, we're going to be in so much gear. I'm not going to potty train.
00:18:04 Steve
Yeah. Right. Diapers were easier.
00:18:06 Alyssa
Correct. We're going to wait until summer. So that's what we did. We just like, we were like, sure. Anytime we were home and he wanted to, he had access to it. But otherwise, we kicked that can down the road and revisited it in the summer where, yeah, he, just over two, was able to do it, but it was very much just like it was initiated by him. So we'll see what my little girl does and if there's any initiation there, otherwise.
00:18:28 Steve
Everyone definitely is different and some kids just don't ever have a problem and that's great. Some people, you know, have the other extreme where they just don't ever want to poop and it's just everything in between.
00:18:36 Alyssa
Yeah, yeah, for sure. So right now what we're looking at in my household is like the nighttime component. And we never took nighttime or naptime diapers away. Again, largely for my convenience. I was pregnant and then had a baby and was like, I'm going to be up enough already. I don't want to be up with you too. If I can kick that down the road, what age should we start to see like bedwetting decrease and for them to have that control?
00:19:04 Steve
Yeah so that's an interesting topic, very controversial. Okay, so about 25 % of five -year -olds have incontinence and the majority of them are bedwetters. And then about 15 % get better a year. So the traditional teaching has been five or six, you can start treating them. And that's reasonable. I'm not going to be overly dogmatic about that. But the kind of pioneer of our research that is kind of a mentor of mine that started all this, treated his son at four and treated him successfully.
00:19:38 Alyssa
What does treatment look like?
00:19:40 Steve
So this guy, his name is Sean O 'Regan. Our M.O.P book is The Modified O'Regan Protocol. He's kind of the one that figured this all out and he's a brilliant guy and really hasn't gotten the credit he deserves for what I think is a very brilliant discovery. So his son was wetting the bed. He was a nephrologist, right? They're medical pediatricians. They're not surgeons and they usually don't see bedwetters or wetters at all. They see, maybe occasionally, they see kids with kidney disease and, um, sometimes UTIs and sometimes reflux, but they don't do the stuff we do in terms of number, or degree of wetters, but his son was wetting the bed. So he told me, he says, I, my wife was like, you're a doctor, you can't fix this? And he's like, I'm going to show her. And so when he researched bedwetting and he found that there was a very strong link between bladder dysfunction and bowel dysfunction, particularly, he said he saw research back to the 1800s, but there's a paper in the middle of 1900s by Schopfner with kids with Hirschsprung disease that had significant bladder dysfunction just because they had a dilated rectum. And so he made a brilliant conclusion that I bet my son has a dilated rectum from withholding poop. He then did two, what could be called crazy things, but ended up being brilliant. He did an anal rectal manometry in his son, which is a test to measure rectal dilation. Put a tube up their bum, you blow up a balloon and you see when they can feel the balloon. And his son didn't feel the balloon until it was three times the expected size. So he said, well, there you go. I was right. He's backed up. And he said, you know, how should I treat this? I'm going to give him an enema every day. And that's what he did. And his son stopped wetting the bed in a month. So I would say that all kids that wet the bed have some degree of rectal dilation that could be made better with treatment. How aggressive you want to be for a kid that's young varies but I think, you know what I'll use one of my daughters, I won't name her, she never had problems pooping, was great probably trained easy, but she was wetting the bed. So I said okay you're wetting the bed, I know this problem's there, I just gave her Miralax for a few weeks, a few months to keep her regular she stopped wetting the bed and we were done forever.
00:21:39 Alyssa
And then do you have to stay on the Miralax?
00:21:41 Steve
It depends on the kid. There's an urge to poop, and a softness of poop that it's that I will go where I won't go for certain kids and that varies. Some kids need, you know, ex-lax to go or they're not going. Some kids need at least a daily Miralax to keep them regular. Other kids will go on their own. So you have to see what your kid's like. But yeah, if you're seeing wetting, you can likely make it better. And then if you make it better, just got to see how your kid does. But when I give Miralax or something like it, I usually say, well, let's just keep them on it till they're like in kindergarten, get through that classroom, talking about it. And then we can kind of go to as needed if they're doing okay. Those things, when you can talk to them about it, it seems a little bit easier to manage.
00:22:21 Alyssa
Sure, sure, sure. Interesting. Okay, also another thing I don't ever say out loud, but Sage, from the minute he potty trained, he wakes up with a dry diaper every morning. And I was just like, this is an anomaly, I'm gonna say nothing out loud.
00:22:34 Steve
Except maybe he's just a really good pooper, right? And that's normal.
00:22:36 Alyssa
Yeah, he is a really regular pooper.
00:22:37 Steve
It's supposed to be normal, but we mess it up a lot of times, right? People have accepted bedwetting as normal, I just don't think it is, you know?
00:22:45 Alyssa
Yeah, that was my next question was like, Is this just a culture shift where, I mean, even with keeping him in diapers at this point, he doesn't need one. It's now just an expense for me overnight when he could be wearing underwear. But at first when I had said, like, yeah, he was too in -chain, I was like, he's waking up dry. Maybe we'll just pull the diaper. Anybody I said it out loud to was like, you're nuts. It's not going to last. Let him wet the bed. I think culturally, yeah, we're accustomed to, they're supposed to keep wetting the bed overnight for a while but they'll outgrow it.
00:23:18 Steve
One thing I'll give you for that is when they're really young you have a hard time knowing like did they wake up and not need to pee and not go you know I'm saying? Or you have a two -and -a -half three -year -old you don't, they can't go to the bathroom on their own, or they may not know the difference of peeing in a diaper versus a bed. Once they're aware they should be able to stay dry honestly.
00:23:33 Alyssa
Yeah and even now like he will wake up in the middle of the night if he has to he'll call out and say like have to go pee and we'll get him out of his crib and bring him to the and he'll go and go right back to bed.
00:23:45 Steve
Yeah, he's got some good bladder genes.
00:23:47 Alyssa
He does, he's got real good bladder genes. That's what I'm saying, I'm not trying to say too much out loud about him. I don't think it's the norm. Is this then something that they would grow out of? Like say your kid potty trains around three and you're still seeing bedwetting, is there any case for like, let's wait and see what happens over the next year? Or is it just like once they start to potty train, if you're still seeing bad wetting, then we got to start diving into some poop stuff?
00:24:18 Steve
Yeah, I think the latter, is my bias, because the former has been the traditionally what's done. Problem with that is, yes, you're right. Like I mentioned, 15 % get better a year, but you don't know if you're the one -year kind of kid or the 10 -year kind of kid. My clinic is full of 10 -year kind of kids, so I'd rather just kind of start treating if you make it better. I mean, again, I'm not going to be super aggressive for a four or five -year -old, But, you know, if you can make small changes like I did with my daughter and it works, then you save yourself a world of hurt. Again, my clinic is full of parents that say, you know, he's 12, he's been seeing a pediatrician for six years, every year they say he's going to outgrow it, nothing's better, and he's missed a million sleepovers, he's stressed out about it. And then a little side note, a little area of research of mine, or at least contemplating research is that it affects sleep. I've done a lot of looking at the papers and even though people think kids sleep too deeply and that's why they wet to bed, it's actually the reverse. Kids sleep poorly due to the bladder overactivity and if you have a kid wetting the bed every night they're probably not getting restorative sleep so you're doing them a harm by not treating it, I think.
00:25:16 Alyssa
Sure, sure. Okay... I heard a thing, that we might debunk here, that for, that there's some sort of hormone situation that kick -starts that then kids stop having to go overnight or they start to notice that they have to go when they wake up, and that it starts at some point in early childhood, around five, six, seven. And then if it doesn't start, they have to take a hormone replacement and then it could start in teenage years where they start producing this. Have you heard this before?
00:25:48 Steve
Yeah, I can explain kind of where that comes from.
00:25:50 Alyssa
Thanks
00:25:51 Steve
There is a treatment for bedwetting that's very common, which is a desmopressin, which is an antidiuretic hormone, which makes you... Expect the opposite of if you drink a beer and you pee more, it does the opposite. Instead of diuretic hormone, it's the antidiuretic hormone. And so even though at the end of the day, you have to have this kind of bladder overactivity, you have to have this persistence of the infant voiding pattern to have the bladder squeezing empty without telling the brain, right? It has to be a sacral reflex. That reflex in and of itself, it's influenced by other factors, right? Like how much did you drink? How fast did you drink it? If you never made any pee, your bladder is not gonna contract. So you can influence, and that's a good point because all the myths of bedwetting came from these ancillary factors. The rectal dilation is going to make the infant reflex persist. And so if you fix that, the problem is solved because it would get to the brain anyway and they would wake up no matter what happened. But if you have this reflex persistent, then if you make them make way less pee, they're less likely to wet. So that's why those pills can work, although they're not perfect and they work poorly. And two, if you put a bedwetting alarm on them, you're recruiting the brain, training the adult pattern to take over. So that's why bedwetting alarm can work even though it's not, it's imperfect and has high relapse. But at the end of the day, what changes is that this reflex wanes with time. Like all infant reflexes, there's no need to have a reflex to pee without feeling it when you're 20. And so that reflex that was present when you're one will be gone when you're 20, but it persists in some people and mostly persists.. the amount of persistence varies genetically, but it won't persist without this rectal dilation. God designed- had a good system, but we messed it up a little bit. And so that transition from infant to adult voiding is what we're dealing with. And that's what does disappear over time.
00:27:48 Alyssa
So that pill treats the symptoms rather than the root cause.
00:27:51 Steve
Correct. Exactly right. And it's poorly effective. It does help. I use it. I mean, if kids want to get dry, they want to get dry. And we'll use it sometimes, but it's not the, it's not fixing the problem.
00:28:00 Alyssa
Sure. That makes sense. Wow. Okay. So, wow. This is for me, just like a whole new lens. This is something that is really new. And I think at least in my like parenting sphere, I hang out, we've got about 300 ,000, little over, folks in our community. And I'm so curious to, I'm so curious to hear from folks, like, for how many of them this feels like new news? Sure does on our end. I know when the podcast pitch came in from your team to be on our podcast, I was like, wait, help me understand. How are these correlated? And as we started to look more into it, I was like, oh my God, yeah, I have to chat with him. I have so many questions. But yeah, I'm really curious to hear from folks how this feels for them. And if it feels really new. Where is this like being circulated? Like I said, like this is kind of new news on my end, and I hang out with parents and teachers in the early ed world all the time. And so I'm wondering, is this something new in terms of how we've been treating it from an awareness standpoint, or has it just not gotten into the Zeitgeist?
00:29:11 Steve
Yeah, that's probably partially on me, partially because of the topic. Like Dr. O'Regan, every time I talk to him, he's like, it's not a palatable subject, right? People don't like talking about pee and poop. And then there's a lot of, you know, when you get into these kinds of things in medicine and science, there are people that think that I'm wrong, right? And they're professors and they have their own research. I don't know. Obviously I really believe our theory. And I think what makes a good theory is that you can predict, I can predict what's going to happen based on a theory. And like, if I have kids that we give really big enemas to, because early on we tried to flush them out more we used larger volume and we made them wet more. Isn't that interesting? Because we stretched them out more. Volume. So we learned that, I was like, oh my goodness, that's like, it was a failure, but it like reinforced my, like we did it. I've had kids that wet their entire lives and then one enema and they're dry and then it comes back. I've seen that a lot. So they were so full for so long and then they had one night of kind of recovery, they're dry, but then it refilled and it was harder to fix. All these things that, oh, and then like kids, as they get full, their rectum gets full, the bladder gets more overactive. So like maybe at this fullness, there's bedwetting, but then more full, there's daytime symptoms, then day wetting, then poop accidents, and then they get better or reverse order. That being said, we've kind of started writing about this around 2010, 12, our first book. And you know, if there's scientific papers out there, there's scientific papers out there that say I'm wrong. You know, it's funny, I mean, we had one published and our residents kind of made fun of me for it. We've done a lot of blogs, podcasts, we have a website, bedwettingandaccidents.com, and we've helped a lot of people all over the world. You know, one thing about it, I think probably, and I want to make this point clear, is that I'm completely convinced in this theory and that we can help these kids, but it's not as simple as you think. Some kids, I've had, you know, neighbor's kids and my own kids, you just give them some Miralax, they get empty and they're dry. Other kids, you know, they've done 90 days of enemas and they haven't put a dent in it. The rectal dilation causes these problems. That's been proven by others, not even us. But it's not easy to get it empty in some people. And so I could see folks like try everything, you know, and this is a kind of desperation some parents are in where they'll try any kind of thing. And I don't want to be seen as a kind of a last resort. I want to be seen as the scientific cure. But if they tried, name something and it didn't work they try my theory and didn't work, then how are we different? So you have to really teach them about it and then see that you can't just go through the motions. You have to actually fix the problem and hopefully they will see progress and we're here to guide them through it if they need the help. But that's hard, I think, because if it was like one pill and you're done, then that would be easy, but it does take a lot of work.
00:31:57 Alyssa
And it sounds like sometimes consistency, right? Like you were saying, where maybe you empty everything and then you're staying on Miralax or et cetera. My like charge to folks tuning in is to, if this is your kid, if you are seeing bedwetting, if you are seeing this constipation or they're holding their poop, et cetera, and you play this, you go to bedwettingandaccidents.com and you start this process, I wanna hear from y 'all on like, I want all the dirt, how does it work? What was your experience with it? So that we can circle back and continue to talk about this and share people's experiences and share this as a resource, because I know so many folks are, I think often sitting in like shame or silence around it, and they have a kid who they're like, no, don't talk about it, that I can't go to sleepovers because I'm wetting, et cetera. And so I think that there's been like a lot of secrecy and silence and shame in this space that talking about it and sharing resources like this can be so helpful for. Thank you so much. Thank you for teaching me literally a full new thing today. Usually when I get to hang out on the podcast, I like learn things along the way, but I have a baseline knowledge, and this one I came in fully green. It was really fun for me. Thank you so much.
00:33:14 Steve
Thank you. I hope it helps some people and you know, we're around to help and to help reinforce what you're saying. These families, 99 % of our moms come in saying, no, my kid poops great. It's not the poop. So check the x -ray. It really helps.
00:33:27 Alyssa
Check the x -ray. I love it. And you have a audience giveaway 12 Signs Your Child is Constipated. We will link that in the blog post in the show notes for this episode for folks who want to snag that. Thank you so much.
00:33:45 Steve
Awesome. Thank you. It's great. Really appreciate it.
00:33:46 Steve
[Music]
00:33:52 Alyssa
This morning I asked Mila if she ever planned to sleep again and the answer is currently unclear. She just started chatting and I'm not sure if she meant yes, yeah mom, I'm gonna work on that, or if she's trying to pull some stuff like she has for the last now basically two months where she's up. Oh my gosh, I think her longest stretch, she had two nights where she had a five hour stretch and we were like, okay, hope. Last night longest stretch was three hours and it was right after I put her down. So like I didn't go right to bed. And so beyond that, it was her longest stretch was two hours that I got.
00:34:39 Rachel
Is she still in the SNOO?
00:34:40 Alyssa
No, I freaking wish she outgrew it. And like, that's the thing when I, she loved the SNOO. And then when we transitioned her out of the SNOO, everything we tried, she's like, nope. There was a little while in there before she started rolling. When we transitioned her out of the SNOO before she started rolling, where she still slept like an eight or nine hour first stretch and then she started rolling and it's just like never gotten better.
00:35:02 Rachel
Is she waking herself up rolling or is she waking up and then wanting to practice?
00:35:07 Alyssa
Waking up and wanting to practice.
00:35:10 Rachel
That sucks.
00:35:13 Alyssa
And just like talking. But if I nurse her, she'll go back down for another like generally hour and a half to two hours. If I don't nurse her, Zach spent an hour trying to get her down last night where she would like calm, but not settle enough to fall back asleep and then finally I just nursed her and she's down for two hours.
00:35:33 Rachel
Sucks. Even after working in sleep for Seed, I would still find myself like googling like what product can I buy right now to give me, like there must be some magical product out there that can make this go away.
00:35:49 Alyssa
I'm like, how about this sleep sack? How about that? Maybe she's cold. Maybe she's hot. Maybe we should try this. You know what? Now let's try her in the pack and play. Like, oh my gosh.
00:36:00 Rachel
Remember when I was like sending you links to like the sleep sacks that had like a lovey kind of attached to it? I was going to make Abel sleep. LOL.
00:36:09 Alyssa
Like that's what I've been missing. A lovey. Sleep, oh my gosh, sleep, it's so real. That's the thing, it's hilarious because we have sleep courses, right? And I was like, all right, going back to it and looking it over and I'm like, all right, let's start from the beginning. I'm like, what can I tweak? What can I play with? When I really come into rational space, I do wonder if she's hungry. She will eat, because we started solids, she'll eat anytime we sit her down, she'll eat, loves. And especially as she's gotten older and I've like stretched her nursing -wise, she would have, as a newborn, she nursed every sometimes 45 minutes, hour, hour and a half, whatever. And then the rolling kind of coincided with her like leaving that early infancy. And I like went back to work more than I had. And all of a sudden I went to like feeding her every two to three hours. And that's kind of where we are now as I nurse like every two to three hours. I'm like, yeah, maybe she's hungry like she was nursing so much during the day. She probably didn't have to at night before.
00:37:16 Rachel
Yeah, and that makes it really hard because if there's even that like small amount of doubt in your mind that she might be hungry it's like hard to think about responding in any other way.
00:37:26 Alyssa
Yeah, and when I feed her and then she goes back to sleep it's like, okay. It seems like you were hungry. And if she's hungry, I obviously want to feed her. But if she just wants to hang out. I love you, and I don't want to hang out with you five times overnight.
00:37:38 Rachel
I know and it's like that back -and -forth of like always wanting to feed a hungry baby and also wanting to be aware that sometimes those hunger feeds turn into habit feeds and I think like that's where it can get tricky mentally because if you didn't have the fear of like is this gonna turn into a habit you just feed her because.
00:37:57 Alyssa
I know yeah. So thats where I am. Who do we get to chat about today?
00:38:03 Rachel
We are talking about Dr. Steve Hodges.
00:38:07 Alyssa
Oh, yeah.
00:38:08 Rachel
Yeah. The urologist who, like...
00:38:10 Alyssa
Fascinating.
00:38:12 Rachel
Yeah. Has this really unconventional approach to constipation.
00:38:17 Alyssa
Hit me with your immediate takeaways.
00:38:19 Rachel
So it's funny that we had him on the pod because years ago, a friend who was struggling with her daughter bedwetting, like, seven, eight years old, still wetting every night, bought his book. And she didn't follow like the whole protocol, but they definitely like brought his strategy sort of into their arsenal as they were trying to figure out like what was going on at the root for their kid. So it's funny to see him pop up in our podcast calendar.
00:38:51 Alyssa
Yeah, that is funny. I'd never heard of him.
00:38:53 Rachel
Yeah. And his, his approach is really fascinating because it's so different than anything else that you read about like toileting or constipation or bedwetting or anything.
00:39:03 Alyssa
I feel like what I've been exposed to was so behaviorist, which by nature, I'm not behaviorist. And like, that's not typically what I subscribe to. I say it a lot. I don't like to put a Band -Aid on a bullet hole. I want to know what is driving this at the root. And that's where I was like fascinated with his work because for me, it felt like getting to the root of a problem, which I love.
00:39:26 Rachel
1000%. And I think when we think about toileting in general for young children, and I'm not just talking about nighttime, but just in general, I think there's a behaviorist umbrella in terms of the most common approaches. I remember having a conversation with a friend. So one of the rules for pre -K here, and I think this is pretty widespread, is they have to be potty trained. As Abel was getting ready to go to pre -K, he had been peeing on the toilet for over a year, but he didn't want to poop on the toilet. He was scared. And I was chatting with a group of parents about it kind of like bouncing ideas off and another parent was like, yeah, we're having the same issue and like I read online that if they poop in a diaper you should squirt them with a cold hose to clean them off to like show them not to poop in a diaper.
00:40:15 Alyssa
Like spraying a cat with a water bottle? Wow. Can you imagine?
00:40:20 Rachel
I can't actually.
00:40:21 Alyssa
If you're that tiny human and somebody sprays you with a hose because you pooped in a diaper?
00:40:26 Rachel
Yeah, and it's like we condition them to poop in diapers, right? Because that's what--
00:40:30 Alyssa
And then we're like and stop.
00:40:32 Rachel
Yeah, stop on my timeline or I'm gonna squirt you with cold water. What?
00:40:36 Alyssa
Wow.
00:40:37 Rachel
Yeah.
00:40:39 Alyssa
Wow, wow, wow. Your sister a long time ago said to me, I was talking about something that somebody had said that I found triggering, and she was like, oh, well, that trigger makes sense because at the core of all of your beliefs around kids is that they deserve respect as humans. And honestly, I was like, oh, like that felt like news to me, which is interesting, I guess. But I was like, yeah, I believe that kids deserve to be respected as humans. And so that's what just came up for me, where I was just like, how disrespectful to do to somebody else. I have compassion for the parent of like, if you don't know what else to do, and you're like, I got to send my kid to school. Of course, you're looking for anything at that point.
00:41:26 Rachel
Totally. I also feel compassion because I think culturally like our approach to many challenges in early childhood is to respond to the behavior, but I definitely was triggered in that conversation.
00:41:39 Alyssa
Yeah. Yeah. That checks out. That makes sense.
00:41:41 Rachel
And I was like trying to figure out like, what am I going to do with Abel? Because I'm definitely not going to squirt him with a hose. Can you like, can you imagine?
00:41:48 Alyssa
Oh my God. Oh my God. You're like entire then rest of your day and week would be just navigating the repercussions of you having squirted him with a hose.
00:41:58 Rachel
I literally cannot imagine because if I even have a slightly off tone, he's crying.
00:42:04 Alyssa
Yeah. What's wrong?
00:42:05 Rachel
Yeah. What's wrong, Mama? Why are you mad at me? I'm not mad. Just really hot.
00:42:10 Alyssa
My clothes are just really feeling too tight.
00:42:12 Rachel
Yeah. But anyway, I agree. One thing that I took away from Steve was like, although it's a little radical, his approach, right?
00:42:23 Alyssa
Totally.
00:42:23 Rachel
But what I love about it is it is looking at a root cause for bedwetting and also it really came through in his interview that he respects kids because this is like-- it's not casual to give a young child an enema.
00:42:40 Alyssa
No. Yeah. No
00:42:41 Rachel
You know, I think about children who struggle even with a basic diaper change like the sensory experience of that and this is that on steroids.
00:42:51 Alyssa
Sure.
00:42:52 Rachel
So it's like little bit like hard to swallow the protocol, but it came through in his interview how much he cares about not just resolving the constipation and the bedwetting, but like the emotional side of this too. I think he had mentioned having some families work with him who had like preteens who wanted to be doing sleepovers and didn't feel like they could because they were still wetting at night. And I think like oftentimes because we're so focused on the surface behavior, we like miss the emotional side of these things and the ways that kids need us to support that as well. And I feel like Steve's approach, a lot of it feels uncomfortable for me in terms of like giving a kid an enema, like that feels hard and weird. But his like tone and the way that he explained things and the way that he talked about supporting his patients, it's like, okay, if you're really dealing with a long -term constipation and bedwetting issue, I think there is a way to use his protocol in a way that's respectful to kids.
00:43:51 Alyssa
A hundred percent. And it also, like, I don't think it's necessary, like he had said, like there are some folks where it's like we're navigating diet or they're on something like a Miralax or a stool softener or something like that, that just like helps that it's not like enema or bust. But what is different to me about his approach is that we're not focused on the wetting as the issue. It's the constipation that's driving the wetting. And I was like, so wait, like that's the part that for me felt so new where I was like, so you got to poop to stop peeing, right? Like, what is this? And that just like functionally felt really new for me. And I was like, oh man, can you imagine if you are a kid and yeah, you've been on all these diets or all these things and supplements and you're taking it and you're still having these challenges and you're just like, I would imagine it comes to a point for some kids where they feel like something's wrong with them. And so having access to a protocol like his, even if it does require an enema in the end, like then can maybe let them know like, this isn't something that's wrong with you. You got too much poop in your system we got to clear out, right? Like that's what's going on and here's how we can help you. And I think just that ability to have a solution when you've probably tried so many things. It's interesting because Sagey's interoceptive sensitive. He has a heightened interoceptive system and poop has been a thing for him always. I don't know if you remember his like newborn baby days. He started on prunes real young because if he is backed up in any capacity, even if it was like he's gone two days without pooping, his entire nervous system is a disaster. Regulation is so hard for him at that point. He can't sit, he can't eat, he has a hard time sleeping, he has a hard time just like regulating emotionally. And we recently like traveled to see family and he had pooped the day before we left. And then he didn't poop the whole three days we were there until we literally were on our way home and then he pooped at a rest stop. It's so random, he loves a rest stop poop. Won't poop anywhere else, but loves a rest stop poop. Will request a rest stop.
00:46:08 Rachel
I remember him as a newborn having interrupted sleep because he needed to poop, which I wouldn't say is typical. I remember troubleshooting with you to try to figure out what's the deal with this sleep? Why is this happening? Most of the time for newborns, the answer isn't like, oh, they need to poop, but it's always -
00:46:25 Alyssa
Because they just poop.
00:46:27 Rachel
Right, it's always been a thing for Sage.
00:46:29 Alyssa
He is so aware, and even now it's been cool because now that he has more language and he's three, he can tell us, I feel it coming, but it's not ready for me to sit on the potty yet. And so what I've learned is like he notices those sensations so much earlier. And so for him, he starts to notice it, starts to notice it, and it's not for a little while until he's ready to like sit down and go. And it took us a little while to like figure that out. He would say like, have to go poop. And he would run in, he'd sit for a little while and he's like, it's not coming out. And then we try again and we try it. And I was like, what's going on? And now as he's just developed more awareness and language around it, I was like, oh, that's what's going on. It's that heightened awareness. He notices those cues so much earlier than I do, than a lot of us do. And it just factors so much into his regulation. And I was like, oh, I wonder too, like it's been interesting now with Mila because we started solids, like after I'd done this interview and so I like had it in the back of my mind. And when we started solids and she was being introduced to foods, obviously her poop schedule changed, right? She went from just breast milk to solids. And I was like, okay, I have to make sure she keeps pooping. Otherwise this is potentially going to be challenging. And then we like found a rotation of like, all right, yep, now she's back to like pooping more regularly. But she, for sure, she would be so grumpy. It like affects her demeanor if she goes too long without poop.
00:47:57 Rachel
I mean, honestly, same. Like, I don't feel good if not, you know what I mean? And the other thing that I love that he said was that bedwetting is never the child's fault. And I love that because I think sometimes, and this isn't just for bedwetting, I think this is just for like any repeated challenge that we're having with kids. I think sometimes we hit this point where they're like, okay, we know they could stop and they're just choosing not to, right?
00:48:29 Alyssa
And they get in trouble for just like their body doing what it does.
00:48:34 Rachel
Right.
00:48:35 Alyssa
Yeah, it's painful. It's very painful. And frankly, I think really a lack of the adult knowing what else to do that we're like, they must just be like not listening to their body. They're just not waking up. They're just not doing this thing. Especially if you haven't experienced it before. It's like, no, when I have to go pee at night, my body wakes up so I can go pee. I don't just pee.
00:48:57 Rachel
Right.
00:48:58 Alyssa
And so it must be that this other person's just ignoring that instinct and going back to sleep.
00:49:04 Rachel
I also think like, because my friend obviously like reached out to her pediatrician and they were just like, yeah, um, usually kids stop wetting by age five. And then if they don't after that, like 10 % of them stop wetting every subsequent year. And they were like, you can use a bedwetting alarm if you want to. And she was just like, okay. They chose not to do an alarm because the way that the alarms work is like you have to get up with your kid every time the alarm goes off.
00:49:35 Alyssa
No, thank you.
00:49:37 Rachel
Like, can you imagine?
00:49:38 Alyssa
Yeah, I am doing it right now. And like, I would rather-- that's what I'm saying.
00:49:44 Rachel
But I'd rather being doing that than with like an eight year old.
00:49:44 Alyssa
That's what I'm saying. Like, I can only do it right now because I know it's temporary. I could not go back to this. No.
00:49:51 Rachel
Right?
00:49:52 Alyssa
In no world.
00:49:53 Rachel
That's what I appreciate about Steve.
00:49:56 Alyssa
Me too. I'm excited to like hear kind of our village's thoughts and feedback and what comes up for everyone tuning in. Head on over on social and let's continue that conversation. We'll post a reel where you can engage with this episode because I really want to hear like what comes up for you. What has your experience been with potty training and accidents and wetting? And in this episode, was there anything that you were like, uh, no, thank you? Or like, oh yeah, I'm really curious and wanna learn more. Cause I think it's one of those that can feel really polarizing or that we might come in with our own like triggers around too, some age bias. We were just laying out the triggers of like, oh yeah, they're choosing this. It feels like defiant, et cetera, that I'm just curious to hear other folks' reactions. Cause I was just like, I felt like the entire interview, I was just like, this is so cool and feels new to me, but it feels so cool. And yeah, frigging getting away from the bandaid on a bullet hole. I love getting to the root. Love it. Sweet. Well, head on over to Instagram and we'll have a reel there where you can dive in and share your thoughts, your feedback, we're at seed.and.sew on Instagram.
00:51:18 Alyssa
Thanks for tuning in to Voices of Your Village. Check out the transcript at voicesofyourvillage.com. Did you know that we have a special community over on Instagram hanging out every day with more free content? Come join us at @seed.and.sew S -E -W. Take a screenshot of you tuning in, share it on the gram and tag @seed.and.sew to let me know your key takeaway. If you're digging this podcast, make sure to subscribe so you don't miss an episode. We love collaborating with you to raise emotionally intelligent humans.
Connect with Dr. Steve Hodges:
Website: https://www.bedwettingandaccidents.com/
Order the book: Bedwetting and Accidents Aren't Your Fault: Why Potty Accidents Happen and How to Make Them Stop
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GIVEAWAY: 12 Signs Your Child is Constipated
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