By Steve Hodges, M.D.
Doctors tend to think “new” is better — new technology, new treatment methods, new drugs. But the longer I practice medicine, the more I realize that low-tech, old-school remedies often work best.
Exhibit A, of course, is the Modified O’Regan Protocol (M.O.P.), the enema-based regimen developed by Dr. Sean O’Regan’s in the 1980s. Research proves it resolves bedwetting, daytime pee accidents and poop accidents (encopresis) far better than anything today’s doctors have to offer.
In this post I’ll discuss Exhibit B: using overnight mineral oil or olive oil enemas as an adjunct to morning stimulant enemas. I call this regimen Double M.O.P. and explain it in detail in 4th edition of The M.O.P. Book: Anthology.
Here’s how it works: Before bed, the child receives an enema of either mineral oil or olive oil, via enema syringe or store-bought Fleet mineral-oil enema. Overnight, the oil softens and lubricates the hard, crusty stool, helping it come out more thoroughly with a store-bought phosphate enema or a large-volume enema the next morning.
Oil “retention enemas” are an old remedy I heard about in medical school but never thought much about; the idea just seemed outdated. But I was reminded of them recently when a mom who lives in Iceland posted about them in our private support group.
Her 7-year-old’s encopresis had resolved on M.O.P.+ (large-volume enemas) but his wetting persisted, and she was seeking new ideas. The boy’s pediatrician — who initially had opposed all enemas — acknowledged the child needed more aggressive treatment. “The doctor called a nurse to ask how they did this back in the day,” this mom recalls. The answer: olive-oil enemas.
Her son was willing to give it a try, and within a few weeks, his daytime accidents diminished. An X-ray showed great improvement.
When she posted this in our support group, it jarred my memory. I pulled out my medical school textbooks and read more about “oil retention" enemas. This idea has been around a long time, and both olive oil and mineral oil enemas seem to be useful for stubbornly constipated children.
Intrigued, others in our support group started trying this remedy, with some success, and I began recommending it to patients at my Wake Forest clinic.
“Mineral oil enemas seem to be helping us,” one mom in our support group posted. “Years of poop build-up is hard to clean out. I feel like I am chipping away at a cement block with a garden hose!”
Since “olive oil or mineral oil enemas” is a cumbersome phrase, I've given this addition to the M.O.P. regimen a handy nickname: Double M.O.P.
On aspect of Double M.O.P. that’s not so handy: You need to shift your child’s regular enemas to the morning. This may make Double M.O.P. impossible for some families, at least on weekdays. But for many children, retaining the oil overnight does seem to enhance the clean-out process, even if it's not a total solution. If your child’s progress has stalled either on M.O.P. or M.O.P.+, I’d say it’s worth a try!
During the coronavirus lockdowns, many families added Double M.O.P. to their child's regimen because kids no longer had to rush off to school. For numerous kids, the oil enemas were a game changer.
Here are answers to questions you may have about oil-retention enemas. I discuss them in more depth in The M.O.P. Book: Anthology Edition.
Q: Is it safe to do oil-retention enemas on top of regular enemas?
A: Yes. I know the number-one M.O.P. safety rule is: never do more than one enema per day. But an olive oil or mineral oil enema does not stimulate the colon to evacuate poop, so it doesn’t “count” as a second enema. It simply softens and lubricates stool so it empties more easily.
I believe Double M.O.P. is safer and probably more effective than adding a solid or liquid glycerin suppository to a phosphate enema. As a regular practice, I don’t think we should be stimulating kids to poop more than once a day, though I do think it’s fine to add a solid glycerin suppository to M.O.P. or M.O.P.+ on occasion. I advise against combining a liquid glycerin suppository (essentially a second enema) and a regular enema on the same day.
Q: Does it matter what brand of mineral oil or olive oil you use?
A: No, as long as there are no additives. Use extra-virgin olive oil.
Q: How often can you safely give a child an oil-based enema?
A: As often as you want or need to. Families in our support group have taken a variety of approaches to oil-retention enemas, including:
•Daily for a few weeks, even a few months
•Every other night
•Weekends only
•On occasion
Fleet mineral oil enemas are not cheap — a 12-pack on amazon costs about $49. A less expensive option is to inject 50 cc to 100 cc of mineral oil or olive oil with an enema syringe. You can use the syringe, such as the Universal Tube Cleanser, to both measure and inject the oil.
Inject the oil before right before bed (older children can do it themselves), after your child has used the toilet for the last time. If your child needs to use the bathroom once more, that’s fine, but the goal should be to hold in the oil for at least 20 minutes. Overnight is better. Just know the oil can leak overnight and the next day, so pullups are a good idea.
Note: Don’t use oil-retention enemas if you are following M.O.P. with liquid glycerin suppositories; those don’t have enough volume to empty out the oil. Double M.O.P is probably most effective when used with M.O.P.+ but may also be useful with pediatric or adult store-bought enemas.
Q: What kind of “output” can you expect your child to produce?
A: It varies, but parents generally note an increase in “hard chunks.”
Here is one mom’s experience giving her daughter night-time mineral oil enemas followed by morning Fleet phosphate enemas:
His production of hard poop seems better. The oil doesn't seem to produce a true bowel movement — it just makes the hard poop in her rectum slippery enough that by bearing down, she can push some out. Then we do the Fleet enema, which seems to produce some hard pieces followed by her fresh, soft poop. I think before we started using mineral oil, the fresher, softer poop would just bypass the hard stuff in her rectum.
Another viewpoint, from a mom whose son uses half a Fleet mineral oil enema nightly:
My son has never been able to retain them overnight. Immediately, clear-colored mineral oil comes out but no poop. The next day, he usually has a spontaneous poop in the morning that seems chunkier than normal. It also seems to make the regular enemas more productive for a couple days. We were replacing a pediatric enema with the mineral oil every 4 days. Now we're at the-every-other-day stage of M.O.P., so we're replacing an enema with mineral oil once a week.
Not every M.O.P. family has had ongoing success with oil-retention enemas. The mom of a 7-year-old on M.O.P.+ provided this account:
After 3 or 4 weeks of daily olive oil, my son’s X-ray showed great improvement and daytime accidents were fewer and then then completely gone. Unfortunately, we had a relapse when we went on a trip for one week and could not do the treatment. Now we are back to where we were when we started the olive oil treatment. Our initial successes seem to be lost on us.
Q: How do kids react to oil-retention enemas?
A: In general, the same way they react to M.O.P. enemas: They get used to it.
As one mom put it: “My son was not at all in to it, to say the least. But I talked him into trying for just one night. After that, he saw that it was not painful and not interrupting him in any way, so he was willing to do it every night.”
My general rule of thumb: M.O.P. is more of a process than a protocol. Different approaches will work with different kids. Something new might work for a few weeks and then stop working. That’s OK. You need to keep tinkering with the basic elements of M.O.P. until you get your child fully cleaned out.
Many parents are shocked to discover how difficult this task can be. You’d think 30 consecutive days of enemas would be more than sufficient to clean out a poop-stuffed rectum. But some children have been so clogged with large, hard masses of stool for so long that enemas and laxatives won’t cut it.
I take the term “medical practice” literally. As a doctor I don’t presume to have all the answers and, based on feedback from families, I constantly fiddle with my basic approach to resolving bedwetting and accidents.
I’m grateful for families who are willing to push the envelope and try new remedies — well, in this case, old remedies!