By Steve Hodges, M.D.
Has your child achieved the vaunted “spontaneous poop”?
That’s a hot topic in our private Facebook support group! “Spontaneous poop” is a term I use often in The M.O.P. Book: Anthology Edition, and it’s worth further discussion.
By “spontaneous poop” I mean a bowel movement that is not preceded by an enema — one that the child feels coming on and “just happens.”
One goal for children on the Modified O’Regan Protocol is to spontaneously poop every day. Why is this important?
Well, every human being should poop daily, and kids who have daytime and/or nighttime accidents are extremely backed up, harboring enough poop for (at least) two bowel movements a day. So, if they’re only pooping after the enema, they’re not getting it all out.
The reason many kids do not, at first, have a daily spontaneous poop is that their rectums are extremely stretched and have lost sensation. These kids just don’t feel the urge to poop, despite having loads of stool stuffed in there. Also, since the enema can empty the rectum quite a bit, the stretched rectum may not fill back up again by the time the next enema is due, so the child doesn’t feel the urge.
When kids start pooping spontaneously, that’s a sign the rectum is shrinking back to size and regaining sensation. It often means bedwetting and accidents will diminish soon, even if total dryness is a ways off.
For families dealing with the most challenging bedwetting cases — kids who have been wetting for years, with no end in sight — the arrival of the spontaneous poop is nothing short of awesome.
One mom in our support group posted that she was “beyond ecstatic” when her 5-year-old spontaneously pooped for the first time, 80 days in to M.O.P. and one week into Double M.O.P. (adding overnight oil-retention enemas). She wrote:
Out of nowhere he just stopped what he was doing, looked at me and said, “Mom, I need to go potty right now.” This is a monumental happening because he hasn't pooped on the potty on his own (not enema stimulated) for six months. I was so afraid his body/muscles would never coordinate, and he'd never poop on his own again. I know we still have a long journey ahead, but the relief I feel in knowing that he is healing is just indescribable!
I was pleased to read this post, not just because the child was clearly improving but also because this mom had absorbed one of my key messages: progress can be slow. Many parents expect total dryness within a month on M.O.P., because it just seems impossible that a child could have 30 consecutive days of enemas and still be backed up. But it’s not uncommon. I see it in X-rays all the time.
Often the signs of progress are subtle, and each step closer to dryness should be recognized and appreciated.
Sometimes, the scenario is reversed: A child will start having dry nights without achieving the spontaneous poop. Of course, this is cause for celebration, too — dryness, after all, is our ultimate goal.
However, a continued lack of spontaneous pooping, even when accidents diminish or stop completely, can be a warning sign. It may mean the child is prone to relapse and that families should delay tapering enemas. In other words, if a child has 7 consecutive dry nights — and is therefore technically “eligible” to taper to every other night — but is still not spontaneously pooping, you might want to stick with daily enemas for a while longer before dropping to every other night.
Along these lines, a mom in our support group posted this question: Our 8-year-old daughter has had 8 weeks of no accidents of any kind, except for two days in a row where she had slight streaking, so we continued on with M.O.P. She will very sporadically have another poop besides the one after her enema each evening. Are we OK to start tapering to every other day, or do we have to wait until we are reliably getting a second poop each day?
I applaud this mom for not rushing into tapering. I advised her that it was OK to drop to enemas every other day but that she should closely monitor her daughter. If the girl does not spontaneously poop on any of those days, an enema or liquid glycerin suppository may be in order.
I see a surprisingly number of relapses when families taper from every other day to twice a week, so if your child is at that stage and still not spontaneously pooping, you may want to hold off before tapering to the final phase of M.O.P.
What can you do to help your child achieve the spontaneous poop? Here are four approaches to try.
•A slight increase in your dose of osmotic laxatives. While on M.O.P., it’s important to maintain a daily osmotic laxative, whether it’s Miralax, lactulose, magnesium citrate, magnesium hydroxide (Pedia-Lax chews), or another alternative. This is a standard component of the protocol that sometimes gets overlooked, especially during the tapering phases.
Some families have had good luck combining two osmotic laxatives in one day — for example, Miralax in the morning and magnesium citrate later in the day.
Just beware of boosting the oral laxative too much in pursuit of the spontaneous poop; your child may end up with diarrhea or poop leaks. Still, you may be able to boost the dose slightly with good results.
•Potty sits. It’s important for children on M.O.P. to sit on the toilet after breakfast and dinner, for a good 5 minutes. Eating stimulates pooping, so that is the best opportunity to get a spontaneous poop.
Of course, getting your child to remain on the toilet for 5 minutes is often easier said than done. Some parents find that iPad or phone time helps. Another mom offered this idea: “I have found that playing music and switching off the light, at my daughter’s request, works best for my 6-year-old. Somehow concentrating on the music with no distractions lets her relax enough.”
•Ex-Lax. Stimulant laxatives such as Ex-Lax or Senekot can be enormously helpful for many kids. “Ex-Lax helps us get over the hump when we get stuck. It really made a huge difference for my daughter," one mom posted.
Another reported: “We occasionally give Ex-Lax to my daughter at bedtime if she hasn't pooped on her own that day, and she will usually poop on her own the next day. It's not an everyday solution but good every once and a while to prevent backsliding.”
I have added stimulant laxatives as an optional component of M.O.P., as I explain in my blog post "Should I Give Ex-Lax To My Constipated Child?" I discuss dosages in the M.O.P. Anthology. For a child who has started to taper and doesn’t spontaneously poop on non-enema days, Ex-Lax is definitely worth a try.
•Oil-retention enemas. For the really tough cases, Double M.O.P. — overnight olive oil or mineral oil enemas, in addition to daily saline enemas — can be the breakthrough approach, though the process is time-consuming.
One mom posted that after 6 months of pooping only after enemas, her son had his first spontaneous poop after a few days on Double M.O.P.
I don’t want folks to become obsessed with their child achieving the spontaneous poop. However, this is definitely a marker to watch as you move through the M.O.P. process. And when your child does start pooping spontaneously, you might find yourself just a little bit excited.
One mom in our support group posted: “My 5-year-old just had the perfect spontaneous poop. Long, thin, and soft snakes. Looks like his rectum is back to normal. Just had to share!”
Have your children track their own pooping habits with Dr. Pooper's Activity Book and Poop Calendar for Kids, available in print on amazon or as an instant PDF download at BedwettingAndAccidents.com.
