By Steve Hodges, M.D.
Even the world’s best-pooping kids can get constipated while traveling, what with the changes in routine, unfamiliar toilets, long stretches in the car, and more ice cream and less broccoli than usual.
For children prone to constipation, travel almost inevitably leads to clogged pipes. And if your child is on the Modified O’Regan Protocol (M.O.P.) for bedwetting and accidents — well, a spring break visit to Grandma’s or a summer camping trip poses a whole range of challenges and concerns.
As one mom in our private Facebook support group posted: “If we skip enemas for a week but continue laxatives, will that set us back to square one?”
Another mom, whose daughter is on M.O.P.+ (large-volume enemas) for bedwetting, wrote: “The thought of trying to do this discreetly is freaking me out. I think my extremely old-fashioned mother-in-law would claim child abuse if she heard we were giving our daughter enemas.”
A dad whose 7-year-old is on M.O.P.+ for encopresis asked: “Is there a simpler method we could substitute for a few nights? She’s had 5 or 6 accident-free days and we don’t want her set back while we’re away from home base.”
There’s no easy answer to these questions. Some families, despite tremendous vigilance on the road, do experience big setbacks.
One mom posted: “During our three weeks abroad, we stayed on top of nightly enemas, but unavoidable diet changes, ‘hover’ toilets without seats, and just ‘away from home syndrome’ have cause the return of [urinary] urgency, a couple leaks, and the dreaded curtsy.” Some families choose to give up travel while they’re in the thick of M.O.P.
Yet others are able to dial back treatment on a trip and then pick up where they left off, no worse for the wear. The mom of one of my patients told me, “We camped for four glorious days without enemas and my son stayed dry. The vacation from enemas was even better than my vacation from work! But I knew we had to resume M.O.P.”
I really sympathize with folks trying to maintain M.O.P. on the road. It can be hard enough, logistically and emotionally, for families to manage enemas, laxatives, and potty sits daily at home. Travel can complicate every aspect of the program.
Plus, the The M.O.P. Book doesn’t cut you much slack; to minimize the risk of relapse, I emphasize sticking to the program exactly as written.
But yeesh, every kid needs a break! So do parents.
In this post, I offer tips for managing M.O.P. on vacation, in hopes that your family can balance the need to stay vigilant with the need to chill out.
Be sure to map out a plan with your child before the trip, so you’re all on the same page. Some kids are thrilled to take a break from the routine; others worry about setbacks and want to stick with the program despite the inconvenience.
Some families are so determined to stick with their regimen on the road that they will even maintain Double M.O.P. — overnight olive oil enemas — at hotels. One mom posted: “I just ask room service for a bottle of oil to keep in the room and bring an empty Fleet bottle for the enema.”
That family gets extra credit!
Following are suggestions to make your vacation a bit easier while minimizing the risk of a setback.
•Get “ahead of the game” before you leave.
If possibly, work in some “bonus” clean-out measures before you leave, as a hedge against trip-related rectal clogging.
Some families have had good luck doing a few extra days of Double M.O.P before a trip, to get their kids maximally cleaned out. Others have done high-dose laxative clean-outs prior to vacation.
Most kids are willing to take extra steps before a trip, knowing they’re about to get a reprieve. At the very least, make sure you’re completely on top of M.O.P. or M.O.P.+ before you leave town.
•On the road, use liquid glycerin suppositories instead of enemas, both for M.O.P. and M.O.P+.
Liquid glycerin suppositories are smaller than enemas and easier to pack and use. For some children, they are just as effective as pediatric phosphate enemas; for others, they’re at least effective enough to prevent a setback during a week’s vacation.
If your child is age 6 or older, use the “adult” liquid glycerin suppositories; younger kids should use the pediatric version. (Don’t confuse either one with solid glycerin suppositories, which may be helpful but are not a substitute for enemas.)
Just know that switching to liquid glycerin doesn’t work for everyone. One mom posted: “We were away for 2 weeks at Christmas. My daughter had been doing really well — no daytime accidents for months, though she was still wetting at night — but almost the minute we stepped off the plane, she started having daytime poop and pee accidents again. During the trip, we did liquid glycerin suppositories every day, but clearly that wasn’t good enough.”
Some families on M.O.P.+ have had better luck on vacation using adult-sized, store-bought phosphate enemas (Fleet or generic). They’re larger than liquid glycerin suppositories but a lot less trouble than traveling with a large-volume enema kit.
•Supplement enemas with Ex-Lax.
For kids on M.O.P., adding stimulant laxatives such as Ex-Lax to the mix can be a game-changer. Ex-Lax also can be a useful temporary substitute for enemas during a vacation, when enemas are just too big a hassle. I suggest experimenting with the dosage and timing before you leave town; this blog post offers some basic guidelines.
While on the road, it’s important to maintain your daily dose of osmotic laxative, such as Miralax, magnesium citrate, or lactulose. You may want to boost the dose slightly, but not so much that your child ends up with diarrhea.
•Work potty sits and pee breaks into your schedule.
It’s hard to get kids to spend a full 5 minutes on the toilet when you’re rushing off to school or activities. Vacation may actually make things easier. Does it really matter what time you arrive at the grandparents’ house or start your hike? Vacation can be a time to slow the pace.
Set the expectation that your child will be sitting on the toilet twice a day to poop, ideally after breakfast and dinner, and enforce family pee breaks every 2 to 3 hours — including on airplanes!
Also, encourage boys to sit while peeing when it’s feasible. While seated, their potty muscles are relaxed, so kids are more likely to empty fully.
•Travel with a toilet stool.
Your child’s pooping posture can actually make a big difference!
One mom in our support group posted: “On our last big trip, my son wasn’t getting much output, even though we used liquid glycerin suppositories. Half-way through the trip we switched to having him sit on a Baby Bjorn kids’ potty. He is 5, so he still fit and it put him in a big squat. His output went back up, and we started having a lot more success.”
If it doesn't take up too much room in the car, bring along your Potty Pet, the children's version of the Squatty Potty.
For taller children, the travel version of the Squatty Potty, the Porta Squatty, is a good option.
No matter what approach you take on vacation, my advice is: keep your expectations low, and don’t worry about making progress. If you do have to skip enemas completely, for whatever reason, it’s not the end of the world.
If you can enjoy your vacation and return home without a major setback, that’s big victory. And rest assured, all setbacks can be reversed.