Blind Spots: Brilliant Book Explains Bedwetting Without Even Mentioning It

By Steve Hodges, M.D.

I’m so busy — and lazy, if I’m honest — that I haven’t read an entire book in ages. But the book I just finished, Blind Spots: When Medicine Gets It Wrong, and What It Means for Our Health, by Johns Hopkins surgeon Marty Makary, M.D., was so riveting I blew through it in a weekend.

I don’t know Dr. Makary, but he clearly knows me.

Blind Spots essentially tells the story of my career and my two decades of discord with the medical establishment, even though the book doesn’t mention me or my medical specialties: enuresis (bedwetting and daytime wetting) and encopresis (chronic poop accidents).

Dr. Makary recounts example after example of critical medical discoveries that were ignored, suppressed, or belittled due to “medical groupthink gone awry,” at the expense of patients’ health and lives.

The explosion of peanut allergies, the opioid-addiction crisis, the hemophilia “holocaust” (thousands of deaths from HIV-tainted blood), antibiotic resistance – these and numerous other catastrophes could have been prevented, Dr. Makary argues, if only the medical establishment had heeded dissenting voices and followed the scientific evidence.

Instead, medical authorities succumbed to the herd mentality. In other words, “Everyone believes it, so it must be true.”

Bingo! That nicely sums up what transpires in my field.

I could relate to most of Dr. Makary’s book, but the story with uncanny parallels to my own experience is the peanut-allergy saga. I’ll summarize here, but I urge folks to read the whole story in Blind Spots.

Back in 2000, responding to an apparent rise in peanut allergies among U.S. kids, the American Academy of Pediatrics (AAP) began recommending that children at high risk for peanut allergy avoid peanuts until age 3. Dr. Makary notes two key problems with this recommendation: 1.) the AAP had no idea which children were at high risk, and 2.) there was no evidence — not a single study — linking peanut allergies with peanut consumption in early childhood.

But never mind the lack of evidence! Based on the AAP’s new guideline, doctors figured: Why take chances? Pediatricians, en masse, began counseling parents to keep their little ones away from peanuts.

Now, not all doctors bought the anti-peanut dogma.

In fact, in 1998, when UK health authorities issued their own peanut-avoidance recommendation — beating the AAP to the punch by two years — Dr. Gideon Lack, a London pediatric allergist, warned the guidance was “not evidence-based” and might actually increase peanut allergies.

Dr. Lack’s concern grew. In 2000, while lecturing in Israel, he asked a room full of allergists if they were encountering peanut allergies in their patients. Only a few hands shot up. Yet when Dr. Lack asked the same question of allergists in London, almost all raised their hands.

“Startled by the discrepancy,” Dr. Makary writes, “he had a Eureka moment.”

Dr. Lack embarked study comparing peanut allergies among Jewish children in Israel and Jewish kids in the UK. The results were astounding: Israeli kids had 1/10th the rate of peanut allergies of their British counterparts.

To Dr. Lack, the discrepancy was easily explained. In Israel, babies are often fed a puffy, peanut-based snack called Bamba, and Israeli health authorities had never recommended young children avoid peanuts.

Published in 2008, Lack’s breakthrough study had minimal impact. The AAP dialed back its 2000 recommendation, stating that introduction of peanuts “should not be delayed.” But the organization did not advocate early introduction of peanuts, stating there was “insufficient data to document a protective effect.”

Nor did U.S. or UK health authorities pursue any such data by funding further studies!

By that point, “avoid peanuts” had become pediatrics doctrine, the correct answer on exams administrated by the American Board of Pediatrics. As Dr. Makary puts it, “the train had left the station.”

Parents who let their toddlers eat peanut products were “viewed almost like criminals by some in the medical establishment,” Dr. Makary writes — like “idiots who arrogantly defied science.”

Meanwhile, peanut allergies were skyrocketing, and the life-threatening kind were becoming common. ER visits due to peanut allergies tripled in one decade.

Dr. Lack wasn’t finished proving the medical establishment wrong. In a randomized trial, he compared children who’d been exposed to peanuts between 4 and 11 months of age with children who’d abstained. The upshot: those exposed early to peanuts had 86% fewer allergies by age 5.

“It was now undeniable,” Dr. Makary writes. “The AAP had it backward.”

Dr. Lack’s study was published in 2015, yet it took another two years for the AAP to fully reverse its 2000 guidance.

The damage persists. In 1999, just 0.6% of American kids had peanut allergies; by 2019, 1 in 18 American children (5.5%) had a peanut allergy, according to one estimate Dr. Makary cites. Today, the U.S. leads the world in peanut allergies, a scenario he calls “a modern-day scandal that’s still ongoing.”

In Blind Spots, Dr. Makary notes a common theme among the medical disasters he explores: “The errors are not oversights of an ancient era; they are avoidable mistakes in modern medicine.”

He asks: “What are we getting wrong today?”

Well, here’s one answer: Medical “authorities” are dead wrong about the causes of and treatments for enuresis and encopresis. As a result, millions of children worldwide suffer greatly.

The enuresis/encopresis story offers numerous similarities to the cases Dr. Makary covers. Among the parallels:

•A “Eureka moment” and a medical breakthrough by a brilliant, tenacious doctor

•Dogma based on groupthink rather than evidence

•Parents shamed by their own doctors for defying the dogma

•Shoddy research published thanks to a “self-affirming bubble effect”

•Media amplification of the shoddy research

•Rigorous research ignored, misrepresented, or denigrated

•Exploitation of desperate parents by product manufacturers

•Rediscovery of — and hostility toward — age-old, low-cost treatments that actually work

•Bias toward modern treatments that are useless and/or harmful

I’ve covered these themes for years in my books and blog posts. However, Blind Spots offers a new framework for my experiences, helping explain why the conditions I treat continue to be terribly misunderstood.

Thank you, Dr. Makary!

Let me start with what the medical establishment purports to know about enuresis and encopresis.

According to organizations such as the AAP and the American Psychiatric Association (APA), bedwetting is a medical mystery, possibly caused by any or all of the following: emotional stress, psychiatric disturbance, defiant behavior, deep sleep, urine overproduction, underdeveloped bladder, and miscommunication between bladder and brain.

In reality, none of these theories hold up.

If you scrutinize the studies, venture beyond the groupthink, and x-ray the abdomens of bedwetting children, you can see that virtually all enuresis — nighttime and daytime — has but one explanation: bladder overactivity triggered by an enlarged, stool-clogged rectum. In other words, chronic constipation.

Stretched by a pile-up of poop, the rectum encroaches upon and aggravates the bladder nerves, causing the bladder to “hiccup” forcefully and empty without warning, day or night.

When the rectum is fully evacuated (no easy task) and kept empty for several months (also challenging), this organ will retract to normal size and stop bothering the bladder. That’s when wetting stops. No amount of talk therapy, art therapy, behavioral therapy, antidepressant medication, bribery, or punishment will dislodge the hard, dry mass of stool responsible for the bladder spasms. A daily enema regimen will do the job nicely, but more on that shortly.

Now, the AAP does include constipation among its list of eight “other bedwetting risk factors,” but the organization attributes nighttime enuresis primarily to a “delay in the development” of the bladder, overproduction of urine, and the child’s inability “to wake up during sleep.”

False, false, and false.

Also false: the AAP’s statements that “Stress can cause bedwetting” and “Treating the stress can stop the bedwetting.”

Oddly, on its web page about daytime wetting, the AAP acknowledges that “almost ALL children with voiding dysfunction also have some form of constipation.” Yet the same page states that daytime accidents can be caused by emotional stress or absentmindedness. “Children become so caught up in activities that they forget or delay going to the bathroom,” the AAP claims.

Again: uninformed opinion presented as fact.

Like enuresis, encopresis is caused by chronic constipation, and many children suffer from the “trifecta”: nighttime wetting, daytime wetting, and poop accidents. With encopresis, the large stool pile-up compromises the rectum’s tone and sensation, so poop just drops out of the child’s bottom. These kids literally cannot feel the urge to poop or sense the accidents happening. Yet adults, including many physicians, often assume they’re “REFUSING!!” to use the toilet, “seeking attention,” or suffering from a psychiatric disorder.

READ: What Frustrated Parents Should Know about Poop and Pee Accidents, Potty "Regression" and "Refusal"

Alarmingly, encopresis accounts for 3% to 6% of psychiatric referrals among school-aged children.

A chart published by the U.S. Substance Abuse and Mental Health Services Administration groups enuresis and encopresis with “disruptive behaviors,” “psychosis,” and “attachment” disorders.” Both enuresis and encopresis rate entries in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), described by its publisher, the APA, as “an authoritative volume that defines and classifies mental disorders,” and in the Handbook of DSM-5 Disorders in Children and Adolescents.

Fact: Encopresis and enuresis are not “mental disorders” any more than a urinary tract infection (UTI) is a mental disorder. Incidentally, chronic constipation is also the root cause of chronic UTIs in girls, but children are not sent to art therapy for infections.

(As for the root causes of chronic constipation, that's a more complex question, that I suspect pertains to genetics, temperament, and life in the 21st century.)

Encopresis is so grossly misunderstood that some children with the condition are prescribed anti-psychotic medication. One mom told me that multiple mental health professionals “were 100% stumped” by her 8-year-old’s encopresis. “They made charts to try to correlate the accidents to stress and other behavioral issues,” she emailed. “Of course, none of the theories ever seemed to fit.”

Eventually, a urologist confirmed the boy’s rectum was clogged and dilated. A regimen of daily enemas plus Ex-Lax halted his poop accidents in one week — the week before the poor kid started middle school.

“We literally went through torture for years,” his mom said.

Due to the medical groupthink Dr. Makary describes, countless children are subjected to useless treatments and deprived of effective remedies, so their conditions linger and/or worsen. Doctors are fond of telling families, “Don’t worry, she'll outgrow it. No kid ever went off to college needing diapers.”

False. You cannot assume a child will outgrow enuresis, especially if that child wets nightly and/or has daytime accidents. I treat teens all the time, and they are panicked about the prospect of waking up in a dorm room with wet sheets. Some delay college or live at home because of their condition.

READ: Don’t Assume Your Child Will Outgrow Bedwetting

Children with enuresis and/or encopresis routinely endure humiliation, suspension or expulsion from school, and a devastating loss of self-esteem. They avoid play dates, sleepovers, and summer camps. Many are shamed and blamed by adults — parents, teachers, even doctors — and some are physically abused.

A Florida 3-year-old with encopresis was handcuffed and jailed by his sheriff-deputy parents, who sought to “teach him the consequences.” A 19-year-old told me her parents beat her for wetting the bed. A 15-year-old told me his dad withholds breakfast when he wets the bed and makes him sleep on a wet mattress “to learn what discomfort is.”

Yet doctors downplay these conditions. The AAP calls enuresis “not a serious health problem.” One of my own urology residents told me bedwetting is “brushed off” in medical school as “not super sexy or exciting to treat, because it’s not life-threatening.”

Except sometimes it is. I’ve collected over 50 news articles about children murdered because their misinformed (and obviously disturbed) parents became enraged over the child’s accidents. “Father sentenced to 28 years for beating 3-year-old son to death over bed wetting," "Texas Woman 'Tortured' 6-Year-Old Twins, Killing One Over Bed-Wetting," "Woman arrested for burning 6-year-old boy's genitals over bedwetting" — take your pick.

Many teens self-harm because of enuresis and/or encopresis. One mom told me her son was hospitalized for suicidal ideation. After a decade of fruitless remedies, she learned about enema-based treatment, and her son was game to try. “It still shocks me how much resistance we got from everyone — the GI doctor, the pediatrician, the mental health care providers, his dad,” this mom told me. “But we did it anyway, and it worked. My son is 16 1/2, and I was finally able to buy him underwear.”

READ: Dear Bedwetting Teenagers: Your Condition is 1.) Common, 2.) Not Your Fault, and 3.) Totally Fixable

Sadly, misinformation about enuresis and encopresis pervades popular culture, including books, film, and TV. (In both of Taffy Brodesser-Akner's popular novels, bedwetting signals psychological distress.) Bedwetting" has even become a political cliche and sports cliche, shorthand for "excessive worry.” (“CNN pollster explains why Democrats are 'bedwetting' over newest election numbers.” Eagles to Bed-wetting Fans: Get Over it. We're 5-2.) According to the Washington Post, some Democrats "jokingly" refer to Barack Obama as "the party's biggest bedwetter.")

Where do novelists and pundits get this idea? From the medical establishment! After all, the AAP states that “stress can cause bedwetting,” and the APA includes enuresis in its manual of mental disorders.

In Blind Spots, Dr. Makary notes that many medical recommendations “fly directly in the face of both science and wisdom,” and that is the case here.

Let’s look at the science.

Again, Dr. Makary nails it: “Published studies get lost in a sort of research Bermuda triangle. Medical specialties can live in silos, and silos can stifle progress.”

For ages, childhood urinary problems and pooping problems were considered entirely separate matters — one pertaining to the bladder (the purview of urologists), the other to the colon (the purview of GI specialists). Still other “experts” viewed enuresis and encopresis as the concern of psychiatrists.

In the 1980s, Dr. Sean O’Regan, a young pediatric kidney specialist practicing in Montreal, wasn’t buying any of it.

Dr. O’Regan had a personal stake in knowing the truth about enuresis, as his 5-year-old son wet the bed nightly. Self-conscious about his accidents, the boy wouldn’t sleep anywhere but home, and this was stirring tension in the family. Dr. O’Regan’s wife made note of the fact that the good doctor was unable to help his own son.

Certain the boy had neither psychological problems nor anatomical bladder abnormalities, Dr. O’Regan sought answers at the renown McGill University Medical Library. He was surprised by what he unearthed: several references, dating as far back as the 1890s, to a link between constipation and enuresis. One study, for example, reported that children with Hirschsprung’s disease, a congenital colon condition that causes severe constipation, typically developed urinary problems.

Doctors from an earlier era had ventured outside their silos!

Dr. O’Regan, to his credit, ventured even further. For starters, he asked a colleague to perform anorectal manometry on his son. The test, the gold standard for diagnosing constipation, would determine whether the boy’s rectum had been stretched by a buildup of stool.

Using a catheter, the colleague inserted a small balloon into the O’Regan boy’s bottom and gradually inflated it, waiting for the boy to report discomfort. But the boy felt nothing. Dr. O’Regan’s colleague reported, “The kid’s got no rectal tone.”

That was the Eureka moment that changed the course of Dr. O’Regan’s career and, ultimately, my own.

On a roll, Dr. O’Regan wondered whether treatment to empty his son’s rectum would restore rectal tone and halt the bedwetting. He devised a three-month regimen: one month of nightly enemas, followed by a month of enemas every other night, followed by a month of enemas twice a week. This was before Miralax (PEG 3350) was approved and before doctors baselessly declared enemas “traumatic” for children.

And so, each night, the O’Regan boy would read Winnie-the-Pooh on his bed while waiting for the urge to kick in. Within weeks, he experienced his first dry nights. During the second month of treatment, his bedwetting stopped. To prevent backsliding, Dr. O’Regan made sure his son completed the three-month regimen.

Then, like Dr. Lack — the UK allergist struck by the dearth of peanut-allergy patients in Israel —  Dr. O’Regan parlayed anecdotal observation into scientific research. Would the regimen that cured his son do the same for other enuresis patients?

To find out, he contacted local pediatricians and attracted a substantial group of test subjects among French Canadian children with urinary problems.

Dr. O’Regan’s first study, published in 1985, tracked 47 girls, average age 8. All the girls had recurrent UTIs, as well as encopresis, daytime wetting, and/or nighttime wetting. Anorectal manometry proved these girls severely constipated. What’s more, the enema regimen proved highly effective. After three months, UTIs ceased in 44 of the 47 girls. Among the 21 girls with encopresis, 20 stopped having poop accidents. Among the 32 girls with daytime or nighttime enuresis, 22 stopped wetting.

In the ensuing years, Dr. O’Regan published additional research and prescribed the enema regimen to hundreds of patients. He delighted in helping children whose accidents had been grossly misunderstood. “These kids were told it was all in their heads, that they were psychologically disturbed,” Dr. O’Regan once told me.

Like Dr. Lack’s first peanut-allergy study, Dr. O’Regan’s research largely went unheeded, disappearing into that research Bermuda triangle.

Certainly, I never learned of Dr. O’Regan’s studies in medical school. Though a “pediatric urologist” sounds like a bedwetting specialist (if not us, then who?) in reality, we’re surgeons who mostly fix congenital anomalies. Bedwetting doesn’t rate much interest. In med school, I did learn that constipation can cause enuresis, but I was taught to treat constipated patients with Miralax. No one mentioned enemas.

I’d been practicing for several years when I dug up Dr. O’Regan’s studies while trying to solve a medical mystery of my own.

I had a 6-year-old patient with urinary reflux, a condition that prevents the bladder from fully emptying and leads to chronic UTIs. Typically, reflux resolves with time, and in the interim, UTIs can be prevented with low-level antibiotics and a regimen to prevent constipation. After all, an idle mass of poop supplies the bacteria that trigger UTIs.

My patient took Miralax and pooped like a champ and passed constipation questionnaires with flying colors. Yet her UTIs persisted, and she developed the urgent need to pee.

According to my training, her only option was surgery to reposition her ureters. I proceeded with the operation and was startled to find her rectum chock full of poop! A grapefruit-size mass of stool was squishing her bladder into a position that explained the reflux. I had totally missed it.

Intrigued, I began asking parents, via standard questionnaire, whether their children showed signs of constipation, and then, for comparison, I’d x-ray the kids. (A plain x-ray is plenty safe and much easier for all involved than anorectal manometry.) Among the first 50 enuresis and UTI patients I x-rayed, all had normal pooping habits, per their parents, yet the films showed mondo poop clogs.

I thought I’d made an epic discovery and could finally prove to my wife I was a genius!

But then I learned my epic “discovery” had been discovered 30 years earlier, by one Sean O’Regan. I was so amazed by his studies that I tracked him down in retirement. Dr. O’Regan didn’t sound surprised to hear from me.

“It’s the rediscovery law of medicine,” he said. “Things are often lost and recovered again.” 

This is yet another theme that surfaces in Blind Spots.

In a chapter on the overmedicalization of childbirth, Dr. Makary decries the practice of separating premature newborns from their mothers. He explains that modern medicine’s “rediscovery of the benefits of skin-to-skin contact” began in the 1970s, after a Colombian village nurse suggested the idea to two pediatricians in Bogota. When these doctors adopted the practice, deaths among premature babies in their clinic plummeted by 70%.

Yet for decades modern doctors, boasting of their neonatal incubators, dismissed the practice as “backward.” The Lancet even published a paper titled, “Myth of the Marsupial Mother.” Today, it's clear that skin-to-skin contact dramatically reduces rates of postpartum depression and NICU admissions.

Similarly, Dr. O’Regan’s step-down enema regimen of the 1980s, routinely disparaged by my contemporaries, far surpasses today’s favored treatment, Miralax.

About 15 years ago, I adopted Dr. O’Regan’s approach for treating enuresis and encopresis and saw my success rate improve dramatically. To better treat the challenging cases, I began tinkering with Dr. O'Regan's regimen, and around 2015, I gave the treatment a name: the Modified O’Regan Protocol, aka M.O.P. Dr. O’Regan, always supportive of my efforts, seems to get a kick out of that.

READ: What is M.O.P.?

Once I began x-raying my patients, I could see that treating accidents with Miralax alone was foolhardy. (Also inadequate: dietary remedies, like fiber and prune juice.) In these kids, the rectum is typically stretched to two or three times its normal diameter of 3 cm max. Sometimes, you see a huge rectal mass flattening the bladder. Treating this hard, dry mound with laxative powder is like trying to clean a crusty old dinner plate with trickle of water.

In these kids, Miralax-softened stool just oozes around the rectal clog, creating a mess without actually emptying the rectum.

Dr. O’Regan instinctively knew this. Though PEG 3350 didn’t exist in his day, other oral laxatives, including senna and magnesium, did. When I asked Dr. O’Regan why he chose enemas, he said, “We knew the root cause of bedwetting was incomplete rectal emptying, and enemas were the only way to solve the problem.”

That’s consistent with my experience and research. When my clinic compared Miralax and Dr. O’Regan’s enema regimen in a small study (60 patients), we found a dramatic difference: After three months, 30% of the Miralax patients had stopped daytime wetting, compared to 85% of the enema patients.

Our data on rectal diameter reveals why enemas worked better. All the patients had started with a rectal diameter over 6 cm. After three months of treatment, the rectums of the Miralax patients remained stretched, to 5 cm on average. Among the enema group, the average rectum had shrunk to 2.15 cm.

Three children in our enema group did not improve, and their follow-up x-rays showed why: their rectums remained clogged. That’s right: For some children, even daily enemas won’t make a dent in the massive stool pile-up. These are the kids who require more aggressive variations of M.O.P. (These days, I work with six variations, all described in The M.O.P. Anthology 5th Edition.)

For the more stubborn cases, one of my go-to remedies involves yet another medical rediscovery — summoned from the past by yet another nurse, this one in Iceland.

Some years ago, a mom in Reykjavik who belonged to my private Facebook support group, posted that her 7-year-old was not making sufficient progress on M.O.P. Daily enemas had halted the boy’s encopresis but not his enuresis (a phenomenon I explain here.)

The boy’s local doctor, supportive of M.O.P. but out of ideas, asked a veteran nurse how stubborn constipation was treated back in the day. The nurse's response: overnight olive oil enemas. This treatment, effective at softening crusty, old stool, did the trick! The Icelandic boy’s accidents diminished, and an x-ray his mom posted on our private Facebook page confirmed improvement.

Turns out, olive oil enemas were pioneered by German physicians back in the 19th century. An 1892 medical journal described this practice as “a ready and safe method of relieving even the most obstinate cases of spasmodic constipation.” In a 1904 paper, a British physician described olive oil enemas as “without question most valuable in obstinate cases of constipation.”

READ: Olive Oil Enemas for Childhood Constipation: An Old-School Treatment Gets Scientific Validation

Today, I routinely recommend overnight oil enemas, in conjunction with M.O.P., for children with impacted stool. The remedy is cheap and easy, requiring nothing more than olive oil and a syringe.

Few U.S. doctors recommend this approach, but it’s commonly used in Japan. A 2021 study from Kobe Children’s Hospital found olive oil enemas useful in 77% of 118 cases reviewed. The authors called the treatment “a safe and effective remedy for chronic constipation” and, when followed by liquid glycerin enemas — a combination I've dubbed J-M.O.P. — “useful for fecal disimpaction.”

You know what’s not useful for severe constipation and fecal disimpaction? Miralax.

Yet PEG 3350 is what virtually all physicians offer enuresis and encopresis patients. And when Miralax fails? More Miralax. When that fails? More.

READ: Why Miralax Clean-Outs Fail

For countless families, this approach is disastrous. One mom in my support group posted:

We did the Miralax merry-go-round with my daughter for about a year. At every doctor's visit, they would up the dose, until it was 4 caps a day for a 2.5-year-old. She would withhold withhold withhold, up to a week and a half, and then have explosive diarrhea that she cried through while clinging to me (poop EVERYWHERE despite a diaper). After 2 urgent care visits and no helpful suggestions, I went to Google and stumbled upon M.O.P. It was the first thing that I found that made sense (and gave me "permission" to do something besides Miralax)."

Another mom posted:

My son got kicked out of two preschools due to daytime accidents. We got started on Miralax, and the poop accidents just got worse. The second preschool kicked us out 3 days before graduation, when my son broke his leg, because they couldn't handle the poop accidents if he was also wearing a full-leg cast. We were doing Miralax clean-outs about once a month, and he was still having poop accidents most days. He went through three changes of clothes on the day of his final chess tournament toward the end of first grade, at which point he decided he'd rather go home than stay and claim his trophy. M.O.P. gave him back his confidence and us our sanity.

A third:

When my son was diagnosed with encopresis at 5, I found M.O.P., but his pediatrician was against enemas, so I took her suggestion of Miralax clean-outs. Fast forward 2 1/2 years. The poor guy had three poop accidents at his 6th birthday party at a park. Yet I kept up with Miralax. Just before covid, he was having daily accidents at school. His doctor blamed it on stress and had me adjust the Miralax dose. I went back to M.O.P. His accidents stopped as soon as we started enemas, and we are now tapering. . . It is crazy that doctors tell us that it is too traumatic for these kids.

It's crazy, but it’s true. “Enemas are traumatic for children” is the party line among doctors of all stripes — pediatricians, GIs, urologists, ER docs.

READ: "My daughter literally leaked stool all day long": Doctors Get Encopresis Treatment All Wrong

One mom in our support group posted: “When I told our doctor we were getting good results with enemas, she told us to ‘stop that right away.’ The most upsetting thing was her language around the ‘trauma,’ which has not been our experience at all. Enemas are just part of our evening routine, like brushing teeth.”

Another mom wrote: “When I brought enemas up to our doctor, he said, ‘There's no way I would do that to my child.’”

A third mom : “When my child told the doctor she liked enemas because she felt better, her statement was immediately dismissed with ‘No, you don’t. No one likes them.’

One doctor told a mom that enemas would “scar your daughter for life.”

These comments are reminiscent of how parents were treated by some physicians during the peanut-allergy hysteria — “viewed almost like criminals” or “idiots who arrogantly defied science.”

When I asked Dr. O’Regan if any of his patients ever suffered complications on his regimen, he replied, “Our only complication was a 7-year-old girl who clogged the toilet at our hospital after an enema. She was legendary.”

In other words, the damage was to the hospital plumbing, not the patient!

Yet, doctors today insist, entirely without evidence, that enemas harm children.

It wasn’t always thus. Enemas are as old as medicine, referenced in the ancient Egyptian Ebers Papyrus and touted by Hippocrates himself circa 400 B.C.E. In the medical literature, you can trace a shift in the perception of enemas, from benign and effective in Dr. O’Regan’s day, to “coercive” and “traumatic” today.

READ: Children with Encopresis and Enuresis Deserve the Best Treatment, But Most Aren't Getting It

Consider: In 1985, Johns Hopkins researchers published a study on children with severe encopresis. These kids averaged 13 poop accidents a week and suffered profound distress. An enema regimen, different from Dr. O’Regan’s but along the same lines, proved “highly effective,” according to the study. The researchers described their regimen as “rapid and easy to perform,” “involving minimal risk,” and “the treatment of choice for encopresis.” The Hopkins folks noted that the treatment’s success “seem to gratify parents” and encouraged families “to cooperate with the treatment regimen.”

Yet in a 2017 book chapter, a psychologist describing that very study disregarded the regimen’s success and wrote that the children “were made to use enemas” (italics mine), wording that suggests the children were coerced into a traumatic treatment.

My patients are not coerced into using enemas. Certainly, some children are apprehensive and need time to work up to the idea (our Enema Rescue Guide, included in the M.O.P. Anthology, helps on that front), but most are grateful for a treatment that works. And many children, even as young as 5 or 6, can insert enemas on their own. My patients typically have autonomy and control over the process.

In Blind Spots, Dr. Makary writes, “Questioning assumptions should not be viewed as a threat. It’s the very way we find truth.” Yet many doctors do not like their assumptions questioned, not by other doctors and especially not by parents.

I wrote a handout titled “The Physician’s Guide to M.O.P.” for parents to print out for their physicians. Parents tell me doctors often dismiss it, even handing the packet right back without glancing at it. Some doctors simply will not abide the possibility that, given a choice, many kids will choose enemas over Miralax.

And yet, kids do.

One mom in our group posted: Our life revolved around the bathroom, accidents, and the timing of dosing of oral laxatives. The doctor insisted that enemas would be traumatic, but after my child came home crying, devastated and embarrassed that she pooped her pants at school and sat in poop for over an hour because she didn’t want anyone to know, we decided to take the plunge. M.O.P. gave us our lives back. Given the choice, our daughter chooses her ‘bum medicine.’

Another mom wrote: It is way more traumatic to have a poop accident in the middle of class and stink up a room full of kids who don’t yet have a verbal filter. My daughter asks for enemas and has increased confidence five-fold because she’s not smelly. She used to ask me in a whisper if she smelled OK. It broke my heart. Now THAT was traumatic, especially when you’re in middle school.”

In Blind Spots, Dr. Makary writes, “The majority’s urge to resist new ideas is powerful.” In my field, the resistance is remarkably strong.

At least the doctors who oppose enemas concede that constipation is causing the accidents. That’s progress! Some physicians reject that idea completely and demean parents for making the suggestion.

Often, comments smack of the paternalism that Dr. Makary believes “plagues modern medicine” — the same paternalism, he writes, that prevented women from being able to do their own pregnancy testing until 1976.

“Our doctor stopped short of rolling his eyes at my questions," one mom wrote, "but in general, his attitude seemed to be that we were wasting his time.”

The doctor prescribed desmopressin, a medication that decreases urine production and, in some kids, does suppress bedwetting. I prescribe it myself in certain situations. However, I emphasize to patients that desmopressin doesn’t work long-term and does nothing to address the root cause of enuresis.

READ: Bedwetting Medication: When It Works, When It Doesn't

Another mom posted that her pediatric urologist “scoffed at the idea that bedwetting had anything to do with constipation,” insisting the cause was either deep sleep or a small bladder (myths I debunk in the Anthology). Another mom wrote that her urologist “said it was our expectations as parents that was the problem.”

What’s the source of such antagonism?

As Dr. Makary explains, human beings automatically default to rejecting new information or, at least, “reframing it in order to ensure that old information in the brain remains true.”

This aspect of human nature infects the way studies are conceived and interpreted, so flawed data trickles down to conscientious doctors who read the journals to “stay current.” As Dr. Makary observes: “Just because there is a study to support an idea does not mean the study was designed properly, conducted ethically, or reported accurately.”

Dr. O’Regan’s research underscores a fatal flaw in most studies that seek to explain enuresis: the subjects are not assessed for constipation. A study might find higher rates of bedwetting in kids with chaotic family lives or restless sleep patterns or “decreased gray matter density in the right dorsolateral prefrontal cortex” and then declare family stress, a sleep disorder, or brain dysfunction a likely cause of enuresis.

Meanwhile, studies that do address their subjects’ constipation status rely on inadequate

diagnostic methods, such as the Rome IV criteria, a lofty-sounding framework that steers researchers and clinicians wrong all the time.

READ: Even Severe Constipation Goes Undiagnosed in Bedwetting Children. Here’s Why.

Researchers revere the Rome IV criteria as if they were etched in tablets received at Mt. Sinai.

But a Dutch study that evaluated the criteria found that 45% of children ages 11 to 18 couldn’t follow the instructions on a Rome questionnaire. For multiple reasons, the authors advised against relying on the questionnaire to select or evaluate research subjects. In my experience, the Rome IV criteria catch the big fish while others slip through the net.

Fact is, many severely constipated children poop every day, don’t feel pain with pooping, and don’t have stomachaches or poop accidents — among the criteria on most constipation questionnaires.

READ: Yes, Your Child Can Poop Every Day and Still Be Constipated

Also, many parents know nothing of their child's pooping experiences, so they can't accurately answer questions on behalf of their kids. I had pooping problems throughout my childhood but certainly never told my mom! I figured painful pooping was normal.

Here's how constipation data is easily skewed: A 2023 study out of Ethiopia reported that caffeine intake and “exposure to stressful events,” such a divorce, are “predictors” of bedwetting. The authors actually did consider whether constipation could play a role, but since few parents reported signs of constipation on their questionnaires, the authors dismissed any possible connection. Considering that highly trained medical doctors routinely overlook severe constipation in their patients, the idea that a sample of Ethiopian parents, about one-fifth of whom lack literacy, could accurately diagnose the condition in their children is wishful thinking.

Back in the 1980s, Dr. O’Regan recognized the inadequacy of questionnaires, noting in his studies that most parents of his test subjects had no idea their children were constipated, let alone severely so. He also recognized that the conventional understanding of constipation was off base. While most people define constipation as “infrequent pooping,” Dr. O’Regan described the condition as “incomplete evacuation of the rectum." Truly, Dr. O’Regan’s observation was brilliant.

READ: To Help Bedwetting Children, We Need a New Definition of Constipation

For all these reasons, I x-ray my enuresis patients. I also do it to rule out the rare conditions, such a tethered cord syndrome and posterior urethral valves, that can cause wetting in the absence of constipation. (I typically don’t x-ray my encopresis patients since chronic constipation is literally the only cause of the condition.)

When it comes to diagnosing the cause of a patient’s enuresis, my motto is: Constipated until proven otherwise.

U.S. doctors don’t routinely x-ray for constipation in enuresis patients, though some do. (Due to lack of training, x-rays are frequently misinterpreted by radiologists. I offer an x-ray tutorial in my Zoom course for medical professionals.) Outside the United States, these x-rays are virtually impossible to come by. Unhelpfully, the British National Health Service tells physicians: “Do not use a plain abdominal radiograph to make a diagnosis.”

As a result, countless super clogged children are declared “not constipated.”

READ: Why an X-ray for Childhood Constipation Can Seem Like a Rorsach Test

Unfortunately, due to rampant underdiagnosis, researchers set out on wild goose chases to otherwise explain enuresis. “Emotional stress” is among the popular theories pulled out of thin air.

In Blind Spots, Dr. Makary writes about theories like this — ideas that don’t warrant rigorous studies because “it’s so obvious” and “we just know it to be true.”

The AAP’s web page on bedwetting states: “Children experience stress when moving to a new home or school, experiencing a parental divorce or losing a parent or other people they love, or going through another major life event." And then, as I mentioned earlier: "This stress can cause bedwetting; treating the stress can stop the bedwetting.”

Similarly, an online network of mental health counselors asserts: “Enuresis can be triggered by separation from a parent, the birth of a sibling or family conflict.”

Where on earth does this idea come from? I don’t know! A footnote on one website led me to a study conducted in India — a study that provided no actual data, stating only that the “birth of a sibling, parental separation, and family discord [are] some of the common emotional problems which lead to the persistence of enuretic behaviour.”

As Dr. Makary observes in Blind Spots, repeating an unfounded theory does not make it true!

Neither does pretending a study supports your theory when it doesn't. Yet this happens frequently in medicine.

In his chapter on peanut allergies, Dr. Makary notes that the only study cited by UK health authorities to support their 1998 peanut-abstinence recommendation “did NOT find an association between pregnant moms eating peanuts and a child’s peanut allergy.” In fact, the author of that study disagreed with the government’s recommendation and felt his research had been misconstrued.

When it comes to enuresis and encopresis, researchers often manipulate study findings to confirm their biases.

In the Ethiopian study I mentioned earlier, 23% of the children surveyed had been “exposed to stressful experiences" such as divorce, according to their parents. The researchers performed some math wizardry and concluded that children exposed to stressful events had “20 times the risk” of developing nocturnal enuresis compared to children not exposed to stress.

Twenty times! That’s roughly a smoker’s increased risk of developing lung cancer compared to a nonsmoker’s. This is a classic case of "correlation is not causation."

Yet "authoritative" medical texts rely on flimsy studies like these to connect bedwetting with emotional stress or behavioral disorders. The Handbook of DSM-5 Disorders in Children and Adolescents asserts: “In fact, some studies have found psychiatric comorbidity in as high as 74% of children with encopresis.” You might think: Wow! That’s super high! Clearly, there’s a connection.

But the study cited, published in the Turkish Journal of Pediatrics, is laughable: The most common comorbid “psychiatric disorder” was . . . enuresis.

Other texts rely on anecdotes and guesswork. For example, a guide for psychiatric nurses acknowledges encopresis is caused by constipation yet states that encopresis “is also a psychiatric diagnosis.” Why? Because “anecdotally, [encopresis] may have some association with psychiatric problems.”

That’s right: “Anecdotally.” “May have.” “Some association."

You can see how an 8-year-old with chronic poop accidents ended up on bipolar medication.

READ: Kids Shoulder Shame and Blame for Bedwetting and Accidents: How Therapists and Counselors Can Help

Often, mental health professionals don’t question the “mental disorder” classification until their own children develop enuresis or encopresis.

One therapist posted in our support group that she felt "pretty devastated about how terribly some encopresis situations were managed with kids I worked with over the years. It makes me feel nauseated to think about a sticker chart.”

Another therapist in our group recounted that she and colleagues treated encopresis “as a symptom under the anxiety or behavioral or trauma umbrellas. We didn’t consider encopresis a medical issue. Until I started dealing with it with my own son, I had no clue.”

That’s understandable. After all, therapists rely on authoritative manuals such as the DSM-5, just as pediatricians rely on the AAP. Over the years, I’ve had several pediatricians join my support group for help treating their own children.

Recently I received an email from a pediatrician whose son has encopresis. A GI doctor billed as an "encopresis specialist" had offered her son nothing more than a prescription for oral constipation medication and anorectal manometry (which would only reveal the obvious!). The pediatrician already had tried chiropractic, acupuncture, and psychiatry, all to no avail, when a physical therapist told her about M.O.P. “No doctor seemed to either know about it or support it,” she told me. The treatment worked so well for her son that this pediatrician now recommends M.O.P. to her own patients, though she’s had few takers. “They all seem to want a nasty mess of laxatives first,” she wrote.

But, I digress — back to the DSM-5.

Strangely, this manual asserts that both enuresis and encopresis “may be voluntary or involuntary.” Further, the book divides encopresis into a subtype “with constipation” and a subtype in which “there is no evidence of constipation on physical examination or by history.”

This second subtype, according to the book, “appears to be less common,” and is “usually associated with the presence of oppositional defiant disorder or conduct disorder.”

Bollocks, as the British would say!

Encopresis is always caused by constipation. Kids simply don’t poop in their pants unless they have a stretched rectum and backup of stool. If a physician can’t find evidence of constipation in a child with encopresis, it’s because the doctor doesn’t know how to look.

Notably, the DSM-5 and related texts observe —briefly — that many children with enuresis also have encopresis, constipation, and urinary tract infections. However, these resources fail to connect the dots. Reading these texts is like watching a TV crime drama in which bumbling detectives overlook obvious clues. You're screaming: No! You've got the wrong guy! 

Perhaps one rationale for including encopresis and enuresis in psychiatry texts is the fact that these kids often experience serious psychological distress. The Handbook of DSM-5 Disorders in Children and Adolescents cites a UK study linking encopresis with elevated rates of “bullying behavior (both as a victim and perpetrator), antisocial activities, attention and activity problems, obsessions and compulsion, and oppositional behavior.”

But what’s the real lesson here? Children suffer when their encopresis goes untreated.

When these kids are treated appropriately, their constipation resolves, and so does their “behavior.” Here’s how one mom described her daughter’s experience on M.O.P., after 3 years struggling with encopresis:

She went from up to 10 soiling accidents a day to none. She had severe, debilitating abdominal pain daily. It’s gone. I would get called 3-4 times a week to fetch her from school. Haven’t gotten a call since starting. She had severe negative self-talk to the point where the doctors were wanting to start anti-psychotics. It is completely gone. She had severe anger outbursts. Gone.

READ: When Constipation Treatment Improves a Child's Behavior or Mood

The Handbook cites multiple third-rate studies linking daytime wetting to “difficult temperament and maternal depression/anxiety,” a blame-the-mom approach that also makes several appearances in Dr. Makary’s book.

Among the most discouraging themes in the psychiatry literature is that for many children, the prognosis is grim — that only 30% to 50% for children with encopresis, for example, may recover after a year. The Handbook cites particularly poor treatment outcomes in children with parents of “low education level, low socioeconomic status” or with families “characterized as divorced, disorganized, or chaotic.”

That’s insulting and ridiculous. Only one factor leads to a poor prognosis: inadequate treatment.

The Handbook suggests teens with encopresis may require a “different treatment approach” due to their age and particularly difficult family dynamics. In support of this nonsense, the manual cites a case report of four teens admitted to the psychiatric unit of an Israeli children’s hospital.

In the characterizing the teens’ parents, the authors, both psychiatrists, use such descriptions as “pedantic and obsessive,” “came from a low-social class,” “lived a Bohemian life” — you get the idea.

After a two-week hospital stay, the teens, who’d struggled with encopresis for 6 years, on average, experienced “complete remission.” The authors attribute this success to the “separation of the parent and child” and “peer pressure.”

Having read the study and summoning common sense, I attribute the success to something else entirely: enemas. The teens’ treatment protocol included an enema on any day the child didn’t poop, as a “means to help the bowel regain normal activity.”

In sum: Four kids who had suffered for years stopped having accidents in two weeks because their rectums were emptied, a scenario that happens every day in my clinic.

It’s a tragedy that the medical establishment’s assertions about enuresis and encopresis go unquestioned, both in medicine and in the media.

Again, this is a theme Dr. Makary discusses: “Today’s public health and medical experts — and certainly the media — have lost the ability to critically appraise research quality.”

I have a Google Alert set for “bedwetting,” so I know how media outlets cover this topic. It’s depressing.

When I read an article titled “Study Ties Teenage Bedwetting to Cyberbullying,” I found that no such study exists! Nonetheless, the piece insists the "interconnection between online bullying and nocturnal enuresis is clear" and advises parents of teens with enuresis to "safeguard" their kids by purchasing cybersecurity technology.

Google also sent me this article: “Back to school anxiety linked to increased bedwetting in children, study finds." Turns out this "study," trumpeted by several media outlets, is actually a poll of 1,000 parents that Pampers paid a PR firm to conduct. On its website, the publicity firm touts its capacity to “power your PR with data-led storytelling” and “generate attention-grabbing headlines.” The firm delivers!

READ: Back-to-School Anxiety and Bedwetting: What's Fact, What's Not

I would ignore such dreck, except this stuff gets posted all over social media and steers families wrong.

Even legitimate journalism outlets accept, without question, the idea that bedwetting has emotional roots. A harrowing New Yorker article, about an Austrian psychiatrist who tormented over 3,500 chlidren post-World War II, contrasts the "backward" ideas about bedwetting in that era with the supposedly more enlightened viewpoints of today.

The New Yorker piece states: "In the early twentieth century, a punitive approach to bed-wetting was common, including in America. Most experts gave little credence to the many developmental, physical, and emotional issues that cause a substantial minority of children to wet their beds past the toddler stage."

Again, there is zero evidence that "emotional issues" cause enuresis. (The developmental issues are bunk, too.)

In Blind Spots, Dr. Makary observes that doctors who buck the party line, in any field, are often dismissed as “controversial,” their findings disregarded or misrepresented. If shoddy research supports what folks already believe, he writes, “it’s hailed as definitive science.” But if a good study conflicts with dogma, “it’s ignored or nitpicked.”

Which brings me to a Swedish study titled “Fecal disimpaction in children with enuresis and constipation does not make them dry at night.”

In this trial, a two-week regimen involving enemas and laxatives did not reduce bedwetting. Therefore, according to the authors, children “should not be given the false hope" that fecal disimpaction alone will make them dry at night.

The paper misses a critical point: Enuresis is caused by chronic constipation, a condition that develops gradually and often takes months to reverse. As I state in the M.O.P. Anthology:

When families start M.O.P., they assume enemas are so powerful, like a dynamite blast, that the child’s rectum will be emptied out within a day or two. Thirty days of enemas seems nuts! But reality can be sobering. Some children are so stubbornly clogged with stool and have so completely lost the urge to poop that a month of enemas achieves little or nothing.

Using a two-week study to conclude fecal disimpaction “does not alleviate nocturnal enuresis” is like using a two-week diet-and-exercise regimen to prove that eating less and moving more “does not alleviate weight gain.” I mean, how could it?

READ: Why Most Bedwetting Treatments Don't Work

Interestingly, the Swedish authors reference Dr. O'Regan's research, a rare citation in enuresis literature. Except they dismiss his results as irrelevant: "It can be assumed that the children examined represented a hard-core population that is not directly comparable to our sample."

What an odd assumption! The Swedish children wet the bed five nights a week on average — “hard-core” enuresis by any definition.

Also odd: The Swedish paper references a retrospective study of mine that found, via x-ray, that 30 consecutive enuresis patients had an enlarged rectum. Without explanation, the authors dismiss my subject sample as “highly biased.”

To their credit, the Swedish authors note a flaw in their study: The subjects were not evaluated for constipation status after 14 days of treatment. “We do not know whether the constipation treatment actually worked against the constipation," adding, "Maybe they were still constipated.”

I would bet on it.

Countless enuresis studies lament that enuresis is hard to treat. The Swedish authors, for example, claim that perhaps 25% of enuresis cases "are resistant to all therapies.” Egyptian researchers, trialing Prozac as a bedwetting cure (big fail) estimate that "approximately 50% of children are "refractory to treatment."

That's nuts! The real problem is that today’s therapies — PEG 3350, bedwetting alarms, bladder medication, even a 2-week enema regimen — aren’t up to the task. M.O.P. will resolve enuresis in virtually all children and at very low cost. All you need is a bottle of liquid glycerin and a pack of syringes.

READ: No, Prozac Isn't a "Reasonable" Bedwetting Treatment

On occasion, M.O.P. fails. Either the rectum simply will not empty (a scenario discussed in the Anthology), or the rectum, despite having emptied, remains enlarged, continuing to aggravate the bladder nerves. In these cases, I usually turned to bladder Botox, a highly effective surgical treatment. Botox is amazing. Injections into the bladder halt accidents immediately by calming the bladder nerves.

The success of Botox confirms the link between constipation and enuresis. Kids with an empty rectum but persistent wetting typically need just one Botox injection. By the time the Botox wears off, in about a year, the rectum has shrunk back to size, and the bladder nerves have recovered. End of story.

On the other hand, kids with stubborn constipation, like patients with spina bifida, need repeat Botox injections to stay dry. That's fine — I'm happy to do annual injections and give these kids a boost. The kids who fare poorly with Botox, whose wetting returns within a few months, are those who did not first implement aggressive M.O.P. treatment; I discourage these families from going the Botox route.

Think about it: If emotional stress, deep sleep, urine overproduction, or a small bladder caused wetting accidents, Botox would fail. After all, Botox does not relieve anxiety or alter sleep patterns, urine production, or bladder size. It simply calms the bladder nerves.

And if enuresis had a cause other than constipation, M.O.P. would fail, too. But it almost never does, if you give it enough time and use a M.O.P. variation that suits your child. (After any 30-day period without progress, I advise adjusting the regimen.)

In Blind Spots, Dr. Makary cautions against believing everything you read in medical journals. After all, in 2023 alone, over 10,000 medical journal articles were retracted. Two prominent university administrators resigned following accusations of data manipulation in multiple studies. One of those studies had been cited by other journals 178 times.

Flawed research has serious ripple effects, tainting what doctors recommend to patients, what journalists report, and how popular culture perceives a medical condition. What's more, bogus studies allow unscrupulous companies to make a buck off desperate families.

For example, Dr. Makary notes that during the peanut-allergy explosion, manufacturers jacked up the Epi-Pen price from $100 to $600.

Today, diaper companies capitalize on bad science and groupthink, spending massive amounts of money to normalize bedwetting. After all, if parents perceive enuresis merely as an inconvenience their child will inevitably outgrow, they won’t question the need to buy ever-larger pull-ups for years on end.

The diaper industry pays parenting bloggers, influencers, faux media outlets, and even physicians to help sell these XL pull-ups under the guise of helping families.

READ: Pampers' Ninjamas Videos Normalize Bedwetting, at the Expense of UK Kids

Consider the Pampers Ninjamas Bedwetting Series of upbeat videos, created to assure families in the UK and Ireland that bedwetting is of no concern. A cheerful doctor says: “Don’t worry, it’s fine,” and “Don’t fret. It’ll stop eventually.”

In the meantime? “Ninjamas are here — they’re saving the day."

The cheerful doctor offers four explanations for enuresis, all erroneous, plus a bunch of useless remedies. (If restricting fluids after 6 p.m. halted bedwetting, my clinic would not exist!) Then, he tells kids, “Before you go to bed, put your Ninjamas pants on/and you’ll wake up in the morning and want to burst into song.”

I assure you: No child who wakes up with wet pull-ups feels compelled to “burst into song.” What does thrill a kid with enuresis is waking up dry in plain old underwear.

Equally grim is the Goodnites campaign for “Bedwetting Underwear,” a product designed for children up to age 17 and 140 pounds (!). The campaign includes a paid advertisement disguised as journalism, published in Pure Wow, a “woman’s lifestyle destination.” According to Pure Wow: “It is good to know that most bedwetting is normal and have a reminder that it will most likely resolve on its own.” 

READ: The Normalization of Bedwetting Harms Families, Helps Diaper Industry

Worse, Goodnites seeks to normalize accidents in kids diagnosed with autism and/or ADHD.

Now, it is true that autistic kids with enuresis “may face a longer experience with nocturnal enuresis" than their neurotypical peers. But this is only because autistic kids are even less likely to receive timely, effective treatment.

I don’t actually fault for Goodnites for capitalizing on this misconception. The real problem lies with the medical establishment. Doctors mistakenly consider enuresis “part of the deal” with autism and ADHD,

READ: Constipation, Bedwetting, and Autism

Parents in my clinic are stunned to learn their autistic child’s accidents are caused by constipation and are entirely treatable with a regimen such as M.O.P. Yes, autistic children can tolerate enemas!

One mom told me her autistic 7-year-old, who is minimally verbal, came to her after his third enema and said, “Bum.” She added: "I actually found him trying to open a Fleet enema and use it on his own.”

Yet doctors either ignore enuresis and enopresis in autistic/ADHD patients or vastly undertreat these conditions. The mom of an autistic teen who overcame bedwetting with M.O.P. emailed:

My son has autism, and when he started having accidents at around 4 years, his pediatrician told us airily, “It’s because he’s autistic.” I did my own research and came across M.O.P., got buy-in from our son (who met the whole experience with a maturity beyond his years) and convinced my husband, who was reluctant at first. We were on M.O.P. for over a year. It is a quality-of-life issue, to live free of the fear of accidents and experience all the simple joys that one can never recapture once childhood is in the rear-view mirror.

READ: Autism and Chronic Constipation: This New York Times Article is Exactly What I’m Talking About

In one of my favorite Blind Spots stories, Dr. Makary recounts the saga of scurvy, the disease of bleeding gums and rotting flesh that killed 2 million sailors during the Age of Exploration. No one could figure out why men at sea, in particular, would develop this gruesome disease.  

Then came along Dr. James Lind, a Royal Navy surgeon and “a curious man, who had a knack for the scientific method.” In 1747, Dr. Lind performed an experiment on 12 scurvy patients, dividing the men into pairs. For 14 days, he gave each pair a different treatment: a mixture of alcohol and sulfuric acid, a half-pint of seawater, a thrice-daily swig of vinegar, and so on.

One pair was assigned to eat two oranges and one lemon per day. Boom! Dr. Lind had discovered the cause of scurvy: lack of citrus.

Dr. Lind’s book, Treatise of the Scurvy, was published 1753. “But sadly,” Dr. Makary writes, “it was largely ignored. As a result, the cure to a global epidemic was rarely used.”

It took another 40 years for the Royal Navy to stock lemon juice on ships.

Fast-forward to today. It has been nearly 40 years since Dr. O’Regan — in pursuit of a teratment for his son — discovered the cause of and cure for bedwetting. I hope it doesn’t take the medical establishment another 40 years to catch up.