Problems with Potty Training, Constipation, Bedwetting, and Preschool Policies (with Dr. Steven Hodges)

Janet Lansbury:  And by bladder issues, do you mean accidents or bedwetting?

Steve Hodges:  Name it. Daytime wetting, bedwetting, UTIs, sometimes urgency frequency, dysuria, any kind of bladder dysfunction in a kid, almost any kind can be attributed to bowel dysfunction. The interesting part is when I first got this data together, I was like: I’m going to write this up. I’m going to win a Nobel Prize with it.

My resident pulled all the data. This had been already described in the ’80s by Dr. Sean O’Regan. He cured his own son of bedwetting. Then he said, “This is why this happens…” What Dr. O’Regan did, his son was wetting the bed and he was a nephrologist. He didn’t wait for somebody to fix his son. His son was only four years of age, which most doctors would not treat for bedwetting these days.

He took himself to the library at the University of Montreal and McGill University, did all research on his own, found a lot of papers describing bowel and bladder dysfunction were correlated. He did an anorectal manometry test in his son, which is a very advanced test. He put a tube in his son’s bottom, which sounds weird, but he inflated a balloon to find out when exactly his son would feel the balloon. And he found that his son felt the balloon at 150 CCs or almost over three times the normal volume.

So he found out very fortuitously that his son had a dilator rectum. He then treated that and the son stopped wetting the bed in a month. Then he’s published his results, had a lot of data. And again, somehow that’s been kind of lost to history and I’m not really sure why.

Janet Lansbury:  Wow. So besides informing you as to the prevalence of constipation and blockages and how that affects all of these common issues that parents have, how has all this information caused you to advise parents in regard to toilet training? And what are the pitfalls that parents could fall into that create these issues?

Steve Hodges:  Yeah. So early on I was really dogmatic. I was like: Well, kids are holding their pooping in. Right? So the younger kids that trained really early tended to withhold more because they were less mature, less aware. And for them… you could teach a very young child to be continent, to not go to the bathroom, to get out of diapers. But then you couldn’t convey to them the importance of going to the bathroom when they needed to. So invariably, if I saw very young children that were trained, whether it be, 12 months old, 18 months old, by definition, if they could train that early, they were really good at using their sphincter to hold their pee and pooping.

So then they would tend to overdo it, hold their pee and poop in too much, and then they present a few years later with accidents. So I became pretty dogmatic saying, “Listen, the later you can train them, the better. Make sure they’re pooping well. Make sure they’re not developing these withholding behaviors,” because that’s the root of all evil. So basically, I wasn’t seeing any kids with accidents obviously before they’re potty trained, but the later they trained the less accidents that we’re having.

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