The Whinypaluza Podcast with Rebecca Greene Episode 092 Bedwetting and Accidents
In this episode of the Whiny Palooza podcast, host Rebecca Greene, a licensed clinical social worker and mother of three, interviews Dr. Steve Hodges, an associate professor of pediatric urology at Wake Forest University and a leading expert on pediatric bedwetting, constipation, and potty training. Dr. Hodges explains how constipation—particularly occult megarectum, a hidden dilation of the rectum—underlies most cases of bedwetting, debunking common myths that attribute the problem to deep sleep, hormonal issues, or genetics. He discusses the pitfalls of early potty training, recommending that children achieve regular, soft bowel movements before formal training, typically around age 3‑4. The conversation covers how parents can detect constipation at home, the importance of tracking bowel movements, and treatment protocols including dietary changes, osmotic laxatives (e.g., Miralax), enemas, and suppositories. Dr. Hodges also addresses school bathroom access challenges, the typical frequency of urination and defecation for children, and the emotional impact on families. The episode concludes with practical first‑step advice for parents dealing with bedwetting, and provides resources such as Dr. Hodges’ website, social media, and private forums for further support.
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No need to whine, it's Whiny Palooza! Have some wine and join us on the Whiny Palooza podcast with Rebecca Green.
Welcome to the Whiny Palooza podcast. I'm your host, Rebecca Green. I'm a wife, mother of 3, and licensed clinical social worker. I also have 3 fur babies at home too. My passion has always been to help children and their families. I always dreamed of being a wife and a mother. Parents are always learning through their struggles, failures, and successes and joys. I am no stranger to this wild ride of parenting, and I know behind every great parent lies a team of supportive friends and family. I want to be part of your support system. I want you to know that you are not alone. We are in this parenting world together. Join me every week for insightful discussions with experts on parenting and marriage, as well as other parents who have found the secret to successes in parenthood. You'll learn tips and tricks to make life with your family better than ever. I hope you will follow along with me while we dive into what it takes to achieve a happy family.
Hello everyone, this is Rebecca Green for the Whiny Palooza podcast, and I am so excited to have Dr. Steve Hodges with me today. Um, Dr. Steve, thank you for being here today.
Thank you for having me.
He is the country's foremost authority on bedwetting, potty training, and childhood constipation. Dr. Steve Hodges is an associate professor of pediatric urology at Wake Forest University School of Medicine. He has authored numerous journal articles and several books for children and parents, including Bedwetting and Accidents Aren't Your Fault and the MOP, MOP book A Guide to the Only Proven Way to Stop Bedwetting and Accidents. Dr. Hodges' goal is to let families know that the stigmatized issue of bedwetting often gets misdiagnosed and goes untreated because most parents are not aware that constipation is actually the main cause. Dr. Hodges offers strategies backed by solid scientific research for resolving bedwetting once and for all. Awesome, let's jump into this. Let's learn more about this.
Yeah, for sure.
So tell us first, how did you become the country's leading authority on bedwetting? How did this happen?
Yeah, what a dubious honor. So it's interesting because most people that do what I do— and I'm not judging, this is not good or bad, this is a reality— um, try to get out of seeing the referrals for wetting because it's not a surgical problem, you know, and because a lot of kids outgrow it. So most places have a clinic set up so that if you have a wetting problem, you see— you don't see the urologist even though you get referred to him. You see a physician extender that gives you kind of a cookbook solution that may or may not be effective. And so the urologists never see it. At my job, at my place of work, we don't have physician extenders to see anybody. We see them all ourselves. So I was seeing these kids, um, treating them the way that we've been taught to treat them, um, and I'd see them back and I would have really poor outcomes, honestly. And so I started getting interested in, like, you know, I kind of honestly got— you get embarrassed, you see people back, you know, every few months they're no better, and you're giving them the therapy that's supposed to work. I do think a lot of people get written off as just difficult cases, you know. And so I started doing some research into it, and then I had a couple of just really interesting events that serendipitously guided me towards my research and got better results and started just, uh, and I think it's a topic most people aren't interested in, maybe because it's weird, you know, because it involves a lot of poop.
You know what I think? I think it's an unspoken topic that we need to talk more about. That's what I think.
Yeah, and I don't know why, but yeah, it's, uh, I make a joke, um, that I presented my first I'll tell a story. I presented my first paper at a meeting on bedwetting, and I didn't know what to call the fact that there's poop in the rectum, but no one knows it. So I called it occult megarectum because that's what it is. This is a scientific description. It's occult. You don't know it's there, and it's a dilated rectum. And I showed that this is a commonly cause of bedwetting, and I thought it was pretty good data. Afterwards, everyone just— when I talked to my colleagues, they just made fun of the title. They're like, occult megarectum. I'm like, oh my, are you serious right now?
You're like, can we get past this and actually help people?
I know. Yeah. These are like, these are like 55-year-old urologists, you know, it's not like it's, uh, laypeople. So it's tough for anybody, I guess.
Well, let's back up for a minute and then we'll go back to this, but you know, you talk about potty training. So let's start with potty training. You said not to do it too soon because we'll avoid consequences if we, if we don't do it too soon. Can you talk more to us about that?
Yeah, so I think that a couple points here. Potty training is a natural process, should happen naturally, kind of like crawling, walking, you know, it happens on its own. Um, and if it doesn't happen from a certain time frame, maybe like, uh, we decide 4 or something, then you could say maybe something's wrong. But I found a lot of people would, you know, for various reasons, maybe family pressure or expense of diapers, would try to push early training. And if the kids got it really young, parents were proud and happy, but they never followed up on it to see if the kids are actually going to the bathroom. And kids that get it at a young age are just good with holders. That means they just really know how to hold things in. And so I found they would hold things in too much, and then they show up 2 or 3 years later with accidents. So I became really dogmatic about, look, you, you know, you have to have them peeing and pooping regularly till at least 3, pooping, you know, soft mushy bowel movements before you even think about it. And as we've gotten more in the research, I think that definitely is the right opinion, but some people just don't have the genes for accidents. You know, their bladders are really resistant to the constipation. And so I'm not so dogmatic. I mean, if you have no family history, you might get away with, a constipated kid not have problems, but that doesn't mean it's good to be constipated. So I do recommend training later, but I'm not as aggressive as I used to because there's always gonna be a case of a kid that trained really early and did fine. But I think the science behind it is still solid.
Well, and it's, it's so interesting, you know, I didn't get to talk to you when my kids were little, but you know, they started school at 3.
Preschool. Yeah.
Preschool was like, you have to be potty trained. And I was like, oh my God.
That is a major point that we, you know, I've written several letters to preschools to say please don't make them be potty trained. And I get it from the preschool side, they don't want to have diapers and especially poop stuff. Yeah, but I think 3, you know, a lot of kids may not be ready. Maybe 4. Yeah, I could see it because, um, if you're not trained at 4, then probably you got something else going on. But, um, 3 is pushing a little bit. None of my kids were ready at 3. Um, 3 and a half maybe.
Yeah. Yeah, I know. Well, and you know, it's so funny because I hear so many parents tell me that their kids will outgrow it. You know, their kids are bedwetters, oh, they'll outgrow it. Where, you know, where does that myth come from and why can't we assume that?
So it's, it's, yeah, it's, this is an interesting debate. Number one, is bedwetting ever normal? That's a question, right? I don't think it is. I think if you're wetting the bed while you're unconscious, it's not normal. But So many kids do it up to about the age of 5, it's considered kind of normal, quote unquote normal. And then at 5, the resolution rate drops off and it tapers off, like it stabilizes about 15% a year. So there is something to the fact that kids outgrow it. The problem is when will they outgrow it, right? And so everyone's been told— I, that's basically all the people I see in clinic, they're like 10, 12 years old, and they said that we were told we'd outgrow it every year for the checkup. We've been changing sheets every night for 7 years. We're sick of this, right? Yeah.
Yeah.
So I think it's better to assume that if you're wetting the bed while you're asleep, especially if you're awake, you know, having accidents or any kind of accidents like that, that you seek care and get it addressed because you can definitely resolve the problem a lot sooner if you're proactive.
Well, there's so many myths. I mean, I was writing down things you said, things my friends have said. You know, their bladder's underdeveloped, it's genetic, they're in a deep sleep. So, I mean, these are all things that people are saying about it.
Yeah. You know, it's interesting because even parents, I get, but even pediatricians or maybe my own colleagues will kind of put out suggestions on causes that are basically, you know, you would come up with that seem right. Like, you know, like the earth seems flat, but it's not, right? And People think, well, they seem like they sleep really deeply, but there's much more to it. They seem like they, they make too much pee at night and none of that's been proven. And there's always these parents always think, well, I was told they have to develop a hormone. There's no hormone. I mean, you can give a medicine that affects the hormones that makes you make less pee, but it's not like God designed us to make a hormone. So we wet the bed until we're a certain age. There are clear signs that kids withhold pooping and in young kids that can affect bladder spasms. The guy that first described this, I mean, it's a really irrefutable study. He basically took all bedwetters. It was his— Dr. O'Regan was the guy that, um, influenced our research. His own son was bedwetting, which is how he got into this, and he fixed his own son. But basically took a bunch of kids after he figured out why his son was wetting, and he diagnosed constipation in them, or a dilated rectum, so to speak. And he would do it an old-school way. He would— because what we're talking about constipation is we're meaning that they're holding on too much poop at the end of their colon. So their rectum or the end of the colon is overstretched. Okay, so he would do a test where he put a balloon in their bottom, which would be a very— you know, not most— not many parents would openly approve of this, but you put a balloon in their bottom and you start inflating it and you see when they feel it, right? That makes sense. So if you feel it at a normal size, and we know what normal size is supposed to be, then the rectum is okay. But if it— if they— if you really inflate that balloon for them to feel it, then their colon is too dilated. So he found that all these kids had these dilated colons that had delayed sensation to this balloon. And then he studied their bladders, and he would see that the bladders would kind of go haywire when you fill them up with fluid. And then he gave them enemas, noticed, documented that the rectum shrunk down, and then retest the bladders, and the bladders were normal. So yeah, and that's the best study I've ever seen, uh, with regards to this problem.
Okay, so let's say that you are just a parent at home. There's no balloon, there's no enema. Yeah. How, how, you know, it's undetected, it's untreated, it's misunderstood. How can we as parents detect, help detect constipation?
I think, you know, there's phases to this. Like early on, babies when they're breastfed or formula fed typically poop pretty soft, mushy poop, and there's not issues. Although very early on, like first days of life, there can be a condition called dyschezia. Where they're just pooping for the first time out in the real world and it doesn't feel right, and they may hold it. I remember my oldest would strain like crazy to poop and then just mustard seeds would come out, you know, nothing hard. And I'm like, that's so interesting to me because I'd read about it, but then I was seeing it firsthand. But most of them get over that, and if they don't, you know, you should talk to your pediatrician. Um, but most of them get to the point where they're just kind of pooping mushy poop and they don't mind it. But then something happens whether it's starting rice cereal, dairy, milk, solid foods, maybe an illness that needed antibiotics that kind of gave them diarrhea for a second and then it got firm again. Something sets them off where they start this withholding, and you will pick it up in most kids. So if you see that, definitely aggressively treat it. You don't want a kid straining to poop, and there's ways to fix that. The other point is, if they're having accidents and you never noticed anything, like they're pooping completely normally, just think about, you know, okay, my kid's wetting themselves. Dr. Hodges said this is pathological, you know, what's the cause, right? And maybe see a doctor. Maybe there's another cause. You know, there are kids that have neurologic disorders, anatomic disorders that you would want picked up. So I think it's important to not ignore the actions. But if they get a clean bill of health, everything checks out completely right, and they're not, and they're not dry, You could either ask for an X-ray to diagnose the poop, or you could just, you know, look at our signs and you'll probably find some of them, very large poops, you know, stuff like that. And you could start our treatment protocol and they would likely improve.
That's amazing. I mean, until I found you or you found me, whichever way it was, I had no idea that this was connected. I mean, I will tell you, parents have no idea that this is connected.
Yeah. I've been grinding it out for 10 years now trying to get the word out. It's amazing. And it's very difficult to, I think the internet's a great, great thing because that's how, you know, we find each other and we can spread news. But it's also, there's so many opinions out there, it's difficult to rise above the— because if I just say, you know, constipation causes bedwetting, and then somebody else says, well, you know, my kid sleeps too deeply, or my kid has a hormone problem, or my kid, um, you know, you could fix it with this oil or something, it's just hard for people to see. And there is no immediate fix. Like, if you, if you come to see me and we put you on a bowel program, you're not going to be better right away. So people really have to believe it. And I don't know how else to put it other than it just makes the most sense. And when I've, when I've compared all the outcomes for treatment, ours is definitely the best. I would be completely open to better ways to resolve this. If there was like a new way to get kids rectum empty, I'm all for it. I just can't, you know, I'm always looking for the best way, the fastest way to get the rectum empty. We've tried enemas, Ex-Lax, suppositories. And I'm not opposed to using bedwetting alarms or medicines because they can all kind of bridge you to cure or help minimize the symptoms while you're trying to fix the colon. But I have never seen someone with a, you know, normal anatomy, normal brain and spinal cord have accidents and not have this colon problem.
Well, and it's interesting because parents even think that it's a behavioral issue. They think that this— they don't even realize that it's medical. They might even think that their kid is, you know, having something behavioral going on with them.
Yeah, and that is, uh, that's the biggest tragedy. I think if we do anything, if we could save maybe some children from abuse, or physical, physical or emotional, over accidents, that would be a great accomplishment. And I'm not saying kids don't put off peeing or pooping, and I will tell you this though, Putting off pooping is common, and it's the reason we're talking right now, and that you can fix with the protocol we have. But the kids— so if they can follow this correctly, if you have, uh, the normal urge to pee like you or I, you could hold it for a while and you'll be like, okay, I gotta go. But you don't, you don't catch me or you like doing the potty dance like kids do, or squatting down because you have to go. And what we found out is that Sure, it looks like, oh, they just wait till the last minute, they just wait till the last minute, they just wait till the last minute. But in reality, when you have a gradual rise in the urge to pee, like I said before, it's a natural process and your body makes you go pee. It's like being hungry. It's not like, I can't not eat. Like if I try not to eat, I will have to eat eventually. I can't not not sleep, right? So you have to go pee. But when you're constipated, that slope gets so steep because of the nerve signals from the rectum that they get— they go from 0 to 100, you know. They go from, I don't have to pee. You ask them, do you have to pee? They say no, and then they pee on themselves or have to rush to the bathroom. And so that's what makes parents so frustrated. They want to blame the kids, but if they understood how it happens, then they would see why they act like that. And I often tell parents, if you had his bladder, you would probably act the same way. Um, and you know, there's nothing wrong with putting a kid on the potty if they have problems peeing every hour to see if they can empty. But it rarely works because they'll sit on the potty, they don't feel like they have to pee, so they don't do anything. They get off the potty, have an accident because it comes out of nowhere. So if you understand how it happens, then maybe you could be a little bit more, you know, patient with a kid. Although it is frustrating, um, when they have to pee 20 times an hour or something because their poop is, is blocked. But once you understand it, you can treat it a little bit easier as well.
I mean, it's such good information. I mean, so what would you tell a parent whose kid is bedwetting? Like, what's the first step to take?
Okay, what I, what I did is first off is just make sure they're pooping regularly when they're a child. You know, if they're straining to poop, if they're putting out huge poops that you're shocked the child was able to produce, then don't just let that slide. Immediately start giving them something. Talk to your pediatrician, help them out with, um, osmotic laxatives or dietary change or whatever so they poop mushy poop without like mental stress over it. And that will save you the most trouble. But if you get the point, like, you know, and it's interesting, my— I have 3 girls. My oldest needed help pooping, my youngest needed help pooping, my middle one was kind of the one that would just kind of grind it out, right? You'd never complain, just kind of get it out. And so I never really thought too much about it. She was the one that wet the bed. And so she was wetting the bed after we potty trained. I'm like, interesting, she got backed up because she never complained. I gave her Miralax right away. Cleaned her out and she was dry in a month. And it was— and I hate to even mention this because, um, I know parents are suffering this for years, but like a month of changing sheets was like too much for me. I was like, this is ridiculous, you know?
And, um, I can't imagine. Yeah, I, I would be going crazy.
It is, it is frustrating. And so, yeah, and we were— luckily she's a mild case and she wasn't backed up, and I jumped right on it, so she was empty and she did fine.
That's wonderful. I'm going to selfishly ask you a question about my children.
Please.
They give me trouble about going to the bathroom at school. And you know, just like, let's just talk about constipation for 2 seconds. If they're telling me that they're holding it all day at school, is that going to cause them issues?
Yeah, that's a big, big problem. You're hitting all the big issues we deal with. So, if I have a kid that I'm trying to get them dry, And my message is, you know, I give the parent the list of medications to give, the enemas or suppositories or Miralax, and then I always turn to the kid. I say, you have only one job for this whole process, is to poop when you feel it, uh, you know. But if they hold it all day, you know, in school because they refuse to go, and then they go, we're just taking one step forward, one step back, right? We're not making progress. But it's tough. So I've, I've given kids, you know, notes. They have free access to the bathroom. I've try to come up with creative ways, maybe use a private restroom if one's allowed, have access to the teacher's lounge. But it's an issue. I mean, if your kid has accents, you really have to get creative and you have to talk to your child in the school system. If they don't have accents, you're lucky. But it's a big problem that kids don't go. And I thought about, you know, speaking to the schools about this, but I mean, they're not going to build private restrooms in every public school in America just for this problem, I wouldn't think. But it would be nice if they had that because It's tough to go. Kids mess with you. It's not a safe environment. And then, you know, we had all that, that TikTok stuff. I don't know if you followed it last month where they were— did you see that? There's like a trend, a TikTok trend where they were destroying bathrooms. So yeah, I was like, what hope is there for humanity? I'll answer that. There's, there's zero hope. But, um, so I said they couldn't even— yeah, they couldn't even go to the bathroom because they were clogged up. So it's a problem.
It's a problem. Yeah, it's a problem. So to all the parents listening, how many times a day should our children be going to the bathroom?
So for urination, you know, no more than 8, uh, but more than once or twice, obviously, when they need to. For pooping, I tied into more just— you want 1 to 2 mushy large bowel movements a day. That's ideal. You don't want to be going lots of times a day. You want them to go— and again, every time I make like a dogmatic rule, someone says— somebody runs with it so much I feel bad. So if your kid's pooping every day and it's soft, or every other day it's really soft, they have no problems, then don't like give them a bunch of laxatives, make them poop every day. But you want to be regular and you want to keep track of it. If parents just kept track of their kids' bowel movements, made sure that they went, um, regularly, talked about it a little bit, as much as they talk about diet and exercise, I think we'd be in much better shape.
Yeah, we don't talk about it. I said to my, um, 9-year-old, I said, did you go to the bathroom today? And she goes, no. And I said, you know, you're supposed to go every day. And she goes, I didn't know that.
Yeah, I know, exactly. And we don't even talk. And I'm like, I always say, I'll say, you know, if you eat every day, you should poop every day. And, you know, we're adults, so we don't have any— we have our own schedule, we have— we don't mind going to the bathroom, we drink coffee, there's lots of reasons for us to go.
Yeah.
And so we take for granted. Another thing too is like, when they're— think of back when they were a baby, how often they wet their diaper because their bladder was growing. They wet their diaper a lot. They pooped regularly, and you would change it if you needed. And then once it's locked in on their own and they're doing their own thing, people kind of lose track. I mean, we all get busy. So yeah, if we can just teach parents to just talk about it, I think, yeah, we'd have an accomplishment.
Yes, that is new for me, and I realized I do not talk about it. So you're helping me too, for sure.
It's so funny. I may have, I may have talked about too much because when I would come home from work, that's the first thing my kids would tell me if they'd pooped. But it worked out. They never had problems.
That's what they should be telling us. And I shouldn't just be assumed— I shouldn't just assume that they're going every day. Like, that's not, that's not good parenting.
I don't really care the answer to the question because I know if a kid's seeing me, they're constipated, but I always ask. And they just look at each other, right? Like, how often do you poop? And the parents and kid look at each other and it's kind of, yeah, it's obviously not kept track of.
Yep. Yep. Well, tell me, what else would you like to share that I didn't ask you?
So I think, you know, potty training is, um, a natural process and kids can have issues with it, but after 3, before 4, usually happens naturally. The biggest way to make sure that it will happen is by keeping regular bowel movements coming out. You don't want the kid stressed out about pooping. The kid should be playing with their Legos, poop, keep playing. They shouldn't like hide in their corner red-faced, um, praying to God for relief. That should not happen. So if you keep them from doing that, then they do much better. But if they do have accidents, pee or poop, don't let anyone tell you that it's either purposeful or it'll go away, because there could be serious medical conditions. I'm talking about just constipation. But maybe they had a spinal cord issue, right? So just get them evaluated. And if everything else checks out, you know, have a normal spinal cord, normal anatomy, normal healthy kid, and they're having accidents that they can't feel, um, then it's what we're talking about. They got backed up. They basically— think of it this way, simple way to think is they held in, they held in, they held in, they held in, their bodies decides we're just going to start taking— letting it out without asking you. And so the body takes over and lets it out.
Makes total sense. Makes total sense. Well, tell everyone where to go find you.
Yeah, so we have a website, it's, uh, bedweddingandaccidents.com. And then I'm on Twitter and Instagram as Dr. Steve Hodges. And we also have a Facebook page, um, Bedwetting and Accidents, a public forum which is just Bedwetting and Accidents, and then we have a private forum which is paid. And then we also have a parents-only, uh, private forum for people that are kind of don't want to be so open about these. I hate that that's the case, but you know, the internet's forever, so people often don't want to talk about the child's accents, um, in the public setting.
I totally understand. Well, I appreciate you getting the word out about this, and I'm confident that you're helping a ton of families.
Uh, thank you. Thank you for helping me do that.
Well, thank you. Thank you so much for being on and for taking time out of your busy schedule.
Awesome.
This is Rebecca Green reminding everyone to spend every day laughing, learning, and loving.
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