Our guest today is Dr. Steve Hodges, who's a Pediatric Urologist at the Wake Forest University Medical Center. He has uncovered the root cause of pee accidents and poop accidents one a child's potty trained. It's not widely recognized; however eye-opening so listen carefully to what Dr. Hodges has to say. He is an author of numerous scientific articles and he's made toileting issues the heart of his research and medical practice.

Steve Hodges. Associate Professor of Pediatric Urology at Wake Forest University of Medicine. He trained in medical school and had residency as a surgeon neurologist to primarily surgery. About half of the patients they see and that being children with being dysfunction, which is a diagnosis for any poop or pee kind of problem in kids. He was interested as to why this is happening, as he was doing what the textbooks and training taught him. He was thinking, maybe we’re missing something. There must be something wrong here. Maybe these kids are being ignored because they’re not very ill.

Minimal effect. If kids couldn’t control their pee, you might be told that they would just grow out of it and that it’s a phase or a psychological explanation that is stress-related. They would typically do three things. They would put you on some kind of a laxative to make you poop every day. You'll be put on a schedule where every two hours you try to pee. Sometimes, they would provide a medicine that relaxes the bladder. All these three are minimally effective.

Aha Moment. He had a couple of events that happened simultaneously. He’s been seeing kids that weren’t getting better. He was getting frustrated with the treatment, while he had to operate on one child as the case needed such. When he operated on the kid, her rectum, or the end of her colon was so full of poop.  He asked the parents right after surgery if she’s been going to the bathroom. The parents said yes and that she’s pooping fine, which for him was really odd.

The next day, he flew to Cincinnati to attend a meeting about children that are born with a congenital anomaly. They treat kids with very rare and complicated congenital anomaly. They see kids who have a non-functioning colon. In this center, when they treat kids in the program, they would x-ray them every day to make sure they were emptying on completely to know what therapy to give the kids.

He thought of doing the same with his patients as he’s thinking that he’s missing something. So he went back home, and on his next clinic he asked all the parents if their kids are pooping or peeing fine. All parents said yes, while after doing an x-ray of every kid and they’re filled with poop.

At first, he thought of sending the kids to the GI or the gastrointestinal doctors and they’ll fix them and everything will be fine. So he started sending them to GI; however, they’re being sent right back to him. So he realized there was a barrier in terms of what it means to being constipated in children. So he went to write all of these as he considers his findings a landmark.

His resident was getting all the paperwork for his therapy when one day she called him up about a guy in the 80’s who knew about his findings and was treating kids and it was lost to history.

There was a nephrologist in Canada whose son was wetting the bed and his wife got frustrated with all the wet sheets. So he went to the library and pulled all the research on bladder function. Now he took his kid to his clinic and did a test, where you empty out the end of the colon, you put a tube up the kid’s bottom, you inflate a balloon and have the kid tell you when they feel the balloon.

He had this hypothesis that the child’s colon was dilated which was causing the wetting. His son didn’t feel the balloon but was already three times the size where most kids would feel it. So he gave his kid an enema every night until his problem got fixed and after a month his kid was dry. He went to publish a lot about this topic, cured a lot of kids who are wetting, but he left the field as he left Canada and went to Arizona for general medicine.

Misconception. So Steve spent a day finding this guy. He’s been a friend since and been an inspiration for all his books and research and he gets to talk to him for advice. So, he’s taken his work and bring it to as many people as possible, because this problem is undertreated, underdiagnosed.

In general, a healthy child should never be incontinence once they’re potty-trained. If they’re having accidents, you don’t explain it away, you don’t come up with any excuse – There’s always a cause.

There’s a misconception of night-training – there’s no such thing as night-training. Night time continence is and should be a natural phenomenon. There’s been a study about infants where they all woke up, peed and went back to bed.


Treatment. For bed wetting, it’s generally a good practice to limit food before bed or have them pee before bed. Those parents who wake their children up several times in the night to have their kids pee, this is not effective as it’s not treating the cause.

For something more aggressive, let’s say a 10-year old who’s wetting the bed, he starts with an x-ray to prove that there’s a bowel issue. For older kids he put them on enema as it works best for various reasons. Enema is not easy, so the parents have to be on board.

So for younger kids wetting the bed, he starts off with an x-ray or starts them off with laxative just to make sure that when they’re pooping, it’s soft bowel movements in good amount every day. So working on that a little bit can make a big difference over a few years.

Parents who would buy into this need to understand that the amount of pooping is not what matters unless the child’s colon has returned to its normal size. So the colon needs to be emptied completely and constantly be emptied so the rectum that got stretched would return to its normal size which fixes the problem, not just getting the poop out.

At the minimum, it’s at least three months to restore the function of the colon.

Support. Most of Steve’s work is spreading around. He has an educational pamphlet that parents can take to their doctors for them to get an idea of where they’re coming from. Hopefully, that would be enough for them to proceed with an x-ray.

They also offer support via website. The actual treatment is fairly simple, there’s not much to do. You just have to get on the program. Make sure someone’s guiding along to get the colon empty and keeps empty so the kids can get dry.

At least they get to have the kids on x-ray and considers constipation might be the cause, if not, Steve encourages that he be contacted so he can help. He has his website and a link for parents with plenty of information.

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