This article is adapted from It’s No Accident: Breakthrough Solutions to Your Child’s Wetting, Constipation, UTIs, and Other Potty Problems, by Steve Hodges with Suzanne Schlosberg.
In late 2010, Zoe Rosso and her mom, Betsy, were escorted off the premises of Zoe’s school in Arlington, Va. The principal told them not to return until Zoe stopped having potty accidents. Zoe had wet her pants more than eight times per month, the school’s limit, and therefore was considered “not potty trained.” Zoe was 3½ years old.
The incident made the front page of the Washington Post and incited extremely hostile (and foolish) comments. Betsy, who fought to keep her child in school, was called a “lazy person who wants to dump the kid off so she can shop” and told to “quit blaming others for her failures.”
Zoe is now 4½, and my patient. I can tell you it’s not Betsy Rosso who failed; the system failed her. Not just the Arlington Public School system, which operates the preschool Zoe attended, but also the medical system, which failed to detect something actually was amiss with Zoe.
Zoe’s pediatrician told the Rossos their daughter was fine. Unconvinced, Betsy took Zoe to a pediatric urology clinic, where Zoe’s urine was tested for infection and her belly examined. According to the clinic’s report, Zoe’s abdomen was soft, with “no masses palpable.” The report indicated Zoe “may have some underlying constipation contributing to her urinary symptoms” but concluded that “aggressive evaluation and treatment is not recommended.”
Turns out, everyone involved in Zoe’s case had it wrong. Zoe was fully potty trained, but she had no chance of staying dry because her entire colon was stuffed with poop, including a mass in her rectum the size of a Nerf basketball. This mass, visible in an X-ray I requested, was pressing against Zoe’s bladder and had caused the nerves feeding her bladder to go haywire. Constipation wasn’t “contributing” to Zoe’s urinary symptoms; it was the main cause.
Our culture has two reactions to potty problems: Either these problems represent a parental failure, or they are not actually problems but rather a normal (if bothersome) part of growing up. Parents are led to believe that kids are kids—they get busy playing and forget to go potty. They wet the bed, but that’s normal for their age.
In reality, potty-trained kids should not have accidents any more often than you or I do. And while overnight dryness often happens well after a child is toilet trained, bedwetting at age 6 should not be dismissed with, “You’re a deep sleeper. Be patient—you’ll grow out of it.”
Accidents and bed-wetting have the same root cause: chronically holding poop or pee or both. A rectal poop mass squishes the bladder and messes with its nerves; holding pee thickens the bladder wall, shrinking the bladder’s capacity to hold urine and triggering hiccuplike contractions. The upshot: wet undies and bed sheets.
These problems cause more than stress and extra laundry. Left untreated, some kids develop chronic medical problems, including damaged colons and, eventually, pain with sex. But toileting troubles are highly treatable—if only the medical profession would treat them.
The notion that constipation causes wetting is hardly new. This link was demonstrated in the 1980s by Sean O’Regan, a pediatric kidney specialist baffled by his 5-year-old son’s persistent bed-wetting. Back then, bed-wetting was considered either a psychological issue or an anatomical problem of the bladder. O’Regan, practicing at the Montreal’s Hôpital Ste.-Justine, didn’t accept either explanation.