MOP is a structured treatment for encopresis — when chronic constipation causes a child to have involuntary soiling accidents. It was developed by Dr. Richard Bartholomew and refined by Dr. Steve Hodges. The key insight: this is a physical problem, not a behavioral one.
Years of holding stool stretches the colon and rectum until the child loses the ability to feel the urge to go. The accidents aren't defiance — the child genuinely can't feel it. The colon needs time to shrink back to normal size and regain sensation.
Daily enemas + Miralax to fully clear impacted stool and keep the colon empty. This is the most critical phase — the colon cannot shrink back to normal size while it's still packed with stool. This phase can take weeks to months depending on how long the problem has been building.
Enema frequency gradually reduces (every other day → twice weekly → weekly → as needed). Miralax continues throughout. The colon is slowly regaining its normal size and sensation. Dr. Hodges' latest guidance extends this phase longer than earlier versions of MOP.
Enemas stop. Miralax continues, often for 1–2 years. Regular toilet sits remain important. This phase is about sustaining a clean colon while the body relearns normal signals.
The newest addition to MOP (added in the Anthology 5th edition). A structured 4-week Senna taper helps transition away from Miralax. Ask your doctor if this phase applies.
Scheduled sits (3x/day, ~10 min each, ideally after meals) leverage the gastrocolic reflex — the natural bowel urge triggered by eating. Since encopretic children have lost sensation, sitting on a schedule replaces the body's missing signals. Consistency over weeks and months is what retrains the system. Use a footstool to raise feet — it helps relax the pelvic floor.
Miralax (PEG 3350) keeps stool soft enough to pass without straining. Straining = holding = re-impaction. Target Bristol Type 4 (smooth sausage). If you have concerns about Miralax, Dr. Hodges acknowledges there are alternatives — Lactulose, Milk of Magnesia, and Senna are commonly used. Citrucel (methylcellulose fiber) can also help maintain stool consistency. Discuss options with your doctor.
Diet alone won't fix encopresis, but it supports the protocol. Key points:
Many kids on MOP also have bedwetting or daytime pee accidents — this is not a coincidence. The enlarged rectum physically presses on the bladder, reducing its capacity and triggering urgency. As the colon heals and shrinks, bladder issues often resolve on their own without separate treatment. This is why MOP is also used for enuresis (bedwetting).
Research is clear: encopresis causes low self-esteem, social isolation, anxiety, and school avoidance. Children often hide soiled underwear out of shame. This is not defiance — they genuinely cannot feel it. Punishment or frustration makes outcomes worse. Positive reinforcement (like this app's star system!) is evidence-based. Some families benefit from working with a child psychologist alongside the physical treatment.
| Date | Enema | Miralax | Sits | BMs | Accidents | ⭐ Stars |
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