Course Description


Are you a health professional seeking more expertise in the treatment of enuresis and encopresis? patients? Knowledge of the Modified O’Regan Protocol (M.O.P.) will give you a leg up in helping families resolve these misunderstood, vastly undertreated conditions.


Taught by Steve Hodges, M.D., in collaboration with Dawn Sandalcidi, PT, this course offers an in-depth understanding of M.O.P. — its variations, nuances, and scientific backing. Among the topics: reading x-rays for constipation, advising apprehensive parents on enemas, adjusting the protocol as needed, treating teens, therapies for the most challenging cases.


Traditionally, enuresis and encopresis have been treated with oral laxatives, dietary measures, behavioral incentives, and bladder medication. Or, children are told, “Don’t worry, you’ll outgrow it.” Dr. Hodges’ experience and research suggests that M.O.P., an enema-based approach, is far more effective.


M.O.P. is named for Dr. Sean O’Regan, the pediatric nephrologist who pioneered the regimen in the 1980s. During his career, Dr. Hodges has guided over 8,000 families through M.O.P. and has continually refined and updated the regimen. M.O.P. is explained in The M.O.P. Anthology 4th Edition, written for parents. However, many parents feel more comfortable implementing the regimen with guidance from a health professional.


This course will teach professionals to offer that guidance with confidence.

Course objectives:


Dr. Hodges’ goal is to “teach everything I know about M.O.P. in 6 hours.” The course is aimed at pediatric pelvic floor physical therapists, pediatricians, nurse practitioners, continence nurses, and others seeking to guide families through treatment of enuresis and/or encopresis.


Among the topics covered:


•When x-rays (KUB) are — and are not — warranted

•Measuring rectal diameter and accurately reading a KUB for constipation

•Why enemas are so much more effective than laxatives alone

•How to respond when physicians call enemas “unsafe,” “traumatic,” or “overly aggressive”

•Guiding patients on enema selection: phosphate, LGS, bisacodyl, large volume with glycerin/Castile soap

•The role of osmotic laxatives and most effective options

•The role of Ex-Lax/senna: dosing, timing, weaning

•Advanced therapies: bladder meds, Peristeen Pump, bladder and anal Botox


Instructor: Steve Hodges, M.D., is an associate professor of pediatric urology at Wake Forest University School of Medicine, author of numerous published studies, and coauthor of seven books for parents and children. His website is

Course preparation: Prior to the course, please read The M.O.P. Anthology 4th Ed. 

Participants can download the .pdf upon enrolling, along with other materials. French and Spanish editions are available by request.

Note: Course times listed below are Eastern Standard Time!


11:00 Introduction: 15 minutes

•How M.O.P. and PT complement each other (Dawn)

•Opening remarks (Dr. Hodges)


11:15 Part 1: X-raying for Constipation (1 hour)

•When x-rays (KUB) are warranted — 1st x-rays and repeat x-rays

•KUB v. ultrasound: Why KUB is preferable and safe

•What if the patient’s doctor won’t order an x-ray?

•How (and why) to measure rectal diameter

•How to read a KUB accurately

•Outliers: when x-rays don’t tell the full story

•Q&A on x-rays


12:15 Part 2: Approaching Families about M.O.P. (45 minutes)

•How to present M.O.P. to families: evidence it works better than other methods

•How to respond if parents say “No way!” to enemas

•How to respond when a patient’s doctor insists enemas cause dependence, electrolyte imbalance, or psychological trauma: evidence enemas are safe

•Setting realistic expectations for M.O.P. based on the child’s symptoms, age, and history

•Treating teens

•Treating kids with ADHD, autism, and/or sensory issues

•Q&A about approaching families


1:00 Part 3: Advising Families on Enemas (1 hour) 

•Guiding U.S. and international patients on enema selection: a review of the options

•When to recommend switching to a different type of enema

•When to recommend M.O.P.+ versus M.O.P.x

•When to recommend overnight oil enemas (Double M.O.P.)

•Adjust M.O.P. for encopresis v. daytime enuresis v. bedwetting

•Advising parents on tracking progress

•Q&A on enemas

           15-minute break


2:15 Part 4: The Role of Laxatives: Osmotic and Stimulant (1 hour)

•The role of laxatives in treating enuresis and encopresis

•Osmotic options: (PEG, lactulose, magnesium citrate, magnesium hydroxide): which work best, dosing, when to combine or switch

•Stimulant laxatives (Ex-Lax/senna): a game-changer for many

•Dosing and timing stimulant laxatives

•Addressing parents’ biggest fear: dependence

•Q&A on osmotic and stimulant laxatives


3:15 Part 5: Treatments Beyond M.O.P.: Medication, Peristeen Pump, Botox (30 minutes)

•Reviewing 3 classes of bladder medications: when they’re appropriate, when they’re not

•Peristeen Pump

•Bladder Botox

•Anal Botox

•Q&A about advanced treatments

3:45 Part 6: Case Studies (1 hour)

4:45 Part 7: Q&A (45 minutes)

5:30 Adjourn

Can't attend the Live Zoom class? The lectures will be available online for 1 year!