Few parenting challenges hit as hard as a child who continues to soil or wet long after the age when most kids have mastered the bathroom. The shame, the laundry, the tension at home, and the worried looks from teachers and doctors create a heavy burden for families. In The Clean Kid Manual 9: Treatments for Bowel and Bladder Control, retired clinical psychologist Robert W. Collins, PhD, lays out a clear, structured approach drawn from his years of clinical work.
Who Is Robert W. Collins?
Robert W. Collins speaks from solid ground. After earning his doctorate in clinical psychology at Indiana University, he conducted early research on conditioning-based treatment for bedwetting. A visiting professorship at the University of Western Australia followed, along with years of clinical work in Michigan. When referrals for encopresis, repeated soiling after age four, started coming in, he saw how much more distressing it was than bedwetting. The odors, the secrecy, and the constant battles over sitting on the toilet turned family life upside down. He developed practical protocols that blend medical understanding with behavioral learning principles, eventually distilling them into this manual and the supporting online parent forums at encopresis.com.
Where Standard Encopresis Care Falls Short
Standard medical care for encopresis usually starts with oral stool softeners, most often polyethylene glycol (Miralax), paired with scheduled toilet sits after meals. This “top-down” approach helps many children and prevents dangerous impactions, but Collins points out its shortcomings. Long-term studies show that only about 60 percent of children achieve reliable results within a year, with complete success sometimes taking much longer. Soft, mushy stools can be hard for a child’s body to sense properly, sometimes barely distinguishable from gas, which can lead to more accidents during play. The delayed action of oral laxatives also makes it difficult for the child to connect the internal urge with the act of going to the toilet.
How the Clean Kid Manual Approach Works
Robert W. Collins favors a different route. He emphasizes thorough cleaning of the colon first, often using rectal suppositories or enemas rather than relying on oral options alone. Once the backlog is cleared, the heart of the program is what he calls the daily Power Hour. Parents set aside time, usually after school or when the child is relaxed, for a series of short toilet sits, typically three minutes each. The goal is a solid, substantial bowel movement during that window. When it happens, the child is done for the day. This repeated, low-pressure practice is designed to rebuild the natural brain-body connection between feeling the urge and responding to it.
The manual walks parents through the process step by step. Collins stresses calm consistency over punishment or long lectures. He explains why many kids “hold” (sometimes for surprising child-logic reasons), how chronic holding stretches the colon and weakens its signals, and why overflow soiling becomes almost inevitable. He addresses common sticking points, resistance, school cooperation, hiding soiled clothes, and emotional fallout in a dedicated troubleshooting chapter. Later sections cover relapse prevention and maintaining gains over the long haul.
For families dealing with both soiling and wetting, Collins is clear: resolve the bowel issues first. A distended colon puts pressure on the bladder and contributes to accidents. Separate chapters then tackle daytime bladder control and nighttime dryness, including thoughtful guidance on using bedwetting alarms effectively.
What Parents Can Expect From the Manual
What stands out is the manual’s grounded, case-by-case feel. Collins does not claim a miracle cure or universal success rate. Instead, he presents a method aimed at children who did not progress with standard care. The accompanying parent forums provide ongoing support, where experienced families help newcomers adjust the approach to their own child’s situation. Sample letters for doctors, success diaries, and visual aids make the program easier to implement and track.
The book does not dismiss diet, fluids, or fiber. Collins simply notes that once daily complete evacuations are happening, parents get a clearer picture of what their child’s body actually needs. He also acknowledges the emotional side: the “nose blindness” to odors, the child’s denial, and the parent’s exhaustion and guilt. Recovery, he suggests, involves rebuilding trust as much as training the body.
When to Involve a Physician
The Clean Kid Manual 9 is not a replacement for a medical evaluation. Robert W. Collins repeatedly advises ruling out organic causes with a physician first. But for functional encopresis and enuresis, the majority of cases, once physical disease is excluded, offer parents and professionals a structured, respectful approach grounded in learning theory and decades of clinical practice.
After decades of work in behavioral medicine, Collins has produced a resource that feels less like a textbook and more like a seasoned clinician handing over the notes he turned to when standard approaches stalled. For families stuck in the cycle of accidents, arguments, and worry, the manual offers both practical steps and encouragement that progress is possible.
