Bowel Movements and Constipation in Toddlers

What's the Story on Withholding? Working Through a Common Training Challenge

By Kelly D. Burgess

Dr. Jody McVittie doesn t really like the term withholding when talking about a child's bowel movement. It implies that the child is always doing it on purpose, she says.

While withholding bowel movements (BMs) is a fairly common toilet training problem, it's not usually an overt behavioural problem. And, the good news is it's easily overcome!

Dr. McVittie, GP, says children hold it in for a variety of reasons. Some of the most common reasons for your toddler not doing a bowel motion in the toilet or potty include:

Pain

A child may have been constipated at one time, passed a painful BM, remembered the pain and tried to hold it for subsequent movements. This initial constipation could be the result of a recent illness, or a variety of other causes, but the long-term problem becomes the pain issue.

Fear

For reasons not fully understood, some children have a fear of letting go of their BMs into the toilet. Certainly this is not a rational fear for an adult, so it may be difficult to understand, but it's very real to the child.

Control

This is not an overt behavioural problem but a common developmental one. Children often feel like they have little control over their environments, and this is an area where they can have complete control.

Distraction

Sometimes a child may simply be too wrapped up in an activity to even think about stopping to go to the bathroom. This is an unconscious reaction, but it can cause problems.

Causes for Constipation

What all of the above issues have in common is that they can lead to constipation, which, when it becomes chronic, can lead to a condition called encopresis. Encopresis is faecal soiling (the loss of stool matter into a child's underwear).

When a child has not yet established regular bowel movements and begins to hold them back (for whatever reason) the colon can become distended and impacted. This causes stool to leak around the impacted faecal matter, and the impaction can become painful and difficult for the child to pass.

Kids with encopresis leak and appear to be incontinent, says Dr. McVittie. Parents get mad and say, Why don t they just go on the toilet? The fact is that this is a medical condition the child has no control over.

Treatment for encopresis varies depending on the cause and usually includes using laxatives for a period of time. But this is why it's important for a parent to seek the advice of the child's doctor or paediatrician when there is a withholding issue.

Determining whether or not it's a medical problem can make the solution a lot easier for everyone.

Constipation can be a cause for day time wetting accidents as well. So keep this in mind if your child all of a sudden starts to have more accidents during the day.

Helping Your Child Let Go

Angela Lewis says her 4-year-old daughter Susanna was the perfect child in every way, never giving her any of the problems or issues many parents face when their children are in the baby/toddler years.

That was until toilet training. From the beginning, Lewis daughter resisted potty training altogether. Finally about eight or nine months ago she began urinating regularly, but she absolutely refuses to poo in the toilet. Lewis has kept her sense of humour, but her frustration is evident.

We have praised her every time she goes pee in the toilet, says Lewis. We've high-fived and danced, all the while telling her she should go and poo too!

So what do the experts think Lewis should do?

Dr. Schmitt, says that in cases where there is no obvious medical issue, control needs to be given back to the child. In other words, Lewis should simply help Susanna deal with her toileting issues and then walk away. (See more of Dr. Schmitt's tips below).

This may seem easier said than done, but for Jennifer Wolf it was this strategy that made her second round of potty training so much easier. When he was working on toilet training four years ago, Wolf's oldest son, now 7, had a serious withholding issue caused by fear.

Wolf's doctor recommended that she try putting him on the potty in his nappy and cutting progressively larger holes in the nappy. Eventually his poo fell into the toilet, he saw it was OK and it was smooth sailing after that.

Since then Wolf has worked on toilet training with another child who also withheld. This time around she handled the problem with a lot more detachment and credits that with the fact that withholding didn t become the major issue it had with her first child.

Potty training is one of those things that can cause parents a lot of frustration, says Wolf. "And yet, when we let the kids take the lead and show us when they're ready, they feel so much more confident and empowered.

The first time Madelyn said to me, I did it! with a big smile on her face, I thought to myself, Now why didn t I let Brian have that experience of feeling so proud of himself? Seeing it from where I stand now, my experiences provide a poignant example of the contrast between training them because we want it done and training them because they're ready."

Helping Your Child Overcome Fear

• Clarify the goal with your child. Tell them your body makes a poo every day and the poo wants to come out every day.
• Ask your child's doctor to recommend a laxative or stool softener if you suspect your child is suffering from encopresis.
• Let your child decide when s/he needs to go to the bathroom.
• Tell your child that you want sitting on the potty or toilet to be lots of fun. Ask if she would perhaps like a special book.
• Give incentives for using the toilet, such as stars on a chart or a calendar. (The Toilet Training Guide has full colour reward charts for both Disney Princess and Disney Toy Story with stickers)
• Make the potty convenient. Be sure to keep the potty in the room she usually plays in. In the early days this gives your child a convenient visual reminder.
• Allow your child to wear absorbent training pants to encourage releasing rather than holding back.
• Help your child change her clothes if she soils herself, without comment or recrimination. Make it a quick, neutral activity.

For more information see Toilet Training Tips.