Encopresis in Toddlers & Preschoolers

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Questions

• 19-month-old fears painful bowel movements
• 2-year-old withholding bowel movements
• 3-y-o screaming while pooping
• 3-year old withholding poop
• 3-year-old won't poop!
• 3-year-old Holding on to Poop, Withdrawing
• 3.5-year-old still holds poop - we've tried everything
• 3.5-year-old with encopresis
• My 4-year-old has been diagnosed with encopresis

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19-month-old fears painful bowel movements

July 2004

My 19 month old daughter becomes extremely anxious and panic stricken at the idea of having a bowel movement. This started after she contracted a virus that caused severe and frequent diarrhea. Now she does she all can to avoid pooping. I'm afraid this could lead to bowel obstructions and other problems. Has anyone ever had experience with this? Bummed about her BMs

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When my daughter was 18 mos., she developed a similar fear of having BM's (in her case, it was because of 2 painful hard poops). Unforunately, it developed into a 2+ year problem. My advice is to take it VERY seriously now, before it becomes an ingrained habit. I think the best advice is to keep your child as regular as possible, and to this end she'll need lots of water, fiber, dried fruits, etc. However, if this doesn't work--it didn't with my child, whose ability to hold in her poops was nothing short of herculean--MIRALAX is the way to go. This is a prescription laxative that is apparently more gentle than Senica (sp?) or the other over-the-counter meds. We gave it to our child daily (at our ped's recommended dose), just to keep th! ings flowing. When she didn't go for a few days, we increased the dose. The key is to keep things regular, and not painful, so that her associations with pooping=pain are replaced with pooping=no big deal. I wish you well, and hope your problem doesn't become as bad as ours did.
Christine

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2-year-old withholding bowel movements

April 2004

My son is almost two years old, and for the past 7 months or so, he has been withholding his bowel movements. It seems as if we have tried everything possible to remedy this problem: his diet consists of strictly whole grain and/or high fiber foods, his consumption of dairy products is very minimal (I am still breastfeeding). We have tried flaxseed meal and flaxseed oil, he has had to endure several enemas and suppositories. Following a recent three-week period of withholding his bowel movement, our doctor prescribed MiraLax. It really works well, but I just hate the idea of my otherwise healthy child taking daily medication. I heard that frequently children stay on this medication for months or even years. I feel horrible every time I add it to his morning oatmeal. But I simply don't know what else to do. Any suggestions?! Our doctor has assured us that MiraLax is quite safe. Has anyone heard otherwise? desperately seeking advice

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I can totally relate to your fears and the difficult situation you face. Our Dr. tried to prescribe MiraLax over a year ago when my son was 3. We were struggling with constipation and he was still no where near potty trained. I could not imagine putting him on laxatives for any extended period and decided to try and handle it with periodic doses of mineral oil and hyper- vigilance about the consistency of my son's BM's.

The mineral oil worked OK for awhile, but near his 4th birthday (still in diapers), he had another bad bout of constipation. He was so miserable and I couldn't bear to see my son in pain again. We were also anxious to have start potty training which we were unable to do because of the constipation/witholding. I knew he would withold if we took him out of diapers and the whole vicious cycle would start over again, so I agreed to try the MiraLax.

He has been on MiraLax for 4 months and I am glad to report he is now (finally!) potty trained and poops easily/happily everyday. I strongly recommend you try the MiraLax now and don't make the mistake of waiting like we did. I do believe it is safe and it has definitely helped my son. The longer you wait, the harder it is to undo the memories of painful BM's.

One other thing, our insurance Blue Shield HMO, does not have MiraLax on their Formulary so we have paid $90/month ($45 2x/month)for the prescriptions. I believe you can fight this and try to have them cover it, but we have not tried yet. Most Dr's would agree that there is no realistic alternative for MiraLax and would be willing to write a letter or call your insurance company. Just be aware, you may need to shell out a lot of $$ or be prepared to fight your insurance company on this issue.

Good Luck! I would be happy to discuss this further, so feel free to email me if you want. lslez

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I posted the same question here a few months back. This is a complete issue of control. Bowel movement is the first thing a child can control in their life.

My advice to you is to give it up. He will live. Let go. He can sense your urgency in trying to control it. Keep giving the laxative. My rule is if he doesn't go for 3 days, then I give it. Usually right about the time I feel it is too long, I give it.

My son is now 3.3 years old. I can communicate with him more about it. But when he was younger..that was more difficult. My niece had the same thing. Go on the internet, this condition actually has a name.

Bottom line is that eventually he will learn that he can poop and be OK. The longst my son held it for was 8 days, and I was a wreck.

Say the serentity prayer to yourself God grant me the serenity to accept the things I cannot change the courage to change the things I can and the wisdom to know the difference

I am not religious but this helped me because I truly could not control his pooping. Let your child feel he contols other things. Give him choices so he feels he is deciding, even with the most mundane of things.

Relax. I was a wreck for so long with this and now that I gave it up he has relaxed about it. I feel my son is coming out of it now. So the whole thing lasted near 6 months.

It started with him when he had a difficult poop with his nanny and she told him it was stuck and she would have to pull it out. email me if you want
yancy

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Has your child been examined by a good chiropractor? My husband suffered from years of constipation, alternating with diarrhea. He underwent thousands of dollars of medical tests, and they found nothing. My Mom and I dragged him to a chiropractor, even though he did not believe in them. After three visits, his bowels were regular. He now willingly goes occasionally when things act up; he feels so much better. Apparently, there was pressure on the nerves that control bowel function. He also has to stick to a high fiber diet, which is what doctors recommend for everyone. It sounds like you have that part covered. You may also want to look into other food allergies, besides milk. Tami

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3-y-o screaming while pooping

Dec 2009

We are at the end of the rope with my 3 year old daughter. At some point between 1 & 2 years, she started screaming every time she went poop. She only pooped every few days. We took her to the doctor. She went on miralax and then other meds for about a year, but no changes. We went to specialist who told us to continue with miralax at a higher dose and give up on potty training for 6 months (she was trained in pee). Screaming stopped, but poop got mushy and runny and came out all the time. Over the next year, we slowly reduced the amount of miralax to none as it just made it ''leak'' out. Here is the current pattern: She starts to feel like she has to poop. She holds it in and is in some discomfort. The next day, she really tries to hold it in and is in greater discomfort. Several times a day, pellet size poops come out in her butt and she needs them wiped away. The next day (day 3), she is still holding it in, but it's almost impossible so she is in a lot of pain, screaming and crying but refusing to walk to the bathroom or even a potty if put in front of her. She won't ask for help. She won't do anything except scream.

We got a referral to child behavior at Kaiser who told us to tell her ''you are in charge of your poop'' and not to help her at all unless she asks. So we tried it and she just stands in the living room (or anywhere else like at park, play area, class, etc) when the urge comes on, screaming. If you try to carry her to the toilet, she screams more. She can articulate that she is ''in charge'' and how to use the potty and where to go and all that, but when it actually comes time to do it, she just screams. At some point on day 3, 4 or 5, if you carry her to the toilet and force her (hold her down and open her legs) to sit there, the poop comes out. Easily. So we are in a 3-5 day cycle where the only day she isn't screaming the day after her poop comes out, but on every other day, she screams and tries to hold it in.

We've tried everything. Bribes, punishment, ignoring her, helping her excessively, reading books about poop, putting her back in diapers, etc. I'll add this cycle is the same even if she is wearing diapers.

The only other thing to note is that she is a twin and her sister has been fully potty trained since 2 1/4. No poop issues.

I'm hoping to god one of you has something that might work because I am about to lose my mind.

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All I can say is, been there....

I had an epiphany at one point and realized my son's screams were, not b/c the poop hurt, but b/c he was fighting so hard to keep it in!

Encopresis is not always a control issue stemming from diaper training-- it could have resulted from a painful poop and fear of it hurting again. Regardless of its start, it gets physical and can get so severe that the rectum's shape stretches out. The poop balls up and then leaks come around it, hence the smears and little hershey kisses that occur, not to mention the excruciating bowel movements!

My son is a great eater but no amount of fiber was going to fix the problem. Our pediatrician said that the Miralax allowed the rectum to shrink back to it's normal tube shape b/c the movements weren't left to gather and ball up. I found Miralax to work more efficiently and less intrusively by splitting the dosage up to 1/2 in the morning, 1/2 in the evening. He was on it for 10 months with a couple of breaks to see if it resolved. During the breaks, he was back to having trouble with a couple of days! I did not want him on Miralax forever!

Finally, I met a homeopath who felt she could resolve this issue for us. She took our case and we decided to try the remedy during an extended school break (Thanksgiving) so if he had a problem, it wouldn't happen at school (he was in kindergarten by then!).

So, on a Tuesday my son took his last dose of Miralax. On Wednesday, he received a homeopathic remedy. I didn't share with him for a few months that he wasn't taking the medicine anymore but when I did he was thrilled! He is now in the 2nd grade and hasn't had Miralax since that last time two yrs ago. He has had no issues whatsoever! One time the same year, he backed up a bit and the homeopath gave him an emergency remedy which caused him to poop within 20 minutes(!!!). Anyway, a day later, he developed a virus with a high fever and in hindsight, we believed his body was reacting to the oncoming virus and would have resolved on its own; that it wasn't a recurrence of the encopresis!

I will readily admit that I didn't put much faith into the homeopathic remedy but I am a true believer now! Even our pediatrician was amazed, thrilled and entirely supportive! LogicalMama

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HI! I'm sorry I didn't respond earlier, but chances are you're still having the problem. We experienced this with our youngest, now 4. She started the problem very young, eventually was completely potty trained, even through the night, but when she did finally poop, it was in a diaper, with me wrapped around her crying as much as she was! We tried Miralax, suppositories, countless fiber drinks, excessive water, etc, you name it. We went to 5 different doctors, though not a homeopath and I'm sure they'll help. It was a matter of fear of pain, so she'd hold it in, then it would be unGodly huge. We would both be sweaty and wailing by the time it was over, and it was about on a 5 day cycle as you describe. Let me tell you what worked! L'il Tummies! WHAT?! I'm telling a friend from NY about it, she says try this over the counter stuff, L'il Tummies that not one stinkin' doctor told me about, and voila! At first, it's hard to get the dosage right. It tips the scale the other way, if you feel me. So, what we did, I highly recommend. It was easier with a diaper, but still..

Give him the highest dosage for about a week or so. Keep him pooping. It doesn't leak, as you described, but it will be a bit of diarreah.It's ok, the trick is to get it all out. Pretty soon he will be pooping without pain, though the excess of it may bother him. It's ok, getting him to poop without pain is the key. Soon you can lessen the dose. We struggled with this issue for almost 3 years. It was all over in about a month. L'il Tummies is a natural herb, Senalina I believe it's called. Perhaps the same thing the homeopath gives, but i wouldn't know! Try it, it'll be alot cheaper and I now know 3 of us that all had the same problem and it was a miracle. Last thing, my little girl still needs a little bit from time to time. She'll still say her poop hurts and i give her a small dose right away. By that night she goes, easily, and she loves her ''chocolate stuff''. Some people struggle with this all their lives, our kids will probably be those people. Better to help them accept that now and give them the power to help themselves. Right in the Walgreens aisle! And seriously, we tried everything else, too! Good luck! excited to share the secret!

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Had a huge issue with this until our daughter turned about 4 1/4 years. Holding poop for fear of pain, then having a huge, scary BM every 5 days or so. Wanting pull-ups for BM's, despite being potty trained. Some leakage in between with use of Miralax.

Finally we spoke with a pedi GI doc who recommended using Magnesium Citrate - having her drink a couple bottles to clear herself out at first. She was actually excited to drink it as like 'soda' which she doesn't normally get to drink. This worked like a charm.

Then we set a regular dose of Miralax to keep her poops very soft. Spent time on the potty after every meal (at least breakfast and lunch). At first was tricky to even get her near the potty, but stressed that was just time sitting there - no need to actually 'do' anything. We made a sticker chart and each time (after each meal) that she sat on the potty, she got to put a sticker up (poop not necessary). Crazy, but this worked like a charm and she became so confident and proud of herself. She soon lost interest in the stickers and now we are just careful to keep her stool soft (though cutting back on the Miralx slightly). Extremely thankful

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3-year old withholding poop

February 2006

My 3-year old was potty trained for about a month when she started withholding her poops. We initially thought she was constipated but after 2 months of this behavior, I now know she is ''not letting it come out.'' It was really bad when she was using the potty. Now, we're back to pull-ups. She will ask for a pull-up when she has to poop. Then she makes all of the pushing and grunting sounds and sometimes cries that it hurts (after 3 days of not pooping, I'm sure her tummy does hurt), and says she is trying to poop. But I finally figured out that what she is doing is working really hard to hold it in. She started this shortly before her 3rd birthday, around the time she transitioning to a new classroom at school, a change she has been looking forward to for some time. I am trying not to make a big deal out of this. I have no problem with her using a pull-up. I've set the bathroom up so she has privacy but can entertain herself. I've offered her a reward for ''letting the poop come out.'' Nothing seems to work. I know it's a control thing and that I should just ignore it, which I am trying to do. But sometimes it makes me crazy as she will spend all day trying not to poop, will be whiny and irritable, won't want to play with anyone or go anywhere, etc. Any advice or words of wisdon or commiseration will be much appreciated!
To Poop or Not to Poop

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Hi we had the same problem 3 things you need to do we went to a specialist and here is the just. Do not have any anxiety or control about the pooping in fornt of them ifthe more they feel you are anxious the worst it is. here is the solution give them one tablespoon of mineral oil 2/day everyday they will not beable to hold it it will come out oily in their underwear pull up etc.. don't worry and it is not harmful for them to be on my daughter was on it for 6 months and i still give it to her when she gets backed up it we were so anxious it was a terrible cycle so give th oil it may take a a day or two to work my daughter took it straight them took some water but you can mix it in whatever works.It is thick so you have to have something to drink right after. once it works try to not focus on it and it will get better I promise. Also the woman we saw was Megg Zwiebeck she lives in Oakland and is an expert on this stuff. I think she is on this network. Good luck
anon

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Honey, I was in the exact same boat with you. Your daughter probably had a painful poop and thought, ''Well, I won't be doing that again!'' My son went through that after my doctor said not to give him juice because it was empty calories. What ended up happening was he stopped drinking all together, got constipated, had a painful poo, and then held in all following poops with all his might. It was horrible to see him pass these huge, painful poops after 3 to 4 days of holding it in. Mix in some Citricel with her juice. It worked for my son, and hopefully it will work with your child.
been there

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I am so sorry you have to experience this. My son, now 4, has very similar pooping issues. About two years ago, he started becoming ''constipated,'' not pooping for three days at a time. We took him to the doctor and were assured that it was normal. Three days turned into 7 and then they took our problem more seriously. Up to two days before he actually pooped, he would be on the ground hysterically screaming ''no poo poo.'' In the three day span stage, we started with prune juice (which he hated), pear juice, whole wheat everything, and lots of fruit and veggies. The doctor suggested sprinkling bran in his food, a good source of fiber and easy to hide.

We also gave him mineral oil... and none of this helped. Finally, after 7 long months we got a referral to a gastroenterologist at Children's Hospital. Dr. Haddad is very kind and attentive. He understood the severity of how this was affecting our lives, and explained that our problem was definitely a control issue, and it would be fixed but we had to think in terms of months and years (a slow process). After our first visit, he prescribed a suppository to make him go immediately (we had been avoiding this), and then Miralax every day (a laxative that makes the stool very soft and easy to pass).

Now, my son is down to half a dose every other day and is pooping almost every day. He gets his medicine mixed w/ juice around 5, and poops at 6pm. He will only poop in a diaper, though is potty trained otherwise. It is more important for him to be going, than worry about the diaper. The dr. says ''he won't be wearing diapers to college.'' Also, letting him decide when to start pooping in the potty will give him that sense of control he fights so desperately for. I hope this helps.
in your shoes

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I don't have any advice on this issue but I do have a three year old who is doing something very similar. In her case she does not want to use the bathroom when she is doing something more interesting -- which is most of the time. Because she is not using the bathroom, she gets constipated and also has small ''accidents.'' Once she is constipated, it is very hard for her to go. We are trying taking her to the bathroom at regular intervals (like after meals), which seems to help but has definitely not solved the problem.
In the same boat

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Hi - Our son did exactly the same thing. He was a very late potty trainer. Its all a haze now, but I think around 3.5 he was using the potty but still pooping in the diaper. I tried many times to gently get him to use the potty. No way - he wouldn't have it. I let it go because it was a control issue and having been told he'd outgrow it. Well, he didn't. Finally at 4 yrs, 2 months old I took away the diaper. He didn't poop for a week then finally went on the potty after much crying. He had gotten to the point he was laying on the couch because if he stood up, the poop would come out. Throughout the week, I did this all nicely, offered him treats, sat on the potty with him for hours and didn't get mad. He just had to let it go. AFter he went one time, he was so ecstatic that he has never had a problem again. He was soooo ready.

My advice? Let your daughter keep the pullups and see what happens. Keep trying gently to get her to poop. But at some point, you may need to get her to go on the potty. For some reason she is 'afraid' of letting go and all you can do is talk her through it. HOpefully it won't be traumatic when she goes the first time (in the potty) and she'll see it feels much better than holding all the time. I have no idea why they choose discomfort rather than release, but some do. Good luck ~ The potty rocks

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My son did that too at age 3. He would hold his poop all day until he got home and into a diaper. It got so bad that he even became impacted. When that happened, his pediatrician treated him and suggested to let him use a diaper when he requested one to prevent more impactions and possible infections. We let him have a diaper to poop. He didn't get impacted anymore and became really confident at controlling his bowels. The diapers requests didn't last long (only 2 months or so) and in the end everything worked out. Less stress for everyone. niki

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My son did this from his first bite of solid food at 8 months till 3 years. we tried EVERYTHING & he still pooped big dry logs after 7 - 10 days & often bloodied his little bum, it was awful. Our wise and wonderful pediatrician, Elmer Grossman, now retired, said this: ''Ok, I think he's a little young, but try this. Go buy a family of dolls, a toy toilet, and some brown clay. Make a little turd out of the clay & initiate a game with him, with you playing the boy, him playing the mom or dad. At some point, after the game is really going strong, have the toy boy say 'Mommy I have to go poo. No I don't want to go poo'. Then watch him. If this works as it should, you may gain some insight into what is causing him to withhold.'' WELL, we got the dolls & the toilet, made the little turd out of clay, & got the game going. When I (as toy boy) said ''Mommy I need to poo. No I don't want to go poo,'' My son said, frantically, MOMMY I HAVE TO GO POO! He ran off to the bathroom & did a big one & was never constipated again. It was extraordinary. We never even got to brandish the clay turd. Whatever was in his mind about poop & pain must have been safer for him to view from the distance of play, he worked it out on the spot & has been an appreciative pooper ever since. He's 17 now. Best of luck, I know you must be frantic.
jenny

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I don't remember the original post, and I haven't had to deal with this problem with my son, but I recently read a book on nutrition by a doctor at the Harvard School for Public Health. He summarized a study as follows: a group of young children with severe constiptation were taken off cow's milk and switched to soy. Within two weeks, two-thirds of the kids started pooping normally and their constipation disappeared. For kids who have constipation so bad they need medication, this might be worth a try if they drink cow's milk. (The book where I read this, BTW, is: Eat, Drink and be Healthy by Walter Willett
My two cents

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I saw this posting a lot later because I was unable to check my e-mail. My son had the same problem when he was 3. I think he just didn't like how messy it was and he had trouble wiping. He just wasn't coordinated enough to wipe well. It would smear and he would miss ''spots'' He just didn't want to deal with it so when he went #2, he would finish sooner than he should've. He ended up constipated and I had to take him to the emergency room where he had to get an enema. In any case, what if you were to provide warm wipes? My brother-in-law is the same age I am and he ONLY uses wipes. I couldn't believe it, but it's true. You could put the box of wipes in a wipe warmer next to his potty... I didn't know this then, but they make flushable wipes. My husband used them to wipe seniors with Alzheimer's at a senior center he used to work at. Just a suggestion.
My Boy Wouldn't Poop Either.

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3-year-old won't poop!

Jan. 2004

our son is just shy of 3 years old. He was starting to potty train, very successfully, when he came down with the flu, and didn't have a bowel movement that whole week. This started a cycle of holding in his poop, willfully. It has now been going on for 6 weeks. At the beginning he had lots of pain so we took him to the emergency room twice where had an enema. He now goes once every couple of days, but just enough to release a little pressure. We now see that the pain is caused by his holding it in, which he does with all the willpower of a 35 year old man. It's amazing! Under the advice of our pediatrician, we are giving him mineral oil morning and night. We are also feeding him lots of juices, raisins, apricots, flax cereal, etc... We are at a loss as to how to comfort him or how to react when he says ''my tushy hurts'' and then proceeds to do whatever he can to keep himself from going (ie jumping around the room and clenching his fists!) HELP! Has anyone experienced this type of thing? The pediatrician says it's common, but hasn't given us specific tips as to how to react (or not?) to the discomfort that accompanies the holding it in. It has been totally disruptive to our lives - hoping someone has some practical tips. Thanks for listening! Carolyn

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I can totally relate. My daughter, now 3 1/2, has been withholding poops since 18 months (two years now). She, too, has impressive bowel control. I often wonder what she could accomplish if she harnessed that power for something constructive!

Our ped. has advised us to give her Miralax, which we do daily, to keep the poops soft. The key is for the child to go every day, or every other day (and not the every 4-6 days as my daughter tries to get away with). If her usual dose (1/2 an adult dose) isn't working, we give her more: otherwise, the stool builds up and hardens, her rectal vault gets distended, and she will have a terrible time letting herself go. At times, we've had to give her 2 full adult doses per day. It sounds like the mineral oil is supposed to do the same thing as the Miralax. My ped. told me that it's much better to treat the problem from within than from without, like with enemas, suppositories, etc.

You had also asked about the behaviors. We have been having success for the past 3 months by following the routine below::

1. Every night, about an hour after dinner, I announce it's poop time. Sometimes she acquiesces, but most often she protests, cries, whines, etc. I don't give in, and basically make her sit on the potty. (''Do you want to walk to the potty, or should I carry you?'' is my opening gambit, but I've also just carried her in and placed her on the toilet. She hates it at first, but calms down pretty quickly and is always in SUCH a good mood after she goes that it seems to minimize the trauma of going in the first place). [I'm hoping that by following a daily routine, her body will start ''wanting'' to go at that time every day]

2. We sit in the bathroom for awhile. I remind her how good she feels when she goes, how big kids/big people go poop every day, and how she'll get a poop treat once she goes. Sometimes we read a story, but I try not to do too many things that will distract her from the matter at hand. Because I think she's forgotten how to go--or rather, she wouldn't allow herself to let go after having the normal feelings of needing to eliminate--I help her visualize how to go: relax her bottom, let her bottom make an ''O'' shape, and let the poop come out. I make up all sorts of silly stories about the poops themselves: anything to make the experience positive!

3. Sometimes all the positive stuff doesn't work, and then I threaten a Fleet Baby Enema--she's had that twice, and hates it. I know--I hate to use threats, but sometimes it's the only thing that does the trick.

4. Once she goes, I make sure her bottom is clean (using baby wipes or warm wash cloth). If her bottom isn't clean, it's apt to get red and irritated, which means the poop will hurt as it comes out next time (not from any constipation, just from passing the sensitive skin).

5. Give her her poop treat, which can be anything your child really wants. In our case, it's some candy.

6. Reiterate how proud I am of her, how she's such a big girl for going poop, how it didn't hurt, etc.

I have learned the hard way that I have to be REALLY vigilant. If we let it go for a few days, all the old withholding behaviors come back full force.

We have good weeks and bad ones. Sometimes she goes into the bathroom all by herself and, lo and behold, makes a poop without any prompting. Other times, she withholds, and then carries on as if I'm trying to torture her when I insist she try and go. This can be a very, very long process, which is discouraging (to say the least). I'm hopeful that by following a routine, we'll eventually get to the point where her body learns to go on its own, and she allows her body to function normally.

Best of luck to you guys! Christine

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Our daughter went through the same struggle and refusal to poop when she was in her 3's. It lasted for months (the screaming and kicking while sitting on the toilet and the 2+ days without a BM). It does get better.

It dawned on me that she was eating a banana and a PB almost every day. Those foods can cause constipation/some tummy pain. In addition to limiting those 2 foods, I also stopped buying Pull-ups and explained to her that 'this is the last one and after that you will have to go poo-poo in the potty.' It somehow clicked for her and she started pooping in the potty. Good luck angela

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My son had this problem too. He is now 10 and, while largely in control, still has some problems related to this.

He held his poop so long that it would slip out when he slept at nap time. Since he was in preschool all day, we were not aware of the problem until he started soiling his pants. His doctor also had us give him mineral oil, which actually caused him to have even more accidents! However, I think that ultimately, that was the way to go. Unfortunately, because we hadn't acted sooner, his body lost its ability to feel when he had to go, which was causing the frequent accidents.

I agree with the folks who say deal with it now and in a positive way - especially as it can lead to a problem that will persist for many years. But I would also look into why it is happening in the first place. In my son's case, I found that he had been teased a bit in the potty room at preschool, which was what led him to not want to spend much time in there.

Good luck! fm

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Hello. I can relate to your delimma. I just went through this with my son. I can't remember if you are potty traing, but we gave up altogether on that and let him know that it was okay to go in his pants if he needed to.

It was not an easy process- we actually ended up having to use enemas (he would not poop for up to a week). Honestly I think some kids go through this. We tried mineral oil, we tried mild laxatives, we tried getting him to drink more liquids, we tried coaxing, we tried threats, everything under the sun. He pretty much resisted everything. After the 3rd enema, he figured out that pooping on his own was a lot easier a lot more pleasant an experience. Another thing that helped was trying to encourage him for being such a big boy, talking a LOT about how everyone poops, etc. We even resorted to bribery- if he pooped X number of times on the potty he could get Annie and Clarabel (Thomas the Tank Engine coaches).

Also now when he poops on the potty, he likes to hold a train or helicopter because he says that they ''help'' him poop. We also made a big deal when he did poop- lots of cheers, hugs, high fives, the works.

I know it is hard, but just try to staty patient and viligent, he will get it worked out. Hope it happens soon! Lisa

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3-year-old Holding on to Poop, Withdrawing

March 2002

Hi everyone, My 3 and a half year-old daughter has been asking for diapers when she needs to go ''poupou,'' and having accidents in her pants when she is not with me. I don't mind these two behaviors. It will take the time it has to take for her to be ready. Now, here is the problem. At her school she has accidents, and sometimes she will deny it with the teachers. Then she withdraw from the other kids (she stays alone); she told me once it's because she does not want the other kids to smell her. At home, she put a piece of schotch tape on the bottom of her favorite stuffed animal; so ''the poupou can't come out,'' she says. Also sometimes even with me, she will not go pipi on the potty, and will refuse a diaper. She just hold herself until she can't hold it no more (the same with ''poupou'' if I am not with her). What disturbs me is that she is holding so much (up to 4 days for ''poupou'' during Christmas time - we were away to my parents, and I guess, she reacted to the new environment) and must feel so uncomfortable; and, now I worry about this withdrawing behavior at school. In the past, she saw all the videos and books about potty training; I promised her the best toys if she does ''poupou'' in the potty. We use a calendar that we put stickers in for pipi in potty (or poupou, if ever,...) I do not act negatively if she has accidents; rather, I try to show that I have confidence in her (''I know that, when you'll be ready to use the potty, you'll get there on time). Any suggestions? thank you

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My son went through a period of time doing the same thing, especially at school. After awhile, we finally discovered that for some reason innate to him (i.e., nothing we ever specifically taught him) he really wanted his privacy, and what was bothering him about going to the potty at school was that there was no door. This is typical in preschools for safety reasons, so that the teachers can always have an eye on everyone, etc. We discussed this with a school and they installed a half door, which helped. Another issue with him was that by holding it in for awhile, it would tend to harden and make going poop, when he finally would do it, a bit painful, whcih would motivate him to hold it in even more next time, and constipation became a real problem. We tried a mild stool softener, which helped a lot. Ultimately, it's a phase that has to do with gaining control and confidence over the whole process, and it will pass. Perhaps try to find out what you can do to make it easier for her, even letting her put on a diaper, and asking the teachers at school to do this for her if she requests it. It won't go on forever, and if it allows her to relax and go when she needs to, that is the most important thing, for now.

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3.5-year-old still holds poop - we've tried everything

Feb 2004

Help! My 3 1/2 yr old daughter has been holding in her poop for about 1 year now. We have tried everything from changing her diet, to drinking prune juice, to giving her mineral oil. All has helped, but she still will not let it go naturally. We have read books about going ''poopy'' and I explain to her that it is a normal bodily function, but she just refuses to let her poop come out when she has to go. She will hold it for as long as she can, no matter what. I will let her fight it for a day or two, but then I can't stand to see her suffer so I place her on the toilet (usually kicking and screaming) until she fianlly goes. She is terrified when she see it come out of her. When she finally does go, she cheers and brags about going and asks for a treat for going, but then the next time she has to go she refuses again. Its just a constant cycle. We go through this about every 2-3 days. She just fights it as long as possible to hold it. Does anyone have any advise on how to let her know that she doesn't have to suffer every time she has the urge and that it doesn't have to hurt when you go? I appreciate any advise.

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There is a pediatric gastro-intestinal group of doctors in San Francisco. Within their office they have a person who specializes in pediatric bio-feedback therapy for issues like this. Please ask your pediatrician for a referral. I know one of the doctors is Dr. Linn.
anon.

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I was so glad to see your posting. My 3 year old has been 'controlling' his poop for about 3 1/2 months now. He was a great daily pooper until one day he had an especially hard poop with his nanny and she ''pulled it out'' because ''it was stuck'' and that was it. From that day on he has held it in and refused to let it go. I have been beside myself often about this. Pooping is the first thing our little ones feel they can control in their lives. My boy is so strong willed that he has hald it up to 8 days. When he does poop it is not hard or constipated. It is actually loose.

I noticed when I became more controlling over him he held it longer. Like when he turned 3 yrs I sort of tightened my discipline of him. That was when he went w/out for a week. His pediatrician prescribed Miralax, a gre! at laxitive that you can hide in any drink. But this makes it as loose as can be. After I actually 'gave it up'--stopped trying to control his poop. He has been pooping every other day now for over a week. He still fights it and he is proud afterwards. I say very little now about it. I sometimes tell him ppop likes to comeout an that it was nice that he let it go. I told him it was up to him if he wanted to poop. I try to make him feel like he controls things in his life.

Incidentally, this happened about 3 weeks prior to our move away from his dad. He may have picked up on the stress in the relationship.

My niece did this with here poop for a year or more. It is actually labeled encopresis. You can go on the internet to read about it. Type in encopresis + without holding All advice I was given is that potty training during this time is futile. This is very common. 3% of all visits to ped. involves poop issues.

Seriously, you have to let go of trying to control it. Its a big lesson for us parents. Also, I remind myself that he will poop normally someday and that, at least with my now 11 year old niece, there are no lasting effects. She doesn't even remember. good luck

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3.5-year-old with encopresis

Help! My 3.5 yr old boy is suffering from chronic constipation. We've consulted with two pediatricians and the only advise we're getting is a restricted diet (no dairy/apples/bananas; eat bran/whole wheat,etc.) and dosages of mineral oil (4-6 tablespoons/day). The mineral oil is coming out, but that's about all. Poops are every 7-10 days - if we're lucky. We've done two enemas about 4 weeks apart; they work in a big way to clean him out, but then nothing. I'm opposed to interventions like this, but you can really tell he's uncomfortable a good bit of the time (this has been going on for about 6 months). He's a very picky eater to begin with, and the few things he will eat are restricted. BTW, he's not toilet trained yet, and I think this problem is standing in the way. Any ideas would be greatly appreciated.

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My daughter was very bothered by constipation. We went thru some very upsetting times. Mineral oil worked, but I only gave it to her went the problem developed, not on a regular basis. She didn't like suppositories, but, on a few occasions, I resorted to them. In July, when she was very uncomfortable and had not gone in over a week, I called the doctor (not the first time) to ask for some help. Milk of magnesia was suggested and she has not had a problem since. I give her a tiny bit (less than a teaspoon) every morning (or, sometimes, every other morning) and it does the trick. It is no longer a big deal to go, she goes every day, and the problem seems to be resolved. I intend to ask the doctor whether I should try to tapper off, if there is any problem with prolonged use of a laxative, etc. But, at this point, remembering how horrible the problem had become, I strongly suggest milk of magnesia. My daughter prefers the mint flavor, but I think there is a cherry flavor as well.

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I have found that if our now 3 1/2 year old daughter gets constipation it relates almost entirely with lack of hydration. If you can get enough fluids into her then the constipation goes away. I am surprised that the two doctors you consulted with did not inform you of this. Best of luck.

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When my youngest son was about 2 1/2 and still in diapers, he went through a painful (for all of us) period of constipation - infrequent and uncomfortable elimination. He would not go for days at a time, sometimes up to a week, and then the poor little guy would stand up, hold onto something until his knuckles were white and he was purple in the face, grunt, and sometimes succeed in his efforts and sometimes not. If he was successful, he would be sobbing; if not, we would try to comfort and encourage him, knowing that the longer he put it off, the worse it would probably be. We began examining his diet, trying to pinpoint anything new that he had been eating. We also had heard that dairy products might be contributing to the constipation, but these were not new. One thing we did cut way back on was the amount of cottage cheese (one of his favorites at the time) since this was cited as a common offender. The problem still continued, however, for several months, on and off. It wasn't until he made the full transition from our in-home shared daycare arrangement to a small preschool that the mystery was solved - our daycare provider, a warm, wonderful woman, had been sharing her lunch and snacks with him, and had been letting him eat all of the pistachio nuts that he wanted. Apparently his little teeth weren't chewing them thoroughly, and they were providing some extra (and painful) bulk to his stool. Once these were eliminated from the diet, and he was no longer holding back in fear that pooping would hurt him, all returned to normal.

 

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I feel your pain, as well as your child's. My daughter had the same problem between 2.5 and 3 years. We tried everything you listed, none of which helped us either. What finally worked was to give her carrots at lunch and mandarin oranges at night (I still stock up at Safeway - the brand she liked best!) She too was a very picky eater, but she understood that this would help her not hurt anymore. E-mail me privately if you would like.

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Have you asked him whether he considers poopy diapers yucky, as in, maybe so yucky that he doesn't want to poop into his diaper? If that's the case, maybe trying the potty for a couple minutes, once in the morning and once in the evening, might be worthwhile. maybe after a cup of prune juice and a half-hour walk.

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This is nothing to fool around with. My daughter had this problem to the point where she lost all bowel control and pooped in her pants all the time (it has to come out at some point and will). I tried all kinds of diet stuff, and the doctors assured me that it was just a toilet training issue, until I finally went to the right doctor when she was 5 years old. This was after two years at least of frustration, mess, and general misery, and many arguments with parents, etc. about diet and toilet training. I myself tend to be non-interferring by nature in these matters. In any case, the doctor had an xray done which showed that her bowel was completely packed with cement-like stuff. He sent me to the store for mineral oil, a fleets enema, citroma, and milk of magnesia. This was an embarassing check out. He had her drink 8 ounces of mineral oil (you can mix it with chocolate syrup but it is gross any way you want to think about it), had me give her an enema, and then the following day take the citroma. Then a tablespoon of Milk of magnesia morning and night for months. The bowel has to be re-trained. The child has to be encouraged and reminded to use the toilet after every meal. Eventually, you taper off the milk of magnesia. Now, if she shows any sign of a problem, I give her milk of magnesia for a day or two. I also give her a lot of fruit. BUT she could not have been cured by diet, and by nature she is a girl who loves fruits and vegetatables and eats a lot of them, so this problem did not originate with diet. I have my own theories about it, but I will spare you. Personality is no small part. The doctor name for this is encopresis, and there is a wealth of information on the web under pediatric encopresis, including recommended tapering off rates. It is not a rare problem, actually.

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To the parent(s) of the chronically constipated 3.5 year old, our son (not 7) experienced the same problems, at around the age of 5. After several trips to Kaiser, several bottles of mineral oil, etc., the prognosis was that the nerves in the intestine weren't wired quite correctly, so that our son's intestines' weren't notifying him that his bowels were full.

Ever since we've been giving him a prescription medicine called Propulsid which apparently inspires the intestinal nerves to send the proper signals, and the results have been good. He still experiences some constipation, but not nearly so bad as it used to be. We're hopeful that after a period of time, we'll be able to abandon the propulsid.

I should probably also add that our son has some diabilities which, for lack of a consistant pattern and diagnosis, are generally classified as developmental delay. Not sure how that might tie in with the intestinal nerve thing, but I thought I'd mention it.

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I understand your concern. When my son, who is now three and half and basically toilet trained, was beginning to use the toilet he would refuse to poop. He held it for as long as could, three days usually and then would have an accident. He actually seemed scared to sit on the toilet. The constipation problem actaully started when he was still wearing diapers, but beginning to sense the control he had over his pee and poop. We saw what it meant to be literally anal retentive, and we felt so bad for him. Like your son, he was uncomfortable so much of the time. Eventually, someone recommended having him sit on the potty at the same time everyday for between ten minutes to a half an hour. Maybe after dinner or in the afternoons when it was convenient for the family. It was to help regulate him and to help him get used to the potty. We didn't read to him or otherwise distract him. We simply stayed with him and tried to let him concentrate on the activity at hand. Eventually, after many, many trials he was able to relax.

I would say we have been working on this for six months. Though he still resists a couple times a week and he rarely poops anywhere but our house, he has come to be able to poop almost everyday. Another suggestion is reading books about toilet training and poop in general - we found our son was squeamish about poop and this helped to ease his unease.

I know it is different since your son is still in diapers, but maybe he is beginning to become ready to use the toilet and is worried about making mistakes. The most important thing is to reassure him and not become overly tense and obsessed about his poops. I know this is difficult, but he can be affected by your anxiety. Good luck!

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Our daughter, age 4, was just diagnosed with Encopresis - chronic constipation. Her prognosis - it takes as long to fix the problem as it did to get the problem. We are giving her Kodremul (a laxative) every evening, and helping her remember to sit on the toilet every day at the same time. With the laxative, she has successfully had a bowel movement every day for weeks. She has always had constipation issues although she was very easy to potty train (I remember when she was 9 months old, trying so hard not to poop.) For her, I think it is a strong-willed, controlling child issue. (They do say that it is phychological, not physiological). In any case, I found lots of info on the web, although I'm still looking for info regarding how encopresis affects behavior. Would love to hear from other parents of kids with this problem and any behavior stuff they went through.

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We have been seeing a pediatric social worker, Meg Zweiback, for three months following a visit to the emergency room with our 4.5 year old son---who had unbeknownst to us been holding onto his bowel movements. It is an extremely long story. I would suggest in the strongest terms though that you discuss this with your pediatrician and work on solving in; there can be some physical complications of 'holding' that can take quite a while to undo. If you can afford Meg, consider calling her. She is a wise, practical, supportive, and experienced. She is $90/hr (we do not see her often, and we will not see her for a long duration---just until the problem is solved). Her phone number is 836-1450. Good luck, however you handle it.

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2001

A while back, someone wrote asking for advice about their child withholding poops. The American Academy of Pediatrics has good information on 'functional constipation' that I thought might be useful to the parent who was looking for insights. http://www.naspgn.org/constipation.pdf Ann

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A few weeks ago, there was a thread of discussion on encopresis and constipation. Somebody wrote that she'd found Juice Plus Fiber online and was going to try it out. I also tried it out, and it has solved my 3-year-old's constipation problem! It's pretty expensive (about $36 for a case of 27 juice boxes), but it worked! My son has nice soft poo-poos now that he can't hold in. (He doesn't like the juice boxes because the boxes aren't the same color he's used to, but we poke a hole in the box and surruptitiously squeeze the fiber juice into a sippy cup with regular cider or apple juice.) The juice isn't thick or pulpy -- it looks and tastes like regular apple juice. They also have orange and grape juice, but I haven't tried those. Here's the website, in case anyone's interested: http://www.earth-friendly.com/juiceplus.php3. Thanks so much to the person who wrote about it in the first place! Hannah

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My 4-year-old has been diagnosed with encopresis

2000

My soon to be 4 year old son has been diagnosed with encopresis (withholding of his bowel movements.) I've read the postings on the website and found them helpful and would like to hear from parents who have successfully treated their child for this problem. We have consulted with our pediatrician and a pediatric nurse about the condition. Currently we are giving our son as much fiber and fluids as he will eat (he's a somewhat fussy eater, but likes some fruits, veggies, oatmeal etc.) In addition, we spike his nightly bottle of milk and water with a little Milk of Magnesia. We have our good days and bad days, but it's hard to see a general curve of improvement. Our pediatrician doesn't want us to pursue toilet training and our son is also resistant to the notion. I'm getting a little anxious about getting him potty trained since I think the delay might cause some social problems with his peers, but we don't make an issue out of it. I should add that this situation has been going on for more than a year. I would appreciate hearing from other parents the answers to the following questions: How long did it take to fix the problem? What did you do? How old was child at the time? How did potty training go? Thanks in advance.

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My son developed the same condition at about this age and it took a long time to get past it. He wouldn't eat enough fiber, so the whole condition got worse. It was really difficult for the family and him. Some days he would miss school.

He wouldn't eat fruit, so we gave him apricot juice. We also had to give him mineral oil (two tablespoons mixed with frozen concentrated Hawaiian juices). The oil helps to make the bowel movements less painful.

Now he's a lot better. But if I forget to push those apples on him, he's clogged again.