Bowel motions

What’s the story on withholding? Working through a common training challenge

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! But the term can be misleading as it would imply that a child is always doing it on purpose.

Children withhold bowel movements 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 which upsets their parents who 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.

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.

In the mean time give your child high-fibre foods, such as fruits and vegetables, and encourage him or her to drink plenty of liquids and avoid an excess of dairy products.

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, her daughter resisted potty training altogether. Finally, about 8 or 9 months ago, she began urinating regularly, but she absolutely refuses to poo in the toilet. Angela has kept her sense of humour, but her frustration is evident.

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

So what should Angela do?

In cases where there is no obvious medical issue, control needs to be given back to the child. In other words, Angela should simply help Susanna deal with her toileting issues and then walk away.

This may seem easier said than done, but for Jennifer it was this strategy that made her second round of potty training so much easier. When Jennifer’s oldest son, Brian (now 7) was being potty trained, he had a serious withholding issue caused by fear.

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

Since then Jennifer 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 as it had with her first child.

“Potty training is one of those things that can cause parents a lot of frustration,” she says. “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 they need 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.

• Make the potty convenient. Be sure to keep the potty in the room they usually play 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 their clothes if they soil themselves, without comment or recrimination. Make it a quick, neutral activity.