It isn't easy to do potty or toilet training. But the challenges of ordinary training seem like a breeze compared with those raised by a stool withholder (translation: a kid who won't ‘go’).
For some insight, we asked paediatric gastroenterologist Dr Fredric Daum a few basic questions for parents who might be encountering this problem with their toddler.
Q: We've heard horror stories about kids who hold it in.
Dr Daum: Withholding of stool is not a medical condition. It is a behaviour. A child who withholds is physically able to go, but is unwilling to do so.
Q: What are the consequences?
Dr Daum: Holding stool causes pain and discomfort for the child. It can also cause a distended, swollen abdomen, foul-smelling flatulence, rapid fullness after eating solids (early satiety), and reflux symptoms, among other things. There can also be emotional consequences: children can experience shame, embarrassment and diminished feelings of self worth.
Q: What are the signs that a kid might be a withholder?
Dr Daum: Hiding while pooping, certain posturing including straightening of the legs, crossing of the legs, holding onto furniture with buttocks squeezed together and legs straightened or dancing around in obvious discomfort.
Q: Why do so many kids do this?
Dr Daum: Children frequently develop an aversion to having bowel movements after pain or discomfort from hard stool - although the problem was initially physical in nature, it then becomes behavioural. Any significant transition or stress (new home, new school, marital discord, family illness) can also be a trigger. Stool withholding is also one way for children to assert control in their lives.
Q: How can parents manage this withholding behaviour?
Dr Daum: The good news is, withholding is resolvable with timely and appropriate intervention. While I am aware that some specialists prescribe therapy with daily enemas and suppositories, I do not recommend this. My belief is that this does not change behaviour and may be viewed as punitive by both parents and the child. Top down therapy with oral laxatives, when managed by a specialist, is safe and effective.
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