Three Year Old Holding His Stool
Dear Dr. Susan:
My story is a long one, but I’ll try to shorten it. Our three and a half year old son had trouble passing stools since he was one years old. They were hard and painful and from that he developed a fear which led to him holding it in and then constipation in a continuing cycle. We spent a long time giving him stool softeners/laxatives which may have helped and/or given him stomach pains. It varied from very extreme pains and months of him having to “give birth” to his stools to relative periods of calm, where he would pass stools without pain, but still be scared. Added to that is a complex struggle for control of his bowel movements. As of now, a high percentage of his day revolves around dealing with this issue.
The status today is that he seems to have gotten past the fear (we think), but he does not like sitting on the potty and when he does, he doesn’t do anything. He spends much time trying to keep his poop in (“dancing”, holding his legs together or crossing them), but mostly soils his underwear with a small stool 6-8 times a day.
This is just a brief sample of the history and where we are today. The issue is a complex one which has taken many turns over the course of two and a half years. Any insight which you may offer would be much appreciated.
Thank you for your help.
Marilyn
Dear Marilyn:
Thank you so much for contacting our site. It is so difficult when the problem has become a behavior and the behavior has become a habit and the habit is not positive. I have ideas, but a real solution comes with his ability to take the problem on himself and use privacy as your tool. Three-year olds need privacy, so I suggest any antsy-dancing routine be talked about in a private meeting between parents and son. Tell him you want to know what he thinks about. Does he always think about “holding poopies?” Then tell him what you think. Tell him that bathrooms are the only places where he can have privacy, and therefore a plan has come to your mind that involves only the bathroom. He should do all his dancing, his worrying, his thinking in privacy in the bathroom. He can take his clothes, and his music or a book only with him, but that’s where he goes. His supply of underwear stays there (put some in the bathroom and be sure his preschool does too).
Tell him not to talk about it, or worry. He will do better if you just prompt him or cue him to go the bathroom when he starts talking about it or “dances.” Ignore his dancing or talking, just point to the bathroom and escort him there. Just remind him he needs privacy. Remind him that he has the problem, no one else. Really, water and fluids and lots of fruit and a good diet should be the long term solution. Contact a dietician, and put him on a recommended diet, even if you have to change eating habits. Eliminate foods that cause hard stools. I also know that increasing exercise and the “hard, physical play” causes the bowels to function better, and the muscles attached to the lateral sphincter muscles contract and let go more efficiently.
Just keep saying, “you need privacy.” “We insist you take this problem to the bathroom.” Thank him. Say it is a family rule. Be firm but gentle. Don’t overreact one way or the other. Just act business-like and he will adjust, but don’t minimize the importance of diet. I assume he has been tested for serious bowel obstruction, but, keep his pediatrician informed of your plan, and stick to it.
He is to change his own pants, but he can call you. Say “If you need to be checked, when you are through, just call me. I will help you.” Wipe him up afterwards, but do none of the work of changing him, then let him put his dirty clothes in the washing machine.
Encourage him when he does go in privacy, otherwise, kindly, remind him to go there.
Thanks again for writing,
Dr. Susan H. Turben
