Withholding/ Encopresis

Summary of responses to a poster about a child who withholds their poop.

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A PSP member writes:

"My 2.5 yr old daughter was diagnosed as a witholder 6 weeks ago (holds her poop back for fear of pain). We've had her on Miralax since then, and at first it worked great, but lately she seems to be able to withold the soft poop as well (it kills me to watch her do this). I will take her back to the doctor, but would like to commiserate with anyone who has/had a witholder. For those of you who got through it, what worked?"

 

Summary:

"Thanks to everyone who responded to my witholding post. I really appreciate hearing about all the personal experience. The main common thread was the reward system, which I haven't tried yet, and can't wait to start."

 

Give laxatives and fruits:

"My firstborn still has a problem--once the colon expands for a long period it is hard to get it to shrink. The problem skipped my second child but my third, a boy, started having problems. The solution was to give him laxatives and every bit of his ripe favorite fruits and then to read books to him on the potty taking plenty of time. After he relaxed some on the potty, I would get silly reading the books and tickle him. Fortunately he was very ticklish and the abdominal contraction from the tickling, the relaxation from reading, and gravity from sitting would take over. This went on for months but eventually he could look at books by himself and go, sitting having become a pleasant experience."

similarly:

"Yeah, our son is 2.5 too and started doing this about 6 weeks ago. Its really miserable isn't it? I would never have believed a little poop could cause so much pain and suffering. The terrible part is that they are doing something that will hurt them and theres so little you can do to stop them and you just want to explain the situation to them in a rational way but of course they are only 2 years old. My doc told us to do the miralax -- we do half a capful every day. he said to do it for 8 weeks so i think soon we will begin to slowly wean off it and probably start doing stuff like prune juice and lots of fruit and fiber to help keep things going. My son's always had problems with constipation, so we have to still be attentive to that. he seems to be doing way better in terms on not being as scared now -- for weeks, he's jump up and down repeating over and over "im scared!" and now he doesnt say it -- or very rarely. sometimes he will ask me "are you putting that thing up my butt?" because in the beginning we had to use suppositories -- just twice. but it really traumized him. anyway, the main thing i had to do was relax -- or just appear relaxed -- not talk about it too much with him -- just be super casual and tell him it was good to poop and i'd change his diaper when he was ready. i hope that helps"

 

Stay hydrated:

"Make sure that she's drinking a LOT of water...because (A) it will soften things up so pain is less likely to occur, and (B) it will "force" the issue, meaning it increases internal abdominal pressure while also increasing the frequency of urination, which may then facilitate defecation..."

 

Try mineral oil:

"Hi, I've got a former withholder, I know how you feel. My daughter got a bad case of constipation after a vomiting bug, and it led to about 2-3 months of total crisis around every poop. It started at 2.5 yrs. I honestly thought that there was no end in sight, but it did eventually pass. I switched peds over it - my old one recommended suppositories which were too traumatic. The new one I went to gave us good behavioral help (told us not to make a big deal around the events, but to praise her when they passed) and recommended before Miralax that we try mineral oil. We started with 2 teaspoons a day for 2 days, then moved to 1 teaspoon, which we kept her on for about 14 days (stopping for a day occasionally if things were starting to get runny). I've got a good eater, so I could mix the teaspoon in a shot glass with 2 parts OJ, and she would drink it with breakfast. It's colorless and tasteless, but it is an oil, so not everyone will be okay with the texture. My sister is a pediatrician and she told me that she doesn't recommend it much because she assumes toddlers won't swallow it, but it really did the trick for us. It basically slicks the track and they can't hold it in. But it's not like a loss of control thing that the suppositories created. She didn't have diarrhea, just small oily poops (sorry for the graphic details, but really, I lost my self-consciousness after this episode as I was undergoing severe morning sickness at the time and my life for 3 months revolved around my daughter pooping and me vomiting).  It all happened so fast that she would eventually forget to freak out. What really helped me was the behavioral input. My pediatrician was very reassuring and supportive and encouraged me to update her and call with questions. That made me feel less alone in dealing with it. My daughter turns 3 next month and we're still not potty trained, but I don't think there are any long-term effects. The other thing my sister recommends generally when kids are struggling at this age are books on the topic. We read a lot about pooping, which also makes it feel more manageable to my daughter."

 

Introduce fiber into your child's diet:

"My 4-1/2-yr-old daughter has had issues with withholding since she was about the same age but it reached its worst earlier this year. I really do sympathize with you (and her). My entire family was obsessed with Sophia's bowel movements! The "plan" Sophia's pediatrician put her on was 1) Senekot (1-2 tablets a day); 2) Benefiber (1 tbsp a day). We also started making sure she drank more fluids throughout the day and were less strict about her intake at night despite the added responsibility of waking her up later to go to the bathroom so she wouldn't have an accident. But at your daughter's age she may still be in diapers or pullups at night? I admit that we got off to a rocky start because I thought Senekot and Benefiber were the same thing so I just gave her Benefiber. On top of that I didn't increase her fluid intake initially, so that it actually had the reverse effect and stopped Sophia up even more. It was awful. Our immediate fix (not our pediatrician's) was to give Sophia an infant's enema. It worked within one minute. She did scream like a wild cat because she was determined to hold it (which was impossible) and this scared the daylights out of us all. But it was actually painless for her. The next step was to follow her pediatrician's directions exactly. It really did work but if we even skipped one day she could hold it again. Her pediatrician did warn us of this. I think it took a good month and a half before we were able to reduce her dosage. Now we don't give her any Senekot (except on occasion) and reduced the Benefiber to about 1 tsp/day. She does not necessarily have a bowel movement every day, but at least every other day and now it is quick and painless (when she did go before, it took her a good 15 minutes). One other suggestion - I'm not sure if your daughter is old enough to appreciate this, but we started using the "star system" to reward Sophia for her bowel movements. We have a hanging calendar on the bathroom door and every time she goes she gets to put a star up for that day.  She gets really excited about it. And now all I need to ask her is "Did you get a star today?" and she knows what I mean. You may have heard all of this before from other parents. I searched all over the Internet and had a hard time getting any information. SoI hope this helps. At the least, know that your daughter is not the only one. It is indeed scary and frustrating to witness but there are actually solutions and she is capable of being "normal" again.

 

Try a combination of foods/supplements and prizes:

"My niece had this problem - She's now 7 and fine. My sis in law used to give her a lot of grapes, ice cream and mineral oil. I think she also encouraged her in the bathroom and gave her rewards for poops. She also took her into the bathroom when she had to go..."

 

Read books on the toilet and rewards:

"Oh,boy,did we go through this! We still keep a collection of books to read to my son when he is on the toilet (he just turned 6). He still withholds in public, and is now articulate enough to state how disgusting he feels publicly used toilets are, so we sometimes have near misses and "skidmarks." Sorry, too much information. Anyway, we accumulated a stash of inexpensive "short-term easily-achievable goal" rewards, or bribes as some people might say. When we were alerted by various signs that he needed to go, such as flatulence, standing quietly with no aim, having a tight and/or full belly, we would offer a "poopy prize," and that worked more than it didn't. We also did the Miralax, but my son already has been eating black beans at least once a day since before he was 2, so that's not the issue. "Squat position" can help, so if you can come up with a game or activity that gets your daughter to squat, it gets things moving. Otherwise, bribe,bribe,bribe. Sorry for rambling-just home from too long a day of work!"

 

It might be emotional:

"My son when through this when he was 5. we took him to the doctor and he did the whole miralax thing for about a year. but i really think it was an emotional issue. it was a direct result of potty training. he was a late bloomer in this dept. he just was not ready. at 3.9, he finally got the pee thing down and went to pre-K in underwear but he still wanted a diaper to do #2. if we didn't give him a diaper, he would actually do it on the floor. we got so frustrated, that i think he just went to withholding as his way to solve the problem. I don't know where your daughter is on the training scale, but she is still very young, so maybe if you gave her permission to do it in her diaper for a little bit longer . . . i don't know. my son is now 8 and he still is not the kind of kid who will go every day. he goes about every three days, but the issue was resolved by the time he was 6 and some months.

 

Give prizes:

"I haven't gone through this with my own daughter, but I'll admit that I was a withholder. I would go into a corner, cross my legs, and hold it in. My parents ended up getting a box of prizes--little things that didn't cost much but seemed exciting to me at the time--and every time I pooed, I got one. That's what worked for them/me."