Bowel Problems

Many toddlers continue to have a bowel movement everywhere and anywhere, except the potty. Some are trained for a time and then regress. Is this yet another sign of the uncanny affection toddlers have for their poop? Is it a reaction to the discomfort or embarrassment of sitting naked on a potty for an extended time? Could it be a last-ditch effort to hang onto babyhood? Or perhaps it's an assertion of toddler autonomy?

Most parents never do decipher this puzzle. One thing is certain: If it's a struggle for control, parents are probably doomed to lose. Those who become angry and punitive may find themselves dealing with chronic soiling, known as encopresis (explained later). To enhance children's motivation, here is a hodgepodge of things parents have tried, with varying degrees of success:

  • Have toddlers sit on the toilet for five minutes every day at the time they are likely to have a bowel movement. As soon as the time is up, reward their success for having remained seated.

  • Immediately offer more desirable treats and toys when toddlers get their stool in the right place.

  • If you've already tried the enthusiastic “hip-hip-hurrah” approach to drumming up pride of accomplishment, switch to being matter-of-fact when toddlers get it right, as if going to the potty were nothing unusual.

  • If your approach all along has been matter-of-fact, try staging victory celebrations.

  • Put them back in diapers. However, know that some youngsters then regress to wetting in them, too.

  • Ask your child why he doesn't like to use the potty. You probably won't get an answer. Tell him if there's anything that bothers him about it, to let you know. Maybe at some point he will. Maybe it will be a problem you can fix.

  • Have your toddler tell you when he needs to go, hand him a diaper, and let him retreat to wherever to do his own thing.

  • See if spending time in an environment where other children use the potty, like a preschool, makes a difference.

  • Wait for kindergarten peer pressure to solve the problem.

  • How would you feel if your insides fell out and disappeared forever? This simple misunderstanding is what causes so many toddlers to work overtime to prevent disaster by becoming constipated or secreting their stool around the house. Many potty-resistant toddlers have made a dramatic turnaround after hearing the simple explanation: “When people eat food, their body uses what it needs. Then it gets rid of the part it doesn't need, which is the poop.”

    So why do some children insist on having bowel movements anywhere but the toilet? In the absence of an underlying medical problem, resistance that develops into full-blown encopresis — constant soiling — often develops from a predictable chain of events:

    • The child is slightly constipated, so her stool is a bit harder than normal. Because passing hard stool is painful, she tries not to have a bowel movement, worsening the constipation and pain.

    • If she uses the toilet, the hard stool causes the cold water to splash, hitting the child's bottom.

    • The combination of pain from passing stool, and the surprise and discomfort of being splashed makes the child nervous — even a bit afraid — about pooping in the toilet again.

    • A vicious cycle is created wherein the child's reluctance to use the toilet causes her to become increasingly constipated. Bowel movements become increasingly hard and painful, which further increases reluctance.

    The situation can escalate to the point that a mass too large and hard to pass through the rectum forms in the bowel. Liquid that can't be absorbed leaks around the mass. The child cannot inhibit the flow, and continuous involuntary soiling occurs.

    To break the cycle, increase his intake of fruits, vegetables, and fruit juice, and keep him well hydrated with water. If that doesn't help, check with the child's pediatrician about administering a stool softener such as mineral oil. A good stool softener will make it impossible for children to contain bowel movements once it takes effect. Since mineral oil can interfere with vitamin absorption, it may be necessary to add a multivitamin; mixing it in juice can make it more palatable.

    Once the child has been having regular soft bowel movements for ten days, rectal soreness should be completely healed. At that point, it is time to work on having bowel movements on the potty. Because children in this situation have come to associate the potty with physical pain and discomfort and the whole situation may have become traumatic, breaking the negative associations and creating new, more positive ones may take some time and a lot of patience. The goal is to help toddlers recover from trauma so they can have a fresh start.

    For starters, have the child sit on the potty or toilet for five minutes every day at the time she usually goes, wearing Pull-Ups while seated. Wearing Pull-Ups should add to her feelings of safety and ensure no splashing occurs if she is on the toilet and does have a bowel movement. If her resistance is too strong to be overcome by reassurance and pep talks alone, offer stickers, toys, or special privileges. Set a timer and engage in a quiet activity she enjoys, such as reading a book, playing with an Etch-A-Sketch, or reciting nursery rhymes. Reassure her that the point isn't for her to have a bowel movement; it's to learn to relax while sitting on the toilet.

    Once she's sat for five minutes without a struggle for at least three days in a row, it's time to up the ante. Make rewards contingent on having a bowel movement there. Leave on her Pull-Ups to add to a feeling of comfort and to prevent splashing, if she's on the toilet. If she doesn't go during her daily five-minute regime of sitting on the potty, provide verbal praise and tell her she can still earn the reward if she goes while sitting on the potty later. Ask her to tell you when she needs to go.

    After a week of having regular bowel movements on the potty, her memories of the trauma are fading (Let's hope!). At that point, have her remove her training pants and try having a bowel movement in the potty or toilet. Continue to set a timer to ensure that she sits for five minutes, but only provide a reward after she actually uses the potty, which may be later in the day.

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