Tips for When a Toddler Withholds His Poop
July 19, 2009 by Dr. Heather
Filed under Annoying Toddler Behaviors, Potty Training
Potty-training complications are pretty common topics of discussion around here. Stephanie’s question about one of the more common complications — poop withholding — comes up at a time when many of us are frantically trying to get our toddlers ready for preschool in the Fall. The frantic pressure parents feel to get their toddler trained — at any cost — so that they can start school — can be a major impediment to the natural process of potty training.
You can't PUSH them to poop!
Here’s Stephanie’s question:
Dear Dr. Heather,
I am sure I have fallen victim to what many moms before me have, and it’s the sense that we have to have our toddlers potty trained for preschool. My eldest, just turned 3, advanced to his new classroom where all the kiddos were “poop-potty-trained”, and mine was not. They said they would work with him. We had been talking about it and reading funny books about it at home. But with this new classroom I upped the ante at home, and disaster has resulted!
He pooped in the potty 2 times and I rewarded him HUGE with toys and praise. He then pooped at school and everyone got super excited for him. And that is where my story ends. Prior to his successes he has pooped hit and miss, not consistently in the potty. And I am embarrassed to say if I caught him pushing in his underwear I would walk/run him into the potty and tell him to poop here and say things like “I know you can poop in the potty, I have seen you do it before. If you poop in your pants Mommy will not be happy. You are a big boy and need to poop in the potty.” I thought I was motivating him and he knew he would get toys/rewards for pooping.
So now we have a withholder. He dances around on tip toes and is trying to hold it in. I see him trying. I try to encourage him and still nothing. After 4 days we used a glycerin suppository and he got relief. Then another 4 days goes by with this same behavior. Another glycerin suppository with positive results. Now we have these frequent (20+) smears a day in his pull up. I am encouraging him to poop-even if it is in his pull up. He won’t sit on the potty anymore, but will still pee in the potty standing up-no problem! I realize now we and school have stressed him out. But now what??? How do I get him back to normal bm’s?
I took him to the pedi and they said he wasn’t impacted and his “tone” was normal. So now this is a control deal, right?
Advice please!!!
Stephanie
Hi Stephanie,
Yes, unfortunately now this IS a “control deal”. And your little guy is proving to you that HE is in control — and he IS — of his pooping.
The common preschool policy of “toilet independence” by age 3 is completely ridiculous, in my opinion. It puts too much pressure on at a time that can easily lead to the complications you’re experiencing. What’s wrong with a few more months of diapers or Pull-Ups? Many schools do understand this, and although they may not advertise it, WILL work with each child on an individual basis. Each child’s timeline is a little different. Giving your child control over the issue is the secret to simplified potty training. The more parental interference, the more complications.
The only thing to do now, Stephanie, is to back off, completely. And by that I mean NO mention of the potty or toileting behaviors, at least for a couple of weeks.
But first, explain to him that “I can see we pushed you too hard to poop in the potty, but YOU are in charge of your pooping. You decide where and when you want to poop.” At this age, he can’t understand the rationale that “poop is inside of you and needs to come out, for your health”. So quit any attempts to reason with him about this. In his preschooler’s mind, he believes that he can WISH away the poop with the FORCE OF HIS MIND. Don’t argue with his fantasy wishes. Rather, back off completely from all pressure to go in the potty. You can still rescue him from long-term withholding by taking the pressure off, and eventually letting nature take it’s course.
Go back to the old way, before Pull-Ups. Try diapers and act like the old way is normal. “It’s OK, let’s go back to diapers.” Or use whatever he prefers; let him choose. Don’t pay attention if he dances around and tries to hold it in. Force yourself to ignore it, but not in a frustrated way. If he poops in his diaper, don’t reward or praise him, just act very matter-of-fact. You want to unload all the emotion out of this issue. You want him to feel comfortable pooping, first of all, since withholding can really cause problems, in the long-run. Then, make sure EVERYONE is on the same page; parents, sitters, teachers, grandparents. You are all on a 2-week-hiatus from potty training.
In the meantime, I suggest doing a major fiber-loading of his diet (of course, with his pediatrician’s approval and direction). The doctor might also suggest something like Miralax to add to his juice in order to “speed things along”, and to minimize the chance of withholding and constipation. (Sneak it in to his drink, so he doesn’t feel manipulated by you.) And make sure to pretend not to notice any accidents or staining, or clean them up without commenting negatively. “Oops, here, let me clean this up,” is enough.
Huge rewards can also complicate matters. Over-doing it with the toys and praise takes away from the child’s own internal sense of satisfaction with mastering this important skill. A huge response, positive or negative, tells the child that he’s doing it for YOU, not for himself. So when you do use rewards, keep them low-key. Stickers, token rewards, and simply stated praise shows your approval for his progress. But it’s HIS progress. You’re just a supportive observer to the process.
And about the suppositories: While effective, they can be rather harsh, from a psychological perspective. It tells the child, “I am forcing you to poop. I am in charge of your body, by forcing this inside of you….YOU are not in charge.” Ideally, we want to reinforce the notion that the child is in charge of his OWN body. Suppositories and enemas can be experienced by the child as a violation of his own fragile sense of bodily control. And while they MAY be necessary if, later on, he has a more severe problem with this, right now I do think it’s premature to resort to that degree of intervention.
After a couple of weeks, it will become clear whether this has already settled into a negative, long-term pattern, or whether he is willing to turn this around. Try this approach and let us know what happens. Good luck!
Aloha,
Dr. Heather
The BabyShrink
Hey, parents! Make sure you scroll through the comments below. There are lots of interesting questions, with my answers, below — this is one of my most “googled” posts! (Oh, I’m so proud.)
It sounds like there is a lot going on here. If there is a “name” that her pediatrician gave her toileting troubles, I assume there is a medical diagnosis? In that case, you really do need a specialist to work with you and your daughter together, in person — someone who can also coordinate with her doctor. Perhaps she even needs a pediatric gastroenterologist? That, plus an early childhood therapist can help you “go back in time” to try to re-work whatever it is in your relationship with your daughter that you would like to try to improve. Ask around — her doctor, nurses, at preschools — for a referral to an experienced, licensed early childhood therapist who will work with you both — and integrate the rest of the family when needed, too. Good luck — and please let us know how it goes!
Hi Dr. Heather,
I have a son who started withholding last November (he was 2; he will be 4 this February). We took him to the pediatrician several times, and we were told the same thing: give him Miralax. We tried the Miralax, but it didn’t help get things moving. Poop would leak out, but no solid BMs while on the Miralax. So then we tried suppositories, and that did work; however, he just doesn’t like going poop. We thought we had turned a corner in September. He was pooping on his own; still some resistance, but not too bad. Then, one weekend in October, he ate a bunch of pistachios. Ever since then, he does not want to poop. We’ve given him a suppository, but last weekend my husband sat with him for 3 hours while he was on the potty, waiting for him to go. He finally did, without the help of a suppository, but he hasn’t had a BM since then.
I am at my wits end, and I don’t know what else to do. We’ve left him alone for the most part this week, and he knows that when we skidmarks in his underwear, that means he needs to go poop. He’s had 0 skidmarks this week! I am just at a loss, and I don’t what to do. Please help!
Amber,
Sounds like you could use some help from an early childhood behavior specialist. Can you ask your pediatrician’s office for a referral? In the meantime, remember that we can’t force a child to sleep, eat, or poop. We need to work together with them to come to solutions. Enemas and suppositories feel invasive to anyone, especially young children. Additional withholding often results as an after-effect. I suggest going back to a PullUp after telling him that you want to give him some space to work this out. Think back to what was working back in September and try to re-create that. If nothing works, I’m here for Parent Coaching sessions. Good luck and let us know!
Update: my son has been laying on the couch, complaining that his tummy hurts. I have heating pad on him to help the cramps; however, I know that it’s because he needs to go poop. I haven’t said anything to him about HAVING to go poop. I asked if he wanted to. He said ‘no’, so I left it at that. He does have skidmarks in his underwear today, and he really needs to go. What can I do? Thank you for your help!
Hi Amber,
Did you ask your ped for a referral? And have you had a heart-to-heart with your son, telling him that its HIS job to take care of his body — and you can’t force him? And that you will remind him perhaps only twice per day — maybe after breakfast and after lunch — to try to go potty? And had him transition back to PullUps fulltime, so that you don’t have to worry about the laundry?
Also, it sounds as if he has encopresis — which means only a little poop leaks out around solid, impacted poops. The first goal is really to get him cleaned out, and the enemas are maybe too invasive. MiraLax often takes 2-3 or more weeks to fully work. Other peds suggest a mineral oil based clean-out first. Ask you doc for what to use to get him cleaned out — that’s non-invasive, and then try the other suggestions, with the docs approval. Then visit my Parent Coaching page for how to sign up to talk to me directly, if you need more help. Good luck!
Hi Dr. Heather, i have a 2 year old son who is withholding bowel movements. his pediatrician told me to give him lansoyl to get him to stop but its been a month and he is still fighting it. i am concerned about the side effects of this laxative, but the the pediatrician says its ok to give for up to 3 months. i dont know what else to do to help him go. i have fully changed his diet and everyday he drinks prune juice. also i live in cananda so i cannot get miralax, the only stool softer i could get here is docusate sodium and he hates the taste and therfore wont drink it. plz i need some advice, i am so stressed and feel like there is nothing i could do to help break this cycle.
Hi Yaneth,
I think Lansoyl is just jellied mineral oil, and as such not really a “drug”. The problem is avoiding having the stool get compacted, which causes pain, and then more withholding. So getting him “cleaned out” (the gentlest way possible) is important, and hopefully the Lansoyl, if used properly, should help. Make regular contact with the doctor to ensure you are using it correctly, frequently enough, etc. Don’t be tempted to use less of it than prescribed.
Then: there’s the psychological component, which is the most important (and most difficult). At age 2 it is easier, though, to allow a regression to the diaper days. Let your son know in a casual way that “you can use the diaper, we are putting the potty away.” Make sure all his caregivers and the whole family stop talking about the potty. Just take the pressure off — and hopefully, nature will take it’s course. Allow a few weeks for his body to get cleaned out and his internal signals to get re-set.
Then, when he starts to show renewed interest in the potty, don’t jump in with excitement. Follow his lead and take it slow. Good luck and let us know!!
My three year old son has been holding for two years now. We tried it all. His belly is always impacted
The other day he was holding and I ran over to him and pulled his pullup down, held his butt cheeks like a pimple and his poop came right out. I was able to do this twice in one week. At first he was thankful and said it didn’t hurt. The next time I saw him holding again I approached him and he ran. Tonight I asked him why do you hold in your poop? He said, because I can… And I don’t like poopy. Help!!!
Hi, Dr. Heather,
I’m a frustrated Mr. Mom to an adorable 2 year and 8 month-old boy. My problem is that he holds his poop only when sitting on his potty. He will sit there and pee, and sit another 15 minutes while I read to him and try to encourage him to let the poop come out, with no success. Then, 10 minutes after putting him in his bed for a nap or bedtime, he will let himself poop literally within 2 minutes of me leaving his room. About 5 months ago he pooped in his potty successfully, but not since. Nothing traumatic happened since then that I know of to have created this avoidance of potty pooping. Can you please give any insight or advice? I’m at a lost. Thanks!
Dear Dr. Heather,
My 2 1/2 yr old daughter initiated potty training a week ago by asking to wear underwear. She was very excited and proud of herself when she used the potty. The first two days she had a couple accidents but after that no accidents. She runs to the potty and says she has to pee. No reminders now. She pooped those first two days too, although she seemed unsure about it and was very happy to show it off. On the third day she didn’t go poo at all which was unusual because she has always gone once a day. Four days later she is clearly holding and saying her poop hole hurts and she doesn’t like poopy anymore. Just like that my regular once a day daughter has turned into a with holder. I put a diaper on her that 4th day and some came out against her will and she said she felt better but the next day it was the same thing-running,crying, saying it hurts when the urge hits and visibly trying to hold it. I’ve tried putting a diaper on her to take the pressure off but she takes it off and says she wants to wear underwear. She keeps screaming ‘mom help me’ when she has to go and it’s killing me! What do I do?? Any advice will be greatly appreciated.
Dr. Heather,
I am at my whitts end and do not know what to do anymore. My son when he was almost 2 became very sick. He started vomited and crying alot. We took him to the Dr. and after many test we found out that he was impacted. He was hospitalized for four days. They had to do two enamas and iv’s and ng tubes. This was something that has affected his potty habits every since. He just turned 4 and we are STILL having MAJOR problems. We have been to many Dr.’s and ruled out any health concerns causing these problems. He just associates having a bowel movement w something very painful. He has been on mirolax for 2 years now and gets a cap daily. We have tryed everything and let him take control and he will do good for several months and then start withholding again for no apparent reason. We try to explain to him if he does not go that he will become sick. I don’t think that he truly understands what he is doing to his body. Right now we are having problems again and have been having to do MagCitrate and mirolax for 3days to get him cleaned out. He can manage to even hold it during all this, he goes to corner and crosses his legs. Dr. told me today he has hard stool down low and to do a enama.
PLEASE PLEASE any help would be greatly appreciated! He starts school this next yr and it scares me not to be able to see if he is pottying or not and being able to take his word. It just breaks my heart and i don’t know what i can do anymore to help him move past this for good.
Sincelerely,
Ashley
hi
its now feb 2012. I dont know how old this post is. We live in the UK, Yorkshire. Having terrible problems with Oliver witholding. We are taking your advice and stopping all training for 2 weeks and putting his nappy back on.
He is 3 and 4 months. He is fully trained with wees and at night.
Its just the poohs we are having trouble with. I have spoke with health visitors here who suggest not putting the nappy on again, as will confusse him. But i seem to want to follow your advice.
I wondered also, he does do small pooh in nappy for a small bit at a time throughtout the day. But when i want to change him he causes such a fuss crying and saying he doesnt want to be changed it ends up in me making him change his nappy
what do you suggest to act like and do when he wont let me change him?
and do you think its good to put nappy on for 2 weeks, i am so worried.
thanks
Gabi
and should i give him laxative when i put back on his nappy for the 2 weeks?
Hi- update on my daughter. I posted in January & did end up just putting the diaper back on. We still use the potty for pee although she will go in the diaper too if she feels like it and the poop withholding has totally resolved itself. She goes in her diaper when she feels the urge, just like she used to with no problem at all. I think putting the diaper back on was the right choice, even if it is delaying our potty training. Hope this helps. Btw my daughter is 2 yrs 8 months.
Aloha Dr. Heather!
First, thank you so much for this article! I have been struggling with the ‘poop part’ of potty training for 9 months now; and I have to admit, I am at the end of my rope. My son, O, has been potty trained (pee) since August, when he initiated it. We went rouge: naked for 1 full week (living in Hawaii helped) and by day 3 we had no accidents and made it through an adventure to the park without a single drop leaking out. Fast forward to now: I have a little boy who withholds but sometimes poops on the toilet. I know that he is scared that his poop will hurt- he had some serious constipation during the summer because of change in diet (weening of rice milk because of arsenic poisoning). And will say “I don’t want the poop-poo to be an ouch”.
I have done everything I can think of: he is on a 1/2 teaspoon of Miralax to keep with ‘squishy’, we took a month long hiatus from poop-training, We just let him poop wherever. I created a sticker chart, which involved him earning a sticker each time he tried to poop, 4 times a day, and then he could earn a toy when he pooped on the toilet. I have tried to take all emotion out of the ‘underwear smear’ while cleaning up, and usually just say: “Ok… let me wipe your bum”. I have bought him his own toilet that he picked out so he could feel like he owned the poop-part of his potty training. But none of these seem to work- he just won’t poop consistently/regularly on the toilet.
Honestly, I don’t know what to do. When he poops on the toilet he so excited, so I match his excitement- dancing around, clapping and hugging… and then give him his toy (usually a matchbox car). But, there is no consistency with the pooping. He constantly has little poops in his underwear and I think it is because he just can’t hold it in anymore.
Please help!
Thank you (mahalo!!) so much!
-Kelly
Kelly:
How old is your little guy? That will help me give you some ideas.
my son 2years,5months he has had a poo issues since he was switch over to cows milk. i am reading but i just don’t understand how he could be holding it back. he says i poop mommy i poop and he will poop no problem he is on restoralax everyday but every now and then he will hold it in and scream loud his butt will be raw and sensitive. one min its clean and fine the next he has a horrible looking butt that is raw and sensitive and looks bused, this is all real close to the hole how is it that this can all happen with in one hour?. he had dire-aha and next min the same thing happen and when it dose end up coming out its something i don’t think i would want to push out my self and real hard too . now the doctors tell me he is holding it in and to keep him on restoralax (even know the bottle says not for every day usage hard on belly ) every day and keep him so he is not so backed up, but how is he backed up if he goes every day some times 3 per day ? and why dose his butt get sore so fast ???(after he poops the hard one the butt goes back to normal not sore or brused)
Dr Heather,
I have a 4 year old boy who has been holding in his stool for almost a year now. We have tried everything including Miralax. We talked to his peditricain about it he says to keep giving the Miralax. We have been giving liquid suppositories once or twice a week but he can even hold back from them now. I have no idea what to do at this point. His father is always telling him to push it out and that irritates the little guy even more. He is starting throw up and gag at the slightest stimuli. I am an ICU RN and used to stress but a year of this is starting to take me over the edge. What can I do?
Hi Dr Heather,
I’m desperate for ANY advice you can give. My son is three years old and has been have complications with passing his stool from a early age. Once he was about one he had became traumatized and refused to go poop. The Dr (overseas) prescribed him latulose and it worked GREAT! Now, we have been back in the US for almost two years. The drs refuse to give me latulose and say keep using the miralax. The problem is he cries still every time he goes. He holds it sometimes for four days. He’s now getting potty trained. At first he was still scared but he’ll go. But now when he goes as usual it’s a hassle. It likes coaching a woman give birth. He has accidents in his underwear, clinches his buttocks, paste back and forth, rock back and forth..etc..just to keep from going. When he does go, its not hard. Sometimes its slush or like a snake and it’s A LOT! However, these last few weeks have been ruff. He’s been doing more then just streaks. I’m talking more like a small bowel movement. I’ve EVERYTHING I know how. From rewards with treats, toys or being forceful. I feel like I’m failing my child because I just don’t know what to do. When I ask him why won’t he go, he replies because the Poo Poo is going to hurt me. I refuse to take him back to the ER. He’s had a finger up his rectum, enema, and I’ve given him a suppository. Now, I don’t give him anything, but the Miralax. He’s terrified of any and everything that goes near his rectum. He just now started trusting me again with cleaning him, because he thinks I’m going to give him a suppository. Sometimes, I think he’s being lazy and stubborn, but when I see him on th e potty crying from FEAR, it just breaks my heart into a million of pieces. What do I do? Now, also he’s a child who had severe persistent asthma. This past year has been ruff. Ambulance rides and a hospital stay. Since then he’s starting chewing the inside of his mouth and rubbing his ears more. I think I’m stressing him out.
@Trista, @Ursula, and @Rasheeda:
I’m so sorry you are having a tough time with this — unfortunately common complication of potty training. All 3 of you have more complex issues that truly need medical support. I am happy to help via Parent Coaching as well.
And please, all, remember that your little ones can’t really explain to you WHY they are having these problems — and they can’t really understand your rationale. The combination approach I’ve described above — having medical help getting them “cleaned out” — in as non-threatening a way possible — PLUS kind, gentle, slow steps forward — with no pressure — will help as well. Try to get second opinions until you find a physician who has a good way of approaching little ones with this problem. Keep us posted and let me know via email if you want some additional Coaching. Aloha!
Dear Heather, I am heartbroken as i read this. i got very angry at my 3y.o. child for having a poo accident in her knickers. This was 2 days ago. I got so angry that when i realised that she was upset i became so upset i began crying. i said sorry to her, and I tried to explain that i was wrong to be angry and that i was too tired (my 1 year old baby threw up that night and broke a glass…it wasn’t a good night and my husband was travelling). But I have no excuse for such anger, i am ashamed.
Anyway, she used to have a BM twice or even three times a day. Since i told her off (2 days ago) she has not had a BM. Today she had a small bit, but would not let me change her or even see the poo…she asked for her babysitter to do it. I think i might have made her scared of pooing. she still wears her knickers as she loves to wear them, but she is only peeing in the potty…no poo. I deeply regret having gotten so angry because i can see the huge stress i have caused her. i am very upset as i write this and the only thing that i would like to hear is that i haven’t caused her a trauma for life…but maybe that is not possible.
A very sad mum
Dr. Heather-
My son, Owen, is almost 4 (in August). What is so ironic about this post is that 1. I didn’t see your reply until just now… almost 2 months later because 2. we had actually been successful with the ‘poop’ part of the potty training!!! And now, I find myself back into the deep-dark belly of the ‘with-holding’ beast. Per your suggestions to other parents, I just dropped the subject of pooping altogether. I said “ok, buddy… I’m never going to talk about pooping again. Just know that I love you, you are a big boy, and YOU are in charge of your poo-poos”. And, honestly. that night he started pooping on the toilet!!! I cried tears of joy… did the “I’m so proud of you’ song and dance and gave him his toy.
Over the last 2 months we had worked from getting a toy (matchbox car) each time he pooped to earning a sticker each poop and a toy every 10 poops. He totally bought in— until last week when I saw the “I’m not going to let this out” face and body clench. Now, he says he is scared and that he ‘will try poopin’ later… after daddy comes home from work’. But, it has been 3 days and he still hasn’t gone.
I’m at the end of my rope. He is still on the miralax, drinks water/juice combo (3 oz of juice + 7 oz of water) 2x per day and about 24oz (sometimes 30oz) of milk (almond- he is allergic to milk and soy). He has fruit at snack each day and then at home after school. We try to get him to eat a bowl of cheerios just to keep things moving.
But, alas, I am here… again… up in the middle of the night… trying to figure out how to get my little buddy to poop.
Thanks so much in advance! (I I promise to scroll all the way down the page to see your response this time!!!)
Many mahalos
-Kelly