What to do with a kid who won't poop?
June 6, 2014 1:27 AM   Subscribe

My five-year-old son is anal retentive. Literally anal retentive. Is this a problem?

I finally know what Freud was talking about. (My son's also a very neat and tidy kid who avoids getting dirty most of the time, so maybe Sigmund knew what he was talking about). My son doesn't like to do number two, and simply refrains as long as he can. This can go on from one to three or even four (five?) days. Meanwhile he eats like normal--which is generally a lot--and stays skinny as a stick.

But he won't poop. He'll have a BM coming on, and he will sit down, squirm, push a pillow on his stomach, anything to stop the muscles, which he's figured out will eventually stop. My wife and I have done sweet talk, funny talk, serious talk, and direct commands to "go to the bathroom and do number two! You have to go--just go!" but he refuses most of the time. Short of forcibly taking him to the toilet, which strikes me as a terrible idea, what to do?

Part of me thinks it's a phase like so many other things, and to let him be and he'll eventually get over his aversion. But I don't know how long that could take, and I wonder if this refraining is effecting his GI tract in anyway, with some kind of (permanent) twisting or blockage or the like. And from our end, my wife and I are more than a little annoyed when we are leaving the house for a trip/errand, we know the kid has to poop, but he refuses yet again, only to have an emergency trip to some public bathroom later that day. And the times he needs to eat his meal but won't because traffic is backed up.

Short of giving him prunes everyday, what can we do?
posted by zardoz to Health & Fitness (26 answers total)
Go to the doctor.
posted by oceanjesse at 1:48 AM on June 6, 2014 [14 favorites]

yeah this can be develop into really serious long term health issues. Please see a doctor, and/or pediatrician sooner rather than later. Inaction could saddle your kid with health issues for life, not to mention the psychological aspect. Take comfort that it is a Thing with some kids.

Here's a good page on it that mentions some of the issues:
Stool-holding can lead to constipation, painful stools and even complete blockage (stool impaction). Children who have a stool impaction constantly leak or ooze stool in small amounts (encopresis). If the impaction persists for very long, the rectum and colon become stretched out of shape and are no longer able to squeeze out stool. Unblocking the child may require enemas. Keeping the child unblocked requires 3 to 6 months of laxatives or stool softeners. Stool holding is an important problem to recognize early and treat vigorously.

There are some excellent treatment suggestions further down the page; give it a read.
posted by smoke at 2:00 AM on June 6, 2014 [4 favorites]

Yes, talk to a doctor.

But from what you wrote, he's really pulling out all the stops in trying to hold it in, the poor kid.

I'd want to know if it's something physical. Did he have a bad poop experience and he's scared? Is it painful to poop in general?

Try to get some answers, because this may be a matter of reward training for pooping or this could be medical.
posted by kinetic at 2:53 AM on June 6, 2014

Definitely see a doctor, since as mentioned this can develop into conditions that are serious and even fatal in extreme cases, but for an example of less severe consequences: I had the same problem myself as a child, though from over-focusing on whatever I was doing to the exclusion of everything else rather than because of an aversion. Although I probably did develop some degree of aversion eventually because waiting so long made taking a dump painful and difficult.

Prunes helped, but I never really overcame it as a reflex, and consequently I tend to have what must be statistically outlier BMs and thus a lifelong problem with clogging toilets, which can be both a figurative as well as literal pain in the ass, and embarrassing when it happens at someone else's house or in a public WC and I end up having to ask where the plunger is.

I'm not a parent and don't know anything about parenting, but intimate acquaintances have mentioned that they train themselves to go at the same time every day. I think if I'd been instilled with a habit like this, if possible, I'd have benefited.
posted by Sockpuppet Liberation Front at 2:56 AM on June 6, 2014

My daughter is 4, and she has had similar issues for a couple of years. He pediatricion had us put her on a daily dose of generic miralax, which helped her bowel movements be simple and not painful. We have been slowly able to reduce the dose, but not eliminate it. She is making progress (after months and months), and yesterday finally pooped in the potty at school.

I highly recommend meeting with your doctor. Now that my daughter is going consistently, easily, and "smoothly" in her diaper, she is much less anxious, but rather proud. Best wishes.
posted by miss tea at 2:57 AM on June 6, 2014 [1 favorite]

Thanks, all, for your input. I should have looked into this earlier, but assumed it was "just one of those things," but obviously not.
posted by zardoz at 2:59 AM on June 6, 2014

I did this when I was around your son's age. For me, it was an issue of control (yeah, very Freudian indeed...). Looking back at it now, several adults around me at the time were dealing with *issues* and I didn't understand it or had control over it. This was my way of acting out. I eventually grew out of it. I don't know if this is helpful for you, but maybe in your case, there's also something going on and this is your sons 5-year-old way of dealing with it.

But yeah, definitely consult a doctor, because there is definitely a possibility of medical implications.
posted by leopard-skin pill-box hat at 3:16 AM on June 6, 2014

One thing I would advise, as counter-intuitive as it may sound, is to not make too big a deal about it to your son, because then it can become a nasty control thing.

So if you are able (with a doctor's advice, of course), to go the daily-Miralax and incentive chart route, then don't make the rewards ONLY about pooping.

I would do the daily Miralax and also start some incentives for a few things, so your kid doesn't equate pooping with the only desired activity.

So maybe he gets rewards for pooping, folding his clothes, unloading the silverware in the dishwasher, brushing the cat, whatever. Make it a few things.

In my experience working with kids who went through this type of thing, as soon as they got a whiff of pooping=reward, it became ALL ABOUT POOPING, which was the last message their parents wanted to give them.
posted by kinetic at 3:26 AM on June 6, 2014 [14 favorites]

Sounds like my 3-year-old, who had been doing this practically her whole life. We did go to the doctor, and put her on miralax + diet modification to add more raw fruits and veggies. It's been six months, and there's progress, but until she's regular long enough for her colon to go back to it's normal size, it's still difficult when she goes. The withholding --> painful poops --> more withholding --> more painful poops cycle is really hard to break, and you want to stop it as soon as possible.
posted by snickerdoodle at 4:28 AM on June 6, 2014 [6 favorites]

I did this as a kid because it hurt to go. I knew that the longer I waited the worse it would be, but as I was a kid pain later was always better than pain now.

My parents and doc thought it hurt because I would hold it, but to this day if I don't add Benefiber to my morning and evening coffee every day it hurts. I medically check out fine. I personally think that my inners are larger than my outers.

We tried prunes as a kid, but while that helped frequency it didn't help with consistency so it still hurt. Your guy probably needs something stronger, but don't give it to him with the promise that it will make him poop every day. Because pooping hurts him, physically and/or mentally. And the last thing he wants to do right now is think he's going to hurt every day.
posted by kimberussell at 4:51 AM on June 6, 2014 [2 favorites]

by the way, even if he's not gluten or wheat intolerant, i have found pysllium fiber to be way better than regular fiber. i have a mild wheat thing, so regular fiber has made things worse in times when it's been needed.

and agree..if you make it all about pooping (or wetting the bed or any other similar thing), he could end up just feeling ashamed at being unable to "fix" whatever is wrong and that will just make it worse. my guardians made a HUGE deal out of a bodily issue i had as a kid and i ended up feeling like the most awful person on the planet because i just simply could not do what they asked and i didn't understand it was about my health, i just thought they were asking me to do something impossible. they were just frustrated tho, but it turned into a vicious circle.

(also, if he's like me, nothing like a big giant milkshake to make things, uh, shake up on out of there...)
posted by sio42 at 4:56 AM on June 6, 2014

Have you asked him why he doesn't want to poop?
posted by Too-Ticky at 5:00 AM on June 6, 2014 [2 favorites]

Came in to say control issues can be at play here too - is there anyone in his life that he butts heads with, ways that he feels powerless, does he have enough decision-making responsibility given his age? In what ways might he fell like his will is being ignored?
posted by St. Peepsburg at 5:08 AM on June 6, 2014 [1 favorite]

Nthing doctor. My little brother was like this, and he had the packed-full and eventual leakage problem in the comment you favorited above. It had nothing to do with his will - he had a colon issue that required treatment.
posted by sevensnowflakes at 5:27 AM on June 6, 2014 [2 favorites]

You know, it's obviously not the same issue, but I went through a phase as a young kid where I refused to pee unless I absolutely had to.

Turned out I had a horrible UTI, and since I was a dumb kid it never even crossed my mind to say to my parents "it hurts when I pee." I just figured this was the new normal and logically concluded that I could cope with it by peeing as little as possible.
posted by showbiz_liz at 5:57 AM on June 6, 2014 [5 favorites]

i had these issues as a child, through my teen years, and well into adulthood. like others here, it was about pain and control. now i take 2 pills a day that make me nauseated so i can poop. no other amount of diet modification or miralax, or anything else worked because i let it go on for so long.
posted by nadawi at 5:59 AM on June 6, 2014

My friend's kid (also particular about tidying up) recently got through this phase. This seems-like-it-will-never-end-until-it-does phase. Obviously it's a good idea to see a doctor but for some kids this is more a personality thing than a physical thing.

He now has a ritual involving special toy cars he gets to take with him when he poops. For a while they gave him special chocolates as a reward for pooping, and he was very proud of this. Mostly I think they tried to be patient and to explain that he wouldn't be so crampy and grumpy if he agreed to poop ("I get it sweetie, let us know when you want to poop!"), and they did the chocolate thing and the car thing and spent a lot of time figuring out what would help him come around to the idea. And it was very frustrating and there was crying and gnashing of teeth and bourbon.

And that's the story of my most stubborn 5 year old friend and how I got to explain that not everyone gets a chocolate when they poop.
posted by heatherann at 5:59 AM on June 6, 2014 [1 favorite]

I asked another mefite who had a similar problem if it had been made clear to the kid that poop isn't part of the body.
posted by brujita at 6:08 AM on June 6, 2014 [1 favorite]

Agree with the "go to doctor" comments. But also know that good old-fashioned enemas used to sort this thing out a few generations back. My dark thought that an initial enema treatment with the promise of more might get things moving.
posted by rmmcclay at 6:27 AM on June 6, 2014 [1 favorite]

I agree with the "ask a doctor" advice as well.

With my son, it was often about him not wanting to stop what he was doing. He would rather play than poop. If he looked like he was trying to hold it, we took away the distraction and made him go. Physically putting him on the toilet helped in our case but if he is physically fighting don't force him.
posted by seanfkennedy at 6:49 AM on June 6, 2014

Up until seeing this thread, I thought I was just a weird kid when I was younger. For me it was going to the bathroom in general, but especially number two. In my case, it was two things: First, pooping always hurt. Second, I hated interrupting playtime/reading to go to the bathroom.

I remember at some point telling my parents that it hurt, and I think it might have been brought up to a doctor, but nothing was ever done about it medically. My mom started a tradition of "the potty train" in which she would come zooming into the bathroom as soon as I announced I was done, bearing a pushalong train (I loved trains) laden with little toys, stickers, books, etcetera. Each time, I got to pick something from the train. That was enough to make me more enthusiastic about going, and stop putting it off quite as much. It still hurts to this day, so it's probably a long-term thing that I should get checked out and quite possibly could have been taken care of when I was younger, but that was how it was dealt with when I was a kidlet.

My opinion? Doctor first, but the Potty Train was basically the best thing ever when I was a kid, so I think that or something similar might be worth a try too.
posted by Urban Winter at 7:26 AM on June 6, 2014 [1 favorite]

I did this from age 5-ish to age 17-ish. In retrospect, it was probably a control issue because my mom was difficult to live with, since it magically disappeared as soon as I moved out of her house, but when I was a kid I had absolutely NO IDEA why I did it, so asking him about it may or may not be useful.

If it makes you feel any better, I have absolutely no lingering health problems from doing this for 12 years. But it did make things difficult for me and my mom when I was a kid -- lots of enemas and suppositories when I was little, and later on lots of backed-up toilets.

Good luck.
posted by rabbitrabbit at 8:29 AM on June 6, 2014

We had a nearly identical problem with our son around the age of three or so. Tried changing his diet to make things easier, used the Miralax, etc., but none of it really made a difference. Then we just started sticking him on the toilet for half an hour before bath time with an iPad and cartoons. He started pooping without even realizing it. Now it's just part of his routine. He doesn't mind going to the potty because Yay! Cartoons! And if he's on there long enough, something will usually happen. We still have occasional issues, but it's more or less resolved now.

Potty problems? There's an app for that....
posted by peterdarbyshire at 10:19 AM on June 6, 2014 [1 favorite]

I used to babysit a much younger kid who had this issue. She had an anal fissure from a big hard stool and then holding back just made the whole situation worse, even as the fissure slowly healed. Hope you solve this soon.
posted by Riverine at 12:28 PM on June 6, 2014 [2 favorites]

This could be related to anxiety as well. I would bring that up to the doctor. Anxiety can strike in a lot of different ways.
posted by mdwiffle at 12:17 PM on June 7, 2014

Thanks for the replies. So I sat down with my son and first asked him if pooping was painful. I've asked him this many times, but probably not so directly. He insisted that it wasn't. Of course, it is sometimes but that's only when he's held it for a few days and it get impacted. You'd think that would be a deterrent.

So I told him the new rule: he has to try and poop every day. He loves reading, and occasionally he'll take a book to the potty, but now I've made it mandatory. Daily poop, with book. Or at least the attempt.

He likes going to the doctor about as much as I do--which isn't so much--so I said if he doesn't poop every day, we'll have to take him to the doctor. He said "I don't wanna go to the doctor!" which is good, now he'll have all the more motivation to poop daily.

So I told him this on Friday, and wow. Three consecutive poops on three consecutive days! So if he can keep this up, looks like problem solved. Of course, with kids it's never quite that simple, but it's a good start anyway.
posted by zardoz at 2:25 PM on June 8, 2014 [8 favorites]

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