Child's bowel habits

My seven year old son, who is very social, outgoing and considerate has developed difficulty with bowel movements.  He potty trained, by 2 1/2 - 3 years of age with ease and had few accidents until the past six months or so, (which coincided with the summer prior to first grade).  He will hold his bowel movements which have been reduced to about one a week or less.  He is contstantly wiping himself after small "accidents" but will not sit and have a bowel movement unless absolutely necessary.  I have made a conscience effort to minimize my reaction to this situation, however I know he can sense my growing frustration.  I make him wash his hands whenever he wipes himself, which can be quite often, and whenever he has his hands in his pants, which also can be quite often, however I don't want to create a compulsion.??  He is a child who likes to have control over things, (ie. he needs to know what is going to happen at doctors, dentist etc.), another aspect of his personality is a desire to thing right, not a jump right in and experiment kind of kid!  He has become quite fearful at times when he feels out of control, however this does not happen often.  
Please help me understand why he is exhibiting these berhaviors and advise me of a course of action to aleviate this problem.

Thank you
Philomena

[Kevin Kennedy, Ph.D.]

Dear Philomena,

Explanations for such change in toileting behavior is generally in the physical, not emotional or psychological, realm. And the most frequent cause for such symptoms is chronic constipation, which should be investigated with your son's pediatrician. Sometimes, children experience pain with bowel movements after they have become constipated, and then avoid the situation and it becomes even more pronounced. Often treatment involves a regimen of stool softeners and laxatives for awhile, until the child is more comfortable and stops avoiding use of the toilet.