My three year old holds back bowel movements

[Amber Garrett]

My three year old little boy has been potty trained for a whole year.  He doesn't even wet the bed at night.  He never has accidents, but around Christmas this past year he started holding back the urge to go poop.  You can tell when he's doing this because he walks funny, but you can ask him if he has to go and he says no.  I usually then make him to go sit on the toilet but he rarely does anything.  He holds it to the point that it smears all in his butt and in his underwear.  I've tried rewards, praising him for going to poop, and punishing him by no t.v. or putting him in time out.  Nothing is working.  Any suggestions?  Anything is appreciated! Thanks!

[Kevin Kennedy, Ph.D.]

Your son's history of having been successfully toilet trained (at a pretty early age) indicates that his recent problems may be due to constipation or even impacted bowels. Have him checked medically to be sure. If this is what is occurring, the doctor will prescribe a regimen to clean him out and then maintain regular bowel movements. This is the most frequent cause of encopresis in children who have already been toilet trained.

[mind over matter]

My older son is now grown but when he was little he suddenly experienced the same symptoms that you are describing. It was very frustrating. I thought at first he was just too preoccupied and held his bowels until it was too late. I too would try the reward and time out techniques. I brought it to my DR.'s attention who did not seem to be too concerned about it. I switched family Dr.'s when he retired and my new Dr. told me that it was not a behavioral issue, that it was called fecal hoarding. What happens is that a child may have some discomfort when having a bowel movement and therefore holds it until they can't anymore. They may have experienced slight tearing with some mild constipation and they associate the soreness with going to the restroom. As they hold it, the muscle and skin around the anus stretches and the loose part of the stool (watery part) slips out, causing the messing in the pants. My doctor recommended an enema to clean him out and then a cleansing (soap and water)enema afterwards. It worked wonders. One regimen of the two enemas back to back and he never had a problem again. I really felt bad when I found out that it was not his fault and that I had gotten upset and punished him with time out; but children do not come with instructions and we can only learn from experience. Talk to your DR. and ask about fecal hoarding. I guess it can be fairly common in small children. Good Luck.