bowel training

my just four year old refues to use toliet for bm.she insist on pull up   she is ffully trained for urine,i have had gi work up,shes fine. tried treats when she was younger with no sucess,it now that she is old enough to understenad cause and effect and wants to go swimming in the pool we explained only potty users can for health and hygine and she understands and yet still tearfull stays at sideline rather then use toliet.SHE DID USE POTTY FOR SHORT WHILE 2 YEARS AGO BUT NOW REFUSES ANY SUGGESTIONS  RIGHT NOW WE ARE NOT GIVING ANY ATTENTION BUT REALLY  ENOUGH ALREADY

[Kevin Kennedy, Ph.D.]

You would not be making a mistake by low-keying this and allowing development to proceed. If you decide to bite the bullet, and you are confident your daughter is ready, set a date on which you will retire the diapers, and be sure there are none avaialable. Of course, tell your daughter you are going to do this, and try to accomplish it with a little fanfare and a light atmosphere.

[oh please already]

thank you for your prompt answer but i dont think that i made the situation clear, emily is fine with not using a pull up or diaper,she just doesnot want to use the potty.the last two times we tried she held her stool for 2weeks plus until she was impacted,she'd rather have an enema then use the potty.At 1st i thought this was a power issue,you know how kids use the attention but she is giving up things i know she really wants just to avoid the potty,I think she is embaressed as well,in all other areas shes the"big girl"We have had a GI and GU work up done which were both clear and spent the last few months not talking about it at all to keep pressure low,the only other thing to note is that she is prone to uti's ,has had 3 inlast 6 months and also was worked up for urianry retention as she can also go 15 hrs if too buzy to stop for bathroom break.i have even address question of abuse but md says no signs,shes just stubborn.How long should I wait to reasses this,ehe is almost ready for school and as i said she is embarressed also.Other then this she is healthy as a ox,developmentaly walked at 7 months,talked full sentances by 1 year always been in front of the pack,how much longer do i let it go ?

[Kevin Kennedy, Ph.D.]

If you are deferring to her wish to use a pull-up for bowel movements, do not do so, but establish a date on which you'll start this practice. Then, consult with her pediatrician around a regimen of laxative/stool softener. This will be important because she will likely hold her stool and, without the medical regimen, she'll become constipated. Be sure she's drinking a lot, particularly water, but also some fruit juice each day (don't overdo the juices, though).

[anothermom]

We went through a very similar situation with our son between the time he was 2.5 to 3.5 years old.

Something triggered the retention - we believe his daycare teacher was pushing him when he wasn't really ready and additionally - he had a virus at about the same time all of this happened that caused him to have pain with a bowel movement.

After that he refused to use the potty for bms and started holding back. We went through the laxative regimen with our pediatrician - but after about 9 months - no real progress was being made. We went to a gastroenterologist who made certain nothing was medically wrong and who had a lot of experience dealing with this type of issue. It's not as uncommon as I would have believed!

He provided us with a complete program for our son which still included the laxative (mostly mineral oil) as well as a regimen for having him sit on the potty twice a day for at least 30 minutes  with a book or some other type of distraction. We tried to time it to coincide with after meal times because that is when your body naturally wants to eliminate. We praised him for sitting there and were firm that it was required. After a few months we were able to celebrate his overcoming his fears and sucessfully making bms on the potty.

The gastroenterologist was great because he talked directly to our son who was fully capable of understanding why this was important and that he really had no choice but to succeed or become pretty ill. He also helped us understand how best to resolve this and what was appropriate in the situation. If you think you need help - I would suggest finding someone like a pediatric gastroenterologist in your area. It was invaluable for us.