2 yr old holding bm's

I am hoping you can help me with my daughter.  

My two year old has been holding her bowel movements.  It started about 6 months ago when she must have had a bm that was painful and she has been holding it ever since.  She will go as long as it is soft as pudding but other than that she holds it.  We have been into the ped's office several times for this and really all he has suggested is a laxative or stool softener.  We had things smoothed out for a short time giving her the Colace when needed and keeping her on baby food in addition to our meal so she is getting a fruit and veg at each meal (she won't eat most regular fruits and vegs) we also give her juices (prune, plumsmart, grape plus fiber) as well as raisins and prunes when possible.  I try to make sure she gets as much whole grain and fiber foods as possible all day, this worked for awhile but it is not working anymore, even with the colace it takes several days to get her to go and during this time she is crying in pain trying to hold it in, we often end up putting her in the bathtub to get her to go.  

I've tryed buying her a "special potty" and even trying to start potty training (she is not yet ready) as well as trying to reward her or pursuade her to go and that doesn't work either.  Is it possible that she is getting to much fiber or that her body has grown immune to the softner and foods we are giving her? Can you suggest any foods or juices that might do the trick? I tried both watering down the juices and not watering them down, we also tried a powder laxative that the doc gave but we used that for several days and it didn't work at all so we went back to the Colace.

Please help if you can, the poor girl is miserable and it is so hard to watch her go through this.  Once we get her "unstopped" she will go for a few days but then the cycle starts all over again.  We have eliminated almost all dairy from her diet.

[Kevin Pho, MD]

I am not a pediatric gastroenterologist, so my insight into this question is limited.

I agree with the increase in fiber content as well as adjusting the food consistency.  

Further evaluation should be made with a colonoscopy.  This is the most comprehensive test of the lower GI tract to exclude anatomical abnormalities or masses.

You can also consider tests to evaluate the colonic motility.  These conditions are relatively uncommon, and may require a consultation at an academic medical center.

Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Kevin, M.D.