4 yr old who holds her poop in

[nopoopoo]

My 4 yr old was fully potty trained for at least 6 mos.  I think what happened was I wasn't paying close enough attention to her diet at liquid intake and let her have too many granola bars and she had a couple very difficult bowel movements.  She started refusing to poop.  I had no idea what to do and it got better but then got worse again and we have never recovered.  It has now been 5 months of holding her poop in.  We give her miralax but it was making everything so messy that I cut it back.  Lately I have tried ignoring it and let her clean up herself and manage on her own.  Well of course I have to intervene at times.  She eventually goes but never on the potty and often it comes in her sleep.  This might be like every 7 days or so.  We are trying to have "potty time" every day for a few minutes.  BUT as soon as I step out of the bathroom she stands up (she calls it grumping) and squeezes her cheeks together and a little comes out then she sits on the toilet and wipes it off.  I can tell because it is a flat shape.  I feel like she has learned the exact wrong way to use her muscles and I don't know how to fix it.  She is extremely strong-willed adn I feel this is primarily her will because she is scared it will hurt.  Rewards and punishments have not worked.  It doesn't matter how many toys we take away or what we bribe her with.  It does not overcome the fear and the bad pattern.  I am considering spanking her when she grumps.  I feel I can't let it go on anymore and have been in tears over her unhealthiness.  She now recoils in fear when I try to wipe her.  She is so scared.  Anyone have any advice?  It doesn't seem to matter how soft the poop is - she still holds it instead of letting it come.  What really bothers me is the character issue part of it - she hides to let a little poop out and doesn't want me around.  She lies.  Help!


This discussion is related to 4 Year Old Son Refuses to Poop.

[whitecow]

I have this same problem with my 4,5yrs old son.
But first: few months ago he started to hold poo but... it's easy. He just didn't let it go because it was his. I fixed him :) I told him how digestive system is working and when he will eat dinner (trouble with dinners as well) he will have every morning BRAND NEW POO! Nursery helped too putting on wall poster with digestive system and made toilets more friendly :)
But now he started again.... and it's no good. He is scared of poo like of monsters or ghoust. Medicine which make poo softer and easier to pass made just worst because he is now dirty from neck to toes and everything around him (walls,floor,carpet,sink,taps,toilet,door,etc.) I and my husband have enough cleaning after him,our hands stinks of poo. We tried every method to stop him hold poo like black mail,putting toys away,talking,we tried calm and shout,etc., nothing is working :( He is screaming when we just wipe his bum! We just don't know what to do now :(
Sorry for my language, english is my second one :)

[routinemama]

Some advice to hopefully help you find some sanity.  This will be a long post but it will be worth it.  I have been dealing with this frustrating and all-consuming habit in my son for nearly two years now.  I am not a stay-at-home mom, but I do have him with me at work or at home 4 days a week and he's in child care 3 days a week.  He will be 4 in September.  We are in no way "over" it, but I will offer my advice because we are in a much better place than we were a year ago and my son poops every morning, usually before 8am allowing us to have a fairly normal life.

First of all, I established a routine that I cannot deviate from - even a little.  I want him to wake up around 6 a.m. so we have plenty of time to work through the b.m. in a calm and positive atmosphere.  "No pressure" is key to our success.  I'll just give you the run-down of a typical day:  

Wake up at 6:00-6:15 a.m.  Very happy to see him, lots of snuggling, talking about what a great day it will be.  6:30, fix breakfast - either a high fiber cold cereal like kamut puffs or hot cereal (well-cooked oatmeal with lots of raisins, sometimes ground flax if he needs extra fiber).  He gets about 1/2 cup of cereal with a little milk as well as 1/2 cup of FRESH fruit (grapes, peaches, grapefruit, kiwis, strawberries, raspberries, whatever), and 1/2 to 1 cup of hot juice or hot mango passionfruit tea.  He has to eat ALL OF THIS before he can do anything else.  It's a ton of food and it's usually a bit of a struggle getting it down.  

After he finishes eating we do active play (running around, jumping, dancing) for about 2-5 minutes depending on how much he's squirming (indicating that it's "time").  Then, I say "it's time for me to jump in the shower."  (Notice I DON’T say “it’s potty-time, or anything like that).  I allow him to choose between big lego blocks and play-dough with cookie cutters to play with while he sits on the potty chair because both activities involve a little bit of pushing.  I have a 6" tall TV tray thing that I put in front of him with his toys/activities on it to encourage him to lean forward a little bit, but not too much!  I have him take his pj pants completely off so he can comfortably spread his legs and I encourage him to breathe deeply and keep his feet apart.  I continue giving him sips of warm water.  (A cup with a built-in straw is so helpful.)

Right before I get in the shower, I'll rub his back a little and quietly say "I know you'll go when your body is ready - you're doing great."  Then, I hop in the shower and pull the curtain.  The key here is that I'm with him, but not totally hovering over him.  He has a little bit of privacy, but he's not worried about missing out on something. We can still visit, sing songs, but he doesn't feel the pressure of me sitting there staring at him.  Also, he doesn't have the reward of having my complete attention which I think sometimes encourages children to keep withholding.  

Anyway, I will spy on him by peeking out from the shower curtain, and he is always clearly trying to hold it in.  I just leave him alone and make chit-chat here and there about happy, positive things or fun outings that we have planned for the day.  I might reach out and make him take another big drink of warm water once in a while. Usually by the time I'm out of the shower he has produced a large, medium-soft b.m.  I don't freak out and throw a party - I just calmly say "that's fantastic honey!  I'm so proud of you - I bet you feel great - this is going to be such a fun day".  Even if I'm right in the middle of the shower when he poops, I step out, dry off so I'm not dripping water all over him, clean him up with a wet wipe, empty the poop into the toilet, clean the potty chair, let him flush it, and he can go do whatever while I finish my shower.  

I do have a Sunday-through-Saturday chart posted in the bathroom with a fun activity for each day.  (swimming, ice cream, playing at the park, getting a cookie at the bakery).  This gives us something to chat about while I'm in the shower.  The chart also says encouraging things on it like “relax, breathe, let the poop go!  Great job!”  

The rest of the day is usually smooth.  He's very active - loves to play outside, do crazy tricks on the swingset, climb, run around the yard, etc.  Since we established this routine, his personality is back to normal - he's very social, reasonable, good natured overall.  He has no other behavioral or health-related issues.

I cook pretty exclusively with non-processed, organic foods and ensure that my son gets a variety of fresh vegetables, protein, and whole grains.  I am constantly altering his meals according to the consistency and size of his b.m. - if it's too soft I make sure he gets a small ripe banana, if it's too hard, I might give him a green salad, a prune, or fresh carrot juice...always a balancing act because even the too-soft poop is a problem.  The poop has to be the perfect medium-soft consistency because if it's too hard or too runny he can hold it in equally well.  

So, back to the schedule:  now it is evening...bed time is 6pm.  Seriously.  He eats dinner around 5pm, is in the bathtub at 5:30.  Here's another VITAL step:  he eats 1/2 cap-full of Miralax mixed into a container of Activia yogurt while he's in the tub.  I don't give it to him too early because I want him to go right to sleep after the yogurt/miralax.  Otherwise we have little accidents.  If he does have little accidents in the late afternoon/evening it usually amounts to just a teensy little bit.  We just clean it up with a wipe and avoid making an issue of it.

Then, it's off to bed.  Our goal is to be asleep by 6:30 at the latest.  We have eliminated his afternoon nap to make this happen.  This way we can count on the early wake-up and allow ample time to get the poop out so I don't have to worry about him having a dozen accidents at preschool resulting in a sore bum and perpetuating the problem.

So that's it.  That's our routine.  I decided to shift gears after I started feeling like my intense, demanding, all-over-the-map approach to this was wearing on my relationship with my child and I was concerned that the negative effects of that would far outlast this phase of poop withholding.  The amazing thing was that the change was immediate - practically overnight.  I started doing this in late December of 2010 and we have had a perfect b.m. nearly every day by 8am.  For the first 3 months, I kept a notebook with bed time, wake up time, breakfast time, what he ate, when he pooped, how much he pooped and how much he struggled before pooping.  The reason I did this was so I could look back and easily see our progress – this was especially helpful when he would have a bad day.  I needed the encouragement to see that 99% of the time, we were doing great.

I'm kind of psycho about this, but my obsessing is a result of the profoundly negative affect it has had on our life.  This has to be one of the most stressful things a family can endure.  I wonder how many more years he will continue to withhold, and sometimes I think I'm going to lose my mind because it's so senseless but with this schedule we are at least functioning like a normal family!  Good luck to you.

[lracehorse]

First, and this is the part i find hardest, you both have to relax about it, because your frustration plus her strong will has created a power struggle between you, and you both need to be on the same page.  Its exhausting, but you have to try to pretend you aren't upset by the grumping and instead encourage the good behaviors, anytime she sits, anytime she poops in the potty at all or even gives a real try.

She's only 4, its not going to affect her character, this is pretty common.  Of course she is hiding if she is scared, thats what you do when you are 4.  And she's not really lying, she's trying to give you whatever answer will make you happy.  Totally normal. Try to be cheerful about her efforts and totally neutral about her mistakes and it will take away the power struggle.

Also, don't leave her alone in the bathroom!  Thats when she grumps, so just clear your calendar for a few days, follow her everywhere, and when you see she needs to poop, get all happy for her (yay! the poop is going to come out!) and run, dance, hop to the potty together to make it happen. I bet if you manage to be happy and like a cheerleader about it you will see her try more, and if you don't react so much to the accidents she will be less invested in them too.