My 4 year old holds his poop!

[Becky:)]

I'm really hoping to find some encouragment here! I feel like I've been all over the web, lol. My son just turned 4 on Tuesday. Last October he had one bout of constipation with a painful bowel movement, and he has been terrified to poop ever since. He had been completely potty trained for 7 months prior to this. His doctor told me to start Miralax and said he'd get over his fear after a few easy BMs, which he kind of did at first. After a time or 2 of it not hurting, he would begin going like normal again with no fuss whatsoever. I'd think we were over this and back off the Miralax (he doesn't have chronic constipation, the Miralax was just to insure that he would not have a painful BM) but as soon as his poop would get firm again (the Miralax makes it pretty runny) he'd freak out, and the cycle would start over.

It has progressed now to the point where it does not matter how soft his poo is, he is always terrified. I've had him to his regular pedi several times and to a GI specialist. He's had basic blood work and a stomach x-ray, which checked okay. I believe this is purely psychological, and its really affecting our everyday lives.

He can hold it for up to a week, even with the Miralax. When he has to go, its usually a big dramatic scene. Afterwards, he will agree that he was making a big deal over nothing, but then he goes right back to holding it. He doesn't eat nearly enough and in fact has lost 4 pounds recently. His stomach stays distended and full from the withholding. He's not the same child. He doesn't want to play or eat. It makes him miserable, and it breaks my heart.

I've done everything I know to do. I've offered rewards. I bought him the It Hurts When I Poop book, I've sat him on the potty and tried to make him go, and lately I've just tried giving the control back to him and not mentioning it, but nothing is making this better. I'm afraid my next step is therapy, and I don't really want to go that route.

Has anyone dealt with this and overcome it? How? I'm so frustrated, and I'm afraid he's going to cause himself serious health issues. Please help!

[corysmilk]

my oldest ds had this. at 4 years old. It went on for months. He would hold it and the liquid would come out anyway, usally in his underware. It became hard to even take him out of the house because I never knew when or if he would have bowel movement/ holding spell. finally after many months of trying to give the poop a personality. ie (in a silly voice pretending to be the poop) "I really want to go in the toilet, that is where I belong, not in your pants" ect. His Nana told him, do you want to clean my poop from my underware? he said "no" and she said well I am sick of doing this next time your gong to clean your own unddies. and she made him dunk them in the toilet and swish em around. He didn't hold it anymore after that.

Just a thought? my ds had anal fisher- a cut that was infected. I had to give him meds up in his bum. It was awful. But I think it helped, and along with the nana thing. Have you talked to a dr? apparently the cuts in the anus can't heal very well because the inviroment is not clean.

Please let us know how things are going.
and feel free to ask me any questions you have, I may have some more advice
Elizabeth

[greeny]

My ds went through a long and awful withholding phase. It seemed to start because he simply didn't want to take the time to go, and just progressed and worsened from there.

After trying many things, here's what worked best:

- Every morning when he wakes up, and every night before bed, he has to sit on the toilet for 10 minutes. It doesn't matter if he goes or not, but he has to sit there. (We don't make him sit punitively or anything; we've just turned it into part of his routine, like brushing his teeth or anythign else he does on a daily basis.)

Since instituting this habit several months ago, he now has regular bowel movements (usually during his morning or night toilet-sits), and very rarely has accidents (which were the result of some poop escaping when he was trying to hold it in).

We tried everything - Miralax, reward charts, talking about it, etc. but the ONLY effective thing was, finally, just having him regularly sit on the toilet.

[kathteach]

We are going through something similar over here, it's awful. My ds holds it for 3 to 4 days. By the third day I freak and give him juice, stool softener, and up the greens and pray. I hate it, I just hate the whole cycle. My child has autism and his therapist has told me that play therapy is very effective for this issue. I haven't started it yet though because I think he is starting to get what we mean when we say don't squeeze it back up into your body. Why don't you want to go down that route? Especially since you say you think it is purely psychological?

I think that making him sit on the potty is really unproductive, I say this from experience. Greeny's way as part of a schedule I see totally working though. I think I will try this myself starting at like 3 minutes and then working up in minute increments. Maybe let him play with my phone on the toilet at the same time so he can relax.

Try to de-escalate the big scenes, when he goes poop I wouldn't discuss it at least not in the moment.

If you want to get him off the Miralax (not sure from your post) I'd wean him off it slowly by giving smaller and smaller doses so his poop doesn't firm up as fast and freak him out.

Hope this helps. It's hard to know why they do this, just keep being calm mama and don't make it a control issue.

[Becky:)]

Thank you all.

I don't want to go down the therapy road because my own negative experience with therapy as a child. My mom put me in therapy at a very young age because she didn't know how to handle normal childhood issues, and as a result, I felt for a very long time that there was something wrong with me. I don't want my son to label himself that way.

Can you tell me more about the play therapy? How do you do it?

I thought we were making some progress. He told me he was over his fear and promised to never hold it again. I was so relieved, but the next day he was holding again. He said he only told me those things to please me. He vows to never poop again.

[titania8]

My 4 yo and I made a contract. It got to the point where he Was having leaking accidents several times a day. So I told him he had to sit on the potty everyday. I didn't care if he went or not, but he had to sit. I asked him what time of day he wanted to do it, and for how long. He chose after breakfast for 4 mins. I wrote it out and we both signed it. He chose where he wanted to keep it (one the fridge). We had a few grumbles in the beginning but I just said "look, see? We agreed." now it's part of our day. We go no where until he's had "potty time".

Good luck!

[Dreaming]

My DS is 4.5 and has done this a long time. We also do Miralax off and on. What I've started doing is put him on the toilet at night when he's been asleep for a couple of hours. I can usually just tell him to go poop at that point and he will and then I put him right back into his bed. I figure if he's not ready, all the bribing and pleading and pushing in the world will not help.
This way, I know he's pooping and he doesn't have to freak out about it.

FWIW, my mom gave me the advice because I used to do the same thing. Eventually, I outgrew it.

[LisaSedai]

Hang in there. My son has this too. The university of Virginia is doing some research study on it you can enroll in. It uses online teaching/tracking tools, has games for the kids and info for kids and parents. I highly recommend it to anyone suffering from this. It has helped us alot. It is free to use and they pay you if you fill in some online questionaires/diaries.

http://ucp2.bht.virginia.edu/welcome

What has worked for us is
having him sit on the toilet twice a day using proper posture and practicing the right way to poop (relax leg muscles, don't have legs dangling off the floor, put hand on tummy, take a deep breath and push with tummy muscles)

giving him a daily dose of laxative (1 square of exlax)-DH was worried about DS becoming laxative dependent but once your child is accident free for a period of time they give you a formula for decreasing the dose and eventually getting off of it.

doing a clean out procedure if there is no BM for 48 hours (miralax or fleets enemas)

good luck

[JudiAU]

Maybe some regular potty time? Ten minutes in the morning, after lunch, and before sleep? Cocentrate on reading stories etc and let him relax? Maybe a different potty like Bjorn if you are using a regular toilet?

[bbinm]

Miralax and a potty schedule is working so far for my 5 yr old... so far....

[teeg1973]

We went through this for a LOOONG time and yes, it can be debilitating, not to mention extremely frustrating and sad.

The regular time on the toilet and the mirilax (which she was on for about 8months to a year) finally did the trick. She still gets freaked out most times when she has to poop, but she will do it on a daily basis....although I have to be in the bathroom with her to give her support. When we travel overseas, I will usually give a dose or two of the mirilax so she doesn't get constipated. When that happens, we have severe crying scenes. She has also had anal fissures and a hemorrhoid that pops out from time to time from pushing

Also, there were times when I could tell that DD really needed to go based on mood and behavior, but was holding it (I have no idea how she did this) and I finally held her down on the toilet. It was a little dramatic, but really ended up being a turning point.

Best of luck to you!

Tracy

PS - play therapy is a great and non-threatening way to approach a variety of issues with children and most therapists would try to make it a positive and healing experience for your child. With that said, I would probably give it a little more time with my child before starting the therapy route (just personal opinion with MY child...and I am a psychologist/therapist!), but you will have to be your own judge of where you are at with your son. The right therapist can also give you support in dealing with this difficult and frustrating situation. I am sorry that you had a bad experience in therapy as a child....

[kathteach]

Becky I am sorry you had to go through that as a child.

My son goes to a therapy clinic called the Child Development Institute. He sees kids there in the waiting room, he does a social skills group with other kids, and some of the kids there are at his school too so for him it's just normal. They don't use the word therapist there either, he goes to see his "friend," Megan.

All great for my little guy with autism who's been receiving intensive therapies forever, right?

My point is that therapy doesn't have to be a secretive thing that makes the kid feel that something is wrong with him. My guess is that you felt like something was wrong with you because of something your mom said about it, or it was isolated in an office, or because your parents didn't talk about it at all and that made you feel weird.

If you are worried your child will feel labeled you can say the therapy is for you. That is true too. You are learning techniques for your child, you are learning more about your child.

The play therapy we've done in the past used dolls and props. It just looks like playing. It's a safe way to work through scary emotions because the doll is feeling/doing it. I'm kind of scared to do it with the poop issue too but I couldn't even tell you why. I told myself if we don't make progress I will and so far we are.

If you want to try the scheduled sitting you can make a picture schedule that shows three activities. For example, first a picture of say, reading a book or having a snack or some activity, the next picture might show a clock and toilet, and the third thing should be a preferred activity--playing trains or watching his favorite show or whatever he likes best. When it's time to sit you can use a timer--for me it feels like too much pressure. When time is over it's over. Praise him for the waiting--NOT the product. Then on to something fun.

We started doing the scheduled sitting about 20 minutes after dinner and it's starting to slowly work. He now poops at roughly the same time and is having less skid marks in the underwear and more poops in the toilet. I think he is slowly starting to be less scared.

I have heard the book "Everybody (or Everyone?) Poops" is a good one but I haven't gotten it yet. http://www.amazon.com/Everyone-Poops.../dp/0916291456

Do you know his poop cues? My son and I sometimes watch thomas the train songs on youtube and he would get relaxed, and then I would feel him squeeze his legs as he put the poop up back inside his body. I also can tell the "poop face" look, strained kind of look. I would tell him "let's go to the potty," and he would get panicked and say NO!! So I started saying, okay, we'll go in three minutes then. And then in three mins I wouldn't ask him, I would just tell him it's time to go and give him a choice. They love the choices, it gives them some control. I would say okay time to go, do you want to go on the big potty or the little potty? (Baby Bjorn potty) and he would choose.

Just keep calm Mama. It's gonna work out. Ya gotta be relaxed. Take it from someone who knows. They can sense our freaked-out-ness and it makes it worse for them. I hope my saying this doesn't offend you but I think you should stop with the promises and emotional conversations about the whole thing, it just ramps everything up. Don't talk about it, you both know what's up and all the emotion just clouds the issue and makes it bigger. He holds it, just say okay maybe next time. Keep it short and light. Don't make it the end of the world, that is scary.

Last of all I have some links for you from the Berkeley Parents Network, lots of anectdotes from moms and there is a little piece in there about play therapy too: http://www.amazon.com/Everyone-Poops.../dp/0916291456

It's gonna be okay, I promise!!