Please help~ my almost 4-year old ds has become afraid of pooping in the toilet and holds it as...

[Uroboros]

Hello Mothering Community~ I hope that some may have some insight and experience with this because my husband and I feel like we are floundering.  Our ds, starting one week ago, became terrified of going poop.  He had become constipated and passed a stool that must have been quite painful and he was scared to be on the toilet.  Since then, he simply tries not to poop, saying he never will again, it hurts, it's scary.  Two days later we brought him to the doctor and she suggested to increase fiber, which we did, and use Miralax.  So here's question 1: what are people's suggestions for a more natural and gentle stool softener? I feel like Miralax is turning it too soft and is making him lethargic.  Since then, he's had two more bowel movements, both in his underwear and only because he couldn't hold it anymore.  My dh and I have fluctuated between being very nonchalant about the whole thing, letting him know that we'll be here to help him if he wants help, and that he'll know when to go, and being very forceful.  In the throes of frustration and fear I held him on the toilet as I knew a stool was right there and I think I terrorized him.  It was awful.  Now, I just try to stay calm as I watch him squirm and writhe in pain as he tries to hold his stool back.  After so much exertion on his part, he often falls asleep.  I feel so powerless and so sad watching him struggle.  It's so intense knowing that I can't make him just let go.  So here's question 2: how can I get him back on the toilet to poop? He will pee on the toilet no problem, unless he feels a poop is right there.

Just an FYI, he was great on the toilet before last week.  He'd go in by himself or ask for me to be around nearby and he'd shout when we was done.  He was proud of himself and pooped almost every day.

I don't want to use laxatives, enemas, suppositories, etc.  I'm struggling enough with this stool softener.  The problem at this point is not constipation.  It's fear of pooping and fear of pooping on the toilet.

[Mom31]

Do a search on here for encopresis.... there are alot of good tips about bowel holding. My son is 8 and has encopresis and it is a daily struggle to get him to poop. Nip this in the bud would be my biggest suggestion...  i was not consistent and at 8 we are still having major issues  There is a product the mothers reccomend that I am going to try... it is called natural calm. I assume you can buy it at the health food store.

[Uroboros]

Thank you so much, Emilie.  I will check this out.

[MountainMamaGC]

I have the same problem with my 3.5 year old. I give her 1-2 tablespoons of Milk of Magnesia as per my GI. I dont trust miralax, as there is an entire yahoo group of women that claim it caused neurological problems in their children, like nervous tics and weird behaviour. My GI says that MoM is pretty safe and magnesium is important anyway. I just make sure she stays pretty hydrated while on it. She still with holds her BMs but its soft when she goes and thats important. The purpose of the MoM everyday is to create a new pattern of painless BMs, so that one day she wont be afraid to poop. This can take months. As of right now she still fears pooping and holds it in, and she tells me she hates pooping. I reward and praise her everytime and ask her if it hurt. When she says no, I reinforce that it did not hurt, and it was good that she listened to her tummy and let the poop out.

I know how frustrating the problem is as I have been dealing with this issue since she was 18 months old. It always comes back just as I think we are done with it. Its hard when life seems to revolve around whether or not they have pooped. I dont even want to take her to the park if its been a few days because she constantly stops to hold it in, and cant run arond and play because she is so focused on holding it in. She shrugs her shoulders as if to shrug it off. I catch her all the time.

[umsami]

My almost 8 year old has encopresis.  We did the Miralax and fiber gummies--but honestly, they weren't a solution. Helped somewhat--but kept having to up the Miralax dose, and still had soiling accidents. In talking to many Moms, I ended up going with the Soiling Solutions protocol.  It does involve enemas and suppositories if needed, but it's usually short term.  If they get to the point that they're soiling in their pants, then usually there is some blockage and an enema really helps.   It's not as horrible as it sounds--and actually DS feels a lot better after the enema.  

Miralax and fiber gummies is the standard tx from most pediatricians and pediatric GIs.  

At this age, though, I'd probably just encourage him to sit on the toilet 10-15 minutes after meals.  Make sure he's drinking enough water too.  Check your library for books on encopresis.  As it just started happening, I might even do some sort of reward chart or offer mini M&Ms for a poop or something.  Ideally, it's a short-term problem and a short-term fix.  I do not wish for you to end up where we are.

[pianojazzgirl]

Originally Posted by umsami As it just started happening, I might even do some sort of reward chart or offer mini M&Ms for a poop or something.  Ideally, it's a short-term problem and a short-term fix.  I do not wish for you to end up where we are.

Yes, I would try this.  I'm not big on rewards in general, but in this case I'd definitely be willing to go there.  Since this is a new behaviour/fear it might not be too ingrained and a system of exciting rewards might be enough to turn this around.  Honestly I might even make it a small toy for every poop (hotwheel car?) - something that would be a real incentive.

Good luck mama.

[tropicana]

watermelon and all juicy fruits in large quantity. as much melon as he wants, any time he wants it! indeed all vegetables. plenty of water, constantly. 

also, canned fruit -- juice and all -- worked for me when i got severely constipated during pregnancy. i had an *enormous* poop that hurt like bloody heck coming out. it was horrid. canned fruit can prevent this in your son. if its a new problem and only a few days old, i would suggest doing the fruit in large quantity immediately before this becomes a chronic problem. 

let him have some easier poops -- and tell him that they will be super easy if he only eats the fruit for awhile -- and maybe his fear will just go away.

good luck!

[Uroboros]

Thank you all for these responses.  It's been so helpful to read what other people are doing.  The update: The last time he had Miralax was four days ago (Saturday).  He hadn't had a bowel movement the day before and was clearly uncomfortable, and we hadn't given him the Miralax on that day.  He did have a bowel movement on Saturday after tremendous fear, even though it was very soft.  He tried as hard as he could to withhold it and it eventually became impossible.  The next day, I picked up a children's probiotic at a local health food store and he's had one of those every day as well as chewy fiber supplements.  He has had a bowel movement every day since then and they are becoming increasingly less scary.  He's gone from seeming as though he is possessed with rage as he withholds, to squirming and whining.  Another feature of what we have done since Sunday is to reward each poop with a small toy that is in a special basket just for this occasion.  Iniiailly he was pretty pissed about this and he let me know that he didn't care for any of the toys in the basket.  What's interesting is that a lot of the stuff I got at first is stuff he loves but that he's loved for a long time.  I got some more things that are a little bit older and kind of different; this has helped.  He can earn a toy by simply pooping, whether in a pull-up/underpants or in the potty. We decided that what we wanted to reinforce now was pooping in general.  We'd deal with potty stuff after his fear lessened.  All of his poops have been in underpants or a pull-up, until tonight.  He had already had a poop this afternoon, in his underpants, earned a toy, etc... I told him that this is all cool but encouraged him to think about the potty and that soon we'll start working on that at some point.  Later on, after dinner, I was upstairs with the kids and I was taking a quick shower. While I was showering, he came in and said that we have a poop problem again.  I told him that I was in the shower and would be right out, but if he needed to go, he should use the potty.  He yelled, held it, and went about his business.  When I got out, I asked if he wanted a pull-up and he said no.  I told him that he could use a pull up if he wanted, just let me know, but if he wants to try to use the potty this time, he could pick two toys out of the basket because I know this is a big deal.  He talked about being scared but kept not wanting the pull-up.  Finally, he ran into the bathroom and jumped on the toilet and he pooped! He was very proud of himself and in fact, assumed his superhero character afterwards.

I don't know if this is the end, but I think we have made great progress.  This has been utterly exhausting and I can relate to what Lydiah wrote about being stressed about going out.  The fear of him having an accident out in the world that would somehow make matters worse, or having him withhold with so much fury somewhere outside the confines of our home was just awful to consider.  I am definitely going to continue with the probiotics and the fiber supplements to keep his stool nice and soft; he seems much more energetic on this combo than on the Miralax, but it could also be that he was holding much more poop inside which was making him feel sick and exhausted.  Not sure which. And I think I have to keep creative with incentives for doing things that are important but very difficult.

Again, thank you.  I'll keep up with postings and want to hear other experiences.  This has been completely upending and I so hope we are seeing the light at the end of the tunnel.

[Sumada]

My ds will be 4 in January and this summer all was going well with potty training and suddenly he started pooping in his underwear. After trying to reason with him (I was desperate until I finally realized he's 3!) and throwing away several pairs of underwear (in front of him too, thought that might have an effect) I finally told him that if he wants to poop, he can either poop on the potty or ask for a pull up. So now he asks for a pull up, which sounds like what you may be doing already. I was so worried about what others would think, but I finally decided that I would rather have him poop, even if it's in a pull up, rather then have him hold his poop.

I think it's important to make sure he is regular again, though. I almost bought some benefiber b/c I suspected ds was holding it when wearing underwear, but I skipped it and went for fruit instead. Luckily, he loves fruit.

I also tell him that his poop likes to go for a swim and make it sound really exciting. We also talk about the "plop" sound poop makes in the potty and make it sound like it's really funny. So maybe making up a story and making it sound SO MUCH fun to poop in the potty may help. It's taken a couple of months of me saying this to him and just last night he pooped in the potty (he did ask for a pull up but then I explained that his poop wanted to go for a swim and he changed his mind and went on the potty).

Good luck. I'm sure he'll be pooping on the potty in no time :)

[MountainMamaGC]

My DD has so much anxiety about pooping she can hold in a diarrhea poop for 3 days. Now that is determination! She was probably one fart away from pooping her pants. lol. Its so silly, but once they have it in their head its very difficult to change their mind about pooping. The other day Lilly sighed and said "I hate pooping mommy." I sighed back and said "I know Lilly, I know." When she does go I use the phrase "Listen to your tummy" I say "Thanks for listening to your tummy and letting the poop out." We are still going strong with the MoM, but she is still holding in it, despite having soft BMs for about a month now.

[monkeybum]

We went through this exact same thing for the exact same reason.  My son was 5 however.  I eliminated dairy, particularly cheese as that constipated him, and increased his fruit intake.  Once I knew the bowels were soft, I resorted to bribery, which got him to go a few times and once he learned it didn't hurt anymore he was ok.  This was about a 4 month process and was by no means easy, but it worked! :)

Good luck!

[Eresh]

Ds1 was having problem when he was first potty learning then got massive constipation. I discovered some probiotic kefir drink was stopping him up. We used fiber gummies, pedia-lax chewables, and pullups until he was pooping in the potty again. Oh, and the little potty chair also helped him gain confidence before going to the toilet again.