This has gotten out of control.

[MountainMamaGC]

My daughter has been withholding her stool since she was 2 years old. She will be 5 in march. All dietary, and allergy causes have been ruled out. She is given a mild laxative everyday to keep her stool soft, in hopes that once her colon shrinks down and she starts going everyday we can wean her off. According to her she doesnt like pooping, she doesnt want to poop or even try. She will hold in diarrhea for 4 or 5 days at a time. Its liquid. She will choose being bloated and miserable and tired, over sitting on the potty. We have to fight her to give her a suppository when we start getting to one week without a movement. We are at our wits end as parents. We have tried rewarding her, disciplining her with time outs and taking privaleges away, we have tried ignoring the problem and leaving it up to her, we have gotten very angry with her, and its now taking over our lives. We are starting to resent her, and she knows it. What can we do?

[DrLauraMarkham]

I hear how difficult this is for you. You have been struggling with this issue for three years now, and it must dominate your life. It sounds like you have tried everything, and nothing has worked. And it would be very hard not to resent your daughter at this point. It is important to resolve this issue now, because when kids reach school age this becomes much more difficult to solve, which can lead to all kinds of problems, not the least of which is an enlarged colon and reduced sensitivity to their own urges.

I am not an expert in this area, and I am not a medical doctor. Mostly, I have recommended that parents play with kids to get them laughing about potty issues, which helps kids to overcome their fear of using the toilet. I also recommend enforced potty sits, several times a day.  Sometimes this works. However, with a case as entrenched as your daughter's, I don't believe it will be sufficient.

Unfortunately, doctors often seem stymied by this issue, and it drags on without solution. The usual medical approach is basically to keep the stool soft and hope the child will get used to having stools. Unfortunately, this seems to work in only about half of cases.

A few years ago, I became aware of the work of Dr. Robert Collins. Basically, he recommends the time in the bathroom that I recommend, only if the child does not go after the first two sits each day, you use a suppository to help them, and if the child does not go after that, you use an enema to make sure the child moves his bowels.

Most doctors, like most psychologists, have been nervous about the suppository/enema approach for fear of traumatizing the child.   I have to say that is my instinct, also.  I think giving kids enemas is very invasive.  However, encopresis is a severe problem that can traumatize a child for life, and the longer it goes on the more traumatic it is.  I have seen, over and over, what happens to kids when they continue withholding their stools. It undermines their social development and their self esteem.

So even though I would not subject a child to enemas lightly,  if my child had this problem and the approach of enforced sits with daily roughhousing and laughing about potty issues did not work within a month, I personally would try the Collins approach.  I have come to this conclusion after several months of following the Collins discussion group that uses his approach. 

Watching new parents begin this approach is interesting, because they feel just as nervous as I would.  But then a miracle seems to happen.  It may take a few weeks, but the kids begin being able to move their bowels on their own without resorting to the enemas and suppositories as often, and within a few months, most of them are off them.  So this approach does seem to retrain the bowel reflexes.

As I follow the discussion on Collin's list, I see relieved parents. Even better, I see kids who are thrilled as they regain control of their own bodies.  However, he doesn't just give them enemas, he has a specific protocol that allows the enemas to be diminished and eliminated, and it certainly sounds right to me that the child would be relieved and happy to regain control of his own bowels.

As I say, enemas are invasive and traumatic, so I would not take this path lightly, but since this is such a challenging problem to solve, his approach is good to know about. I want to add that when you buy Collins' book (which costs a hefty $75), you get access to the forum of parents using his approach that I have been reading. That seems invaluable to read BEFORE trying his approach, to make sure you really want to do it.   You can even just pay a lesser amount and get access to the forum, which has archives.  Collins' website is  http://www.encopresis.com/.  Just so you know, I have nothing to do with Collins and am recommending his approach as a last resort, not a starting place, once you do your own research.  I am also a psychologist, not a physician, so I am giving you my opinion as an informed mental health professional only.

I wish you luck in solving this very challenging problem.  Please remember to be patient with your daughter, and to love her as much as you can, unconditionally, through this.  Your love is what will help her get through this with her self-esteem intact. She will eventually be able to use the toilet normally.  Your goal is for her self esteem and your relationship to come out stronger for this experience.