This post was written by Stephen Clingman, MD, PPG – Family Medicine and Primary Care.
If you've noticed that your child's bowel movements have become irregular or less frequent, you might think that constipation is the cause. However, in some cases, the issue may stem from stool-withholding behavior. While this lack of bowel activity can lead to constipation and other adverse side effects, it's important to understand the reasons behind it to help your child overcome their aversion and return to a healthy routine.
Symptoms
Stool withholding behavior occurs when a person voluntarily prevents themselves from having a bowel movement. This act is often more prevalent during potty training years but may also occur in individuals with developmental disabilities.
Signs of this behavior can manifest in a variety of ways. A child may clench the muscles around the anus to hold the stool in the body and resist attempts to get them to poop. This can lead to uncomfortable symptoms such as gassiness, abdominal pain, visible swelling or a sense of fullness. Extended periods of withholding may also cause changes in hunger, including a decrease or loss of appetite. In other instances, some may even vomit due to the pressure in the abdomen.
Causes
There are several reasons why a child may engage in this behavior. Here are some common explanations:
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Pain or discomfort: One of the more common reasons for avoidance is that the individual has experienced pain during a past bowel movement. This memory can create fear around pooping, causing them to forego the process entirely to prevent further discomfort.
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Seeking power: Children sometimes withhold stool to exert control, especially during potty training. When their caregiver instructs them to use the bathroom, they try not to do so as an act of defiance.
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Negative reinforcement: Well-meaning caregivers may have unintentionally become angry or frustrated with an act of pooping, perhaps due to loss of control or lack of getting the bowel movement in the toilet. As a result, the person may feel that pooping is a behavior that gets them into trouble.
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Trauma: In other cases, past abuse or trauma may lead to stool withholding as the act may evoke distressing memories.
Consequences
When someone doesn't evacuate their bowels for too long, the stool can dry out as the body continues absorbing water. This leads to more pain and difficulty during bowel movements and further reinforces their fears, encouraging continued withholding.
Prolonged withholding can weaken the colon muscles due to continued efforts to evacuate the stool when the child resists evacuation. If this occurs, the person will have to strain more to get the stool to move, which can continue the cycle of avoidance. In very rare cases, it can lead to severe complications such as a colon rupture.
Treatment
Interventions for stool withholding often focus on a combination of addressing the physical and psychological reasons for avoidance.
If a lack of bowel movements has led to hardened stool, medications like stool softeners and laxatives can help soften it and make evacuating easier and less painful. In severe cases, an enema may relieve the blockage, but this method should be used cautiously to avoid provoking additional psychological trauma.
Caregivers can help break the cycle of bathroom-related anxieties by providing education and reassurance. It's important to explain that having a bowel movement is a natural and necessary part of life. If appropriate, rewards for successful bowel movements can also be beneficial. In some cases, counseling may be required to address deeper fears or trauma.
When to seek help
Overcoming stool withholding behavior can be frustrating and stressful for both the individual and those caring for them. Remember to exercise patience and compassion. Building a healthy bathroom routine can take time, and setbacks are a natural part of the process.
If after one week all strategies to encourage stool passage are unsuccessful, consult the child's pediatrician. They can perform diagnostic tests to ensure that the lack of stooling isn't due to a medical condition, which would indicate constipation rather than stool withholding. This should always be ruled out in cases of stool withholding that don't resolve with encouragement.
If your child does not have a provider, you can find one by visiting the website here or calling 877-PPG-TODAY.
