Overcoming bad toilet experiences
JOHN SHARRYanswers readers' queries
My son is four and a half years old. He will not poo in the toilet. He says he doesn’t know when it’s coming. He had a bout of constipation many months ago and would then hold on to it. He makes bits of poo in his pants now. Has a muscle stopped working? And, if so, how can it be fixed?
It sounds like your son might have developed a condition called encopresis, which means he has lost full control of his bowel movements and thus experiences soiling.
The condition usually starts when a child who is constipated experiences making a bowel movement as painful. Passing a hard stool may cause them to gain a small anal tear which makes further bowel movements hurt. This pain makes them avoid going to the toilet, which aggravates their constipation. They then get into a habit of resisting the natural urge to make a bowel movement and begin to “hold on to their poos”.
Over time, the constipation can worsen and the child’s colon can become impacted, which can lead to soiling. At this point they have lost full control over their bowel movements and faeces can leak out without their full awareness. They have unexpected accidents and more often do poos in their pants than in the toilet.
When your son says he does not know when they are coming, he is likely to be telling the truth and when he avoids going to the toilet it is likely to be out of genuine anxiety.
Though a messy and embarrassing problem, encopresis can be successfully treated. Generally, a multi-pronged approach of medication, positive training and diet leads to the best results.
The first step would be to take your son to your GP for an examination to determine the level of constipation and to prescribe medication as needed. Your GP may do this himself or refer your son to specialist paediatric clinic. Two types of medication can be prescribed: one to be used over a short period to clear your son’s impaction and one to be used over a longer period while you retrain him to use the toilet.
In parallel, it is important to start a positive retraining process to help your son relearn to use the toilet. He may associate going to the toilet with negative or painful experiences; you want to overcome this and make it a positive experience for him.
In doing this, the key is to get his co-operation in having “another go” at tackling the problem.
Reading a children’s book together on the subject can really help, such as Clouds and Clocks: A Story for Children Who Soil by Matthew Galvin or It Hurts When I Poop!: A Story for Children Who Are Scared to Use the Potty by Howard Bennett, both of which are targeted at your son’s age group. There is also a good free downloadable booklet Beating Sneaky Poo available from dulwichcentre.com.au.