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Stool holding: When your child holds back bowel movements and is not toilet
About 5% of children refuse to be toilet trained. They get into a tug-of-war with their parents
over using the toilet. Some of these children decide to hold back bowel movements (BMs). That behav-
ior can lead to constipation, painful BMs, and even complete blockage (stool impaction). Impacted chil-
dren constantly leak (ooze) stool in small amounts (soiling or encopresis).
If the impaction persists for long, the rectum and colon become stretched out of shape and are no
longer able to squeeze out stool. Unblocking the bowel may require some enemas. Keeping the child
unblocked requires three to six months of laxatives or stool softeners. Stool holding is an important prob-
lem to recognize early and treat vigorously. The following steps can help you help your child end stool
holding and soiling:
Clarify the goal with your child. Remind your child that his (or her) job is to make a poop
come out every day. Tell him "your body makes a poop every day" and "the poop wants to come out
every day". Emphasize poop production and release. Older children who don't like stool leakage can be
told "If you poop every day and keep your body empty, nothing will leak out."
Give laxatives to keep the rectum empty. Most stool holders need a laxative. Laxatives (bowel
stimulants) cause the large intestine to contract, pushing the stool toward the rectum. Most laxatives con-
tain senna, a natural plant extract. Don't worry that your child might become dependent on laxatives -
that is, that the bowels won't move well without them. Laxatives can be withdrawn gradually, even after
your child has used them for many months. The most important goal is to keep the rectum empty.
Your child's laxative is _____________________. The dose is __________given___________________
Backup plan to prevent blockage: If your child goes 48 hours without a BM, give ___________________
as follows _____________________________________
Give stool softeners for hard bowel movement. Stool softeners make stools softer and easier to
pass. Unlike laxatives, they do not cause bowel contractions or pressure. Some commonly prescribed
stool softeners are mineral oil, milk of magnesia, Miralax, and high-ﬁber products.
Your child's stool softener is _________________________. The dose is __________________________
Increase the dose gradually until your child is passing one or two soft BMs each day.
Transfer all responsibility to your child. Your child will decide to use the toilet only after he
(or she) realized that he has nothing left to resist. Have one last talk with him about the subject. Empha-
size that his body makes poop every day and that it belongs to him. Explain again that his poop wants to
go into the toilet and his job is to help the poop come out of his body. Tell your child you're sorry you
forced him to sit on the toilet or reminded him so much. Tell him from now on he doesn't need any help.
Then stop all talk about the subject (potty talk"). Pretend you're not worried about it. When your child