Question: “At 2 years, 9 months my child announced “I want to use the potty” so we jumped on it and two weeks later things were going great, literally. Then my beautiful child began holding the BM’s, and at that point we backed off everything. Going number 1 on the potty was not the problem, it was going number 2, so we returned to pull-up’s for BM’s (still not sure if that was the right decision) but it’s what we decided. Up until a few months ago that was working, we were hopeful we would get back to the potty but my child has made it clear that’s a big no no so we have encouraged but not pushed.
“The problem is now we are holding it regardless of pull up. We’ve had to resort to some extreme measures to get things moving again. I can’t get in to my pediatrician for another 8 weeks or so and I’m desperate. We have tried high fiber foods, probiotics, etc. to help with regularity and nothing has worked,and yes, there’s plenty of water a day.
“I’ve read this is sometimes associated with control so we make sure there are plenty of other choices throughout the day including clothing, activities, foods, etc. My mother’s instinct tells me there’s nothing medically wrong – but I have the appointment none the less. In the meantime I’m at a loss and could use some advice about what to do next, and while I don’t want to make it a tramatic situation I also know holding a BM is not healthy.”
Answer: First let me say that I agree with your mother’s instinct: it is very unlikely that anything is medically wrong.
Withholding stool while in the process of potty training is normal. In fact, if kids don’t learn how to feel the urge to poop and then hold off they wouldn’t make it to the bathroom and successfully train. Sometimes, though, this withholding goes too far, as it has with your child. Often what happens is that the child has a single negative experience when pooping (either it was too hard or painful to pass) and sort of decides he’s never going to poop again and begins withholding the stool. Sometimes the negative experience isn’t with the process of defecating but having some toilet water spray up on his bottom or hearing a particularly loud flush that startles him.
Whatever the reason for the withholding, when it first happens it quickly develops a life of its own.
When the child withholds the stool it gets larger and therefore more difficult and sometimes painful to pass. Each time this cycle repeats it makes the idea of pooping on the potty scarier and the withholding gets more intense. You were smart to dissociate pooping from the potty to try to get things back on track and indeed I recommend allowing the child to return to pooping in diapers or pull ups until the cycle of withholding seems to have passed. Once he is having soft, regular, anxiety-free bowel movements in the diaper, restarting the potty training in the bathroom makes sense.
First make sure that the stool is indeed soft and easy to pass. Since your child will be nervous about pooping in the potty again he is likely to have the urge to withhold his stool. To counteract that urge, use a tablespoon of mineral oil mixed into yogurt or applesauce each day which can really help keep the stool softer and easier to pass. If that isn’t enough, use Miralax, which is over the counter to achieve a daily, soft bowel movement during this time of transition.
Have your child first start to wear underpants all day and when he has the urge to poop put on a pull up or diaper and go wherever he is. The next step is to keep the pull ups in the bathroom and have him go in there to put it on and poop when he feels he needs to go. The third step is to have him put on the pull up and sit on the potty or toilet with it on to have his bowel movement and then transition to pooping directly on the toilet or potty. By desensitizing in this way you make it less anxiety producing and by using the mineral oil or Miralax you make it more difficult for him to withhold his stool.