Poop Problems: Paediatric Stool Withholding
Lauren Rudko, PT, MSc. PT
Registered Physiotherapist – Pelvic Health
When a child holds in their bowel movements (stool), it can not only be uncomfortable for them but also increase stress for their caregivers. Stool withholding can occur for various reasons, but in most cases, it leads to constipation, which can in turn lead to further stool withholding. The following blog post explains why stool withholding occurs, outlines the symptoms caregivers should look for, discusses its effects, and provides some tips on resolving this issue.
Why Stool Withholding Can Happen
Children withhold stool for various reasons. In some cases, the child has a short period of constipation, which makes the stool harder and painful to pass, resulting in a fear of having a bowel movement. Their rationale could be that if they withhold, then they won’t experience the pain. In other cases, the child may not want to stop playing to use the washroom, so their solution is to withhold. The physical environment itself can also play a role in withholding. If a child has a fear or dislike of the available washroom, or if there is limited washroom availability (for example, it was in the classroom in kindergarten and now, in first grade, it’s down the hall), the child might withhold stool due to increased anxiety around the toileting environment.
What Cargivers Should Watch for When it Comes to Stool Withholding
The symptoms of stool withholding in children can be very similar to those of constipation, especially as constipation can be present concurrently. A child may have increased stomach aches, poop accidents (fecal incontinence), gas and general discomfort. Physical behaviours can be telltale signs. Some children have a specific posture when withholding stool, such as crossing their legs or sitting on their heels. Others may present as less regulated and may be more easily frustrated or less willing to engage in activities. Oftentimes, a child may also avoid using the washroom for urination because they are worried that they might have a bowel movement while urinating, so urine leaks can also occur.
What are the Effects of Stool Withholding
Aside from frustration and general discomfort, the most significant impact of stool withholding is that, over time, it can lead to constipation. As the large intestine is designed to be a sensory organ, rather than a storage organ, when stool sits there for longer than necessary, regular function becomes disrupted. One of the primary functions of the large intestine is to absorb water from the stool. The longer that stool sits in the large intestine, the more water is absorbed and the harder the stool becomes. Over time, more stool can accumulate and stretch the tissues, making it more difficult for the child to sense when they need to have a bowel movement. New, more watery stool that hasn’t had its water content absorbed yet can pass through the harder stool, resulting in diarrhea or accidental bowel movements.
What Can be Done to Help Stool Withholding
Resolving stool withholding requires a multi-pronged approach that addresses physical, psychological, and environmental concerns. From a physical perspective, we need to address any constipation that may be present, typically through the use of laxatives that help soften the stool by adding water, making it easier to pass. Pelvic health physiotherapy can help by providing exercises and tools that relax the pelvic floor muscles, making it easier to have a bowel movement.
The psychological perspective needs to be unique to the child. Be curious as to why a child may be withholding. Is it due to pain, the physical toileting environment, or a combination of both? What changes can be made to the physical environment to allow the child to be more relaxed and likely to have a bowel movement? In some cases, the child may prefer more privacy or a different toileting setup (e.g., a floor potty vs. a toilet) to help them feel more comfortable. Children can also be sensitive to the caregivers’ stress and/or anxiety around the situation, so taking a step back and allowing the child to have a bowel movement in any manner that they feel comfortable, be that standing, in a pull-up, or only in a certain washroom, can help the child decrease their fears or anxieties around toileting.
The environmental perspective is often closely linked to the psychological. Addressing what the child dislikes about the environment can help them feel more relaxed and confident around bowel movements. For example, if the washroom at school is located down the hall and this feels overwhelming to the child, they may benefit from having a buddy or a teaching assistant accompany them until they feel more comfortable with the environment.
Other Resources for Poop Withholding
Stool withholding should be addressed in a multi-factorial, biological, psychological, and environmental way. Often, taking a step back can decrease anxiety and help resolve the issue more quickly than increasing pressure on the child to have bowel movements. Connecting with a pelvic health physiotherapist who specializes in paediatric concerns at Proactive Pelvic Health Physiotherapy Center can help unpack the multiple reasons stool withholding can start and how to resolve it.