Overcoming Constipation: Helping Your Child Stop Holding in Bowel Movements

The issue of withholding bowel movements?

Hello, Dr.
Zhang.
I would like to consult you regarding my 3-year-old daughter.
Since she was 1 year old, she has developed a habit of withholding bowel movements due to several instances of painful defecation.
She usually holds it in until the last moment, averaging a bowel movement every 3 to 4 days.
In October, she contracted enterovirus, which led to a decrease in her food intake, and she went a week without a bowel movement.
We had to seek help from a pediatrician, who performed a bowel evacuation and prescribed medication, hoping it would help her associate bowel movements with less pain and encourage her to continue.
However, it seems that she has become even more adept at withholding, as she still refuses to have a bowel movement despite taking the medication, even after the dosage was increased (it has now been three days).
How should we handle this situation? Is there a way to persuade her? Are there pediatric specialists who address issues related to children withholding bowel movements?

Tian, 30~39 year old female. Ask Date: 2005/10/26

Dr. Zhang Yingwen reply Pediatrics

Constipation can be influenced by dietary habits and lifestyle factors, and it is also important to consider the possibility of organic issues, such as congenital megacolon or abdominal tumors causing pressure.
However, most cases are primarily due to poor bowel habits.
Improvement methods include increasing fluid intake, consuming more fruits and vegetables, and incorporating high-fiber foods into the diet.
It is also essential to establish a routine of daily bowel movements, even if there is no urge to go; attempting to use the toilet regularly can help.
If a bowel movement occurs, providing a reward can encourage children not to view bowel movements as a daunting task.
If there is already a habit of withholding bowel movements, it is advisable to seek help from a pediatric gastroenterologist, along with medication treatment.
Thank you for your inquiry.
If you have any further questions, please feel free to consult at our outpatient department.

Reply Date: 2005/10/26

More Info

Constipation in children, especially when it leads to withholding bowel movements, can be a challenging issue for both the child and the parents. Your situation with your 3-year-old daughter, who has developed a habit of holding in her bowel movements due to previous painful experiences, is not uncommon. This behavior can often stem from a fear of pain associated with defecation, which can create a cycle of constipation and withholding.

Understanding the Issue
When a child experiences pain during bowel movements, they may start to associate that pain with the act of defecation. As a result, they may begin to hold in their stool to avoid discomfort, leading to a buildup of stool in the intestines. Over time, this can cause the stool to become harder and more difficult to pass, exacerbating the problem. In your daughter's case, the recent episode of enterovirus and decreased food intake may have further complicated her bowel habits, leading to increased anxiety around defecation.

Strategies for Overcoming Constipation
1. Create a Positive Environment: It's essential to create a stress-free environment around bathroom time. Encourage your daughter to sit on the toilet for a few minutes at regular intervals, especially after meals, to help establish a routine. Make this time enjoyable by reading a book or singing songs to distract her from any anxiety.

2. Dietary Changes: Ensure that your daughter is consuming a diet rich in fiber. Foods such as fruits (like pears, apples, and berries), vegetables, whole grains, and legumes can help soften the stool. Additionally, ensure she is drinking plenty of fluids, as hydration is crucial for preventing constipation.

3. Use of Stool Softeners: If your daughter is still experiencing difficulty despite dietary changes, consult with her pediatrician about the possibility of using stool softeners or laxatives. These medications can help make bowel movements more comfortable and less painful, which may reduce her anxiety about going to the bathroom.

4. Behavioral Techniques: Positive reinforcement can be effective. Praise her for any attempts to use the toilet, even if she does not succeed. You might consider a reward system, where she earns small rewards for using the toilet or for every successful bowel movement.

5. Professional Help: If the problem persists, it may be beneficial to consult a pediatric gastroenterologist or a child psychologist who specializes in behavioral issues related to toilet training. They can provide tailored strategies and support to help your daughter overcome her fear and develop healthier bowel habits.

6. Patience and Understanding: It's crucial to remain patient and understanding throughout this process. Children can be sensitive to parental stress, and your calm demeanor can help her feel more secure. Avoid punishment or negative reinforcement, as this can increase anxiety and worsen the situation.

Conclusion
Overcoming constipation and the habit of withholding bowel movements in children can take time and requires a multifaceted approach. By creating a supportive environment, making dietary adjustments, and possibly seeking professional guidance, you can help your daughter feel more comfortable with the process of defecation. Remember, this is a common issue, and with the right strategies, many children successfully overcome it. If you have ongoing concerns, do not hesitate to reach out to your pediatrician for further assistance.

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