Sometimes children develop a pattern of stool withholding, which results in chronic constipation. If a child develops a pattern of avoiding stooling, either because of painful bowel movements or because of control battles with parents, the stool can become dry, hard, and packed in the colon. Even when the child begins to stool daily, the “pipe line” may remain full causing cramps and abdominal pain.

When chronic constipation is diagnosed:

Avoid potty battles with the child if not already potty trained. All attempts at potty training must immediately be halted. Younger children may be given the choice to wear diapers again.
The stool must be made soft, easy to pass, and painless. Softening the stool with mild medications is not habit forming, even over long periods of time. Stool softeners must be used for long enough that the child essentially forgets the fear of pain with stooling. Sometimes, the stool softener may be required for months at a time. Do not use medications without discussing this with the doctor.
Regular stool habits should be encouraged. Older children who are potty trained may decide that they don’t want to have a stool often enough. Perhaps they are proud of themselves for being potty trained and want to exercise their ability; perhaps the bathrooms in school are unappetizing or perhaps they simply get “too busy” to go. In any event, you can avoid this problem by having the child sit on the toilet every day, after breakfast and after dinner, as a regular habit. This permits the child to have a specific time when they are not interrupting another activity. Also, everyone has a reflex that when the stomach is filled with food, the rest of the intestines move along to make room. A sticker chart may encourage the child’s cooperation.
These simple maneuvers, practiced consistently over time, should teach good bowel habits without unnecessary control issues. If you have further concerns, please do not hesitate to discuss them with us.