Dr. Robert Needlman
Specialist in pediatric behavior and development.
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 Ask Dr. Needlman
Bowel Movement Accidents at Four | | | QUESTION | | | Dear Dr. Needlman,
My daughter's almost four-year-old daughter who has been fully potty trained for over a year has suddenly started having bowel movements in her underwear. When I ask why she says she was busy playing. What is the best way to handle this?— Clueless Mom in Jacksonville, FL | | | ANSWER |
May 23, 2001 | | | Dear Clueless Mom,
It's actually very common for preschool children to have an occasional "BM accident." Typically, they come about just as your granddaughter has said: A child feels the urge to use the bathroom but chooses to ignore it because he's busy playing. Then he strains a bit (for example, while running, climbing, or even coughing) and a small amount of stool comes out. The children are surprised and often a little embarrassed. Next time, they know to "listen to their bodies," and interrupt their playing to use the bathroom. Children who tend to be more impulsive, and who get very wrapped up in their playing, sometimes take several times before they learn this lesson.
For these usual accidents, which only happen once or twice, I don't think you need to do anything more than offer reassurance and perhaps a gentle reminder if you sense that your granddaughter might really need a bathroom. It also helps to get the child into the habit of sitting on the toilet for a few minutes (about 10 minutes) after meals once or twice a day. The intestines are normally more active after eating, so this is a time when children can often "go" relatively easily.
If the accidents are happening more often, you should consider other possibilities: Have your granddaughter's stools changed in consistency? Large, hard, infrequent stools sometimes signal constipation, which is a common cause of misplaced bowel movements. Staining of the underpants by liquid stool can also be a sign of constipation. The large, hard mass of constipated stool allows liquid stool to leak out around the edges.
Is the stool problem part of a larger picture of behavioral or emotional difficulties? Are you and your granddaughter (or your daughter and another family member) caught up in a power struggle, either around this or some other issue? When children feel a lack of control in other areas, they sometimes focus on bowel and bladder functions as something they can control.
If any of these seem to be the case, you'll probably want to involve your granddaughter's doctor or nurse practitioner. Unless the problem is occurring only very infrequently, I wouldn't wait more than a couple of weeks before consulting a doctor, since constipation tends to get worse and harder to treat over time, and stool problems can be very upsetting to children, parents, and granddaughter alike.— by Robert Needlman, M.D., F.A.A.P. |
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