Dr. Robert Needlman
Specialist in pediatric behavior and development.
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 Ask Dr. Needlman
Severe Stool Retention in Potty-Trained Toddler | | | QUESTION | | | Dear Dr. Needlman,
My 2-1/2-year-old was fully potty trained and is now in an eight-week period of stool retention with a hugely distended abdomen and some leakage. Has seen gastroenterologist, been treated with laxatives. The results have been sporadic. The problem seems serious and is not getting any better. We've backed off on any coercion to use potty. Can you help?— M.J. in Marin County, Calif | | | ANSWER |
March 8, 2001 | | | Dear M.J.,
In situations like this, I approach the problem with a combination of medical and behavioral interventions. Once a child is very constipated, it hurts to pass the large, hard stool. Often the child learns to hold the stool back to avoid pain. The only solution to this is to keep the stool quite soft for several weeks so that bowel movements are painless.
When a child has a lot of hard stool packed in the intestines, laxatives often don't work well. The first step is to clean out all the hard stool. Sometimes it takes several tries with enemas, mineral oil, or other clean out techniques to achieve this goal. Pediatric gastroenterologists are pros at doing these clean outs and are also the experts best suited to detect those rare cases when some other medical reason causes the clean out to fail.
Behavioral intervention, in a nutshell, involves removing all pressure to perform. For many children this includes a brief spell back in diapers if that's what's comfortable for them. For others it just means that you encourage them mildly, don't push, and don't over praise. It's their body. Sometimes it helps to draw pictures or tell stories about how the poop needs to come out so there's room for more good food to come in.
Constipation is very common in young children who are just learning to take charge of toileting. Rarely is there any deep down medical or psychological cause. Once the problem is fixed, it's done. On the other hand, these problems don't get better on their own and tend to get worse if left untreated. Therefore I'd recommend that you keep working closely with the doctors until you solve the problem.— by Robert Needlman, M.D., F.A.A.P. |
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