Potty Training: Poop-Withholding After a Trauma

Trauma such as illness or injury can cause regression in the developmental achievements of young children. In other words, your child may develop any nature of difficulties that may not be "diagnosable" per se, but rather a short-lived reaction to something traumatic. Reader Alison's son broke his leg, and since then has become a poop-withholder. Here's her dilemma: Dear Dr. Heather,

My son broke his leg when he was about 18 months old and had to wear a cast for a month. Prior to this event, his poops were regular. After a week of having the cast on, he didn't poop and when he did, it was uncomfortable for him. This started an irregular pooping schedule for him and he has remained constipated since then.

He will now be two next week. The pediatrician suggested a suppository and Miralax. We did a suppository thinking it would get things moving since he seemed soo uncomfortable. We have tried laxative drops that he likes, but seem to give him cramping and diahrrea. When we don't give him anything, the consistency of his poop always seems soft, not hard. But he will do the poopy dance, and then have to push really hard and cries when he has to poop. The process of waiting for him to poop can eat up an entire day! He will go on his own after 2-3 days, if he has not gone by the 4th day, we have done a glycerin suppository since he seems soo uncomfortable and they help right away, but he hates it and I feel awful doing it. We push high fiber, etc..nothing dietary seems to help. I feel like it's all emotional. He will run around and around, and we will try to stop him and hold him and encourage him until he will push and go. We tried poopy prizes, nothing seems to encourage him. It is not about potty training, although we have offered for him to go on his potty. He went twice on the potty but it seemed to freak him out.

He is a sweet boy and I don't want him to be emotionally bruised from this experience. Should we take the same advice you gave to the 3 year old and ignore him when he does the poopy dance? Do we not offer poopy prizes? How many days do we wait before doing a suppository? Please help! We feel awful and don't know what to do!!

Thank you,

Alison in Berkeley

Hi Alison,

Poor guy! I assume his doctor says there is nothing wrong, medically. Have you tried the Miralax? If not, it's worth a shot. If you use, it, I wouldn't point it out to him. I think anything that smacks of parental control over his poops is bound to backfire (so to speak!). So if you use it, sneak it in. Or just tell him it's "vitamins" that you put in his drink.

On the behavioral side, you're right, it's not about "potty training" per se, but it IS about his sense of control and mastery of his own body. And that comes before potty training. He is still quite young for potty training anyway. Many preschoolers don't "get it" until 3 1/2 or even older, and that's OK.

The event of breaking his leg very possibly set him back, emotionally. It's common for physical illness or injuries to cause temporary regressions. Perhaps the experience of being so incapacitated by the cast really scared him, or he got some kind of wacky idea in his head that somehow his poops CAUSED his injury. You really can't know. Toddlers get all kinds of weird ideas in their minds, things that don't make sense to us, rationally. But they can be very powerful ideas to the little ones.

This is what I would suggest: Within the bounds of what is medically acceptable, completely BACK OFF the poopy talk and encouragement. First of all, tell him that it's HIS body, HIS tushie (or butt, or whatever your family calls it), HIS poop, and NOT MOMS OR DADS (or his doctors, for that matter). When HE is ready to make his poop, that's fine. Be matter-of-fact and reassuring. You might also reckon back to his injury to reassure him that his body works perfectly well again. "Remember when you got your owie on your leg? That's all better now. Your leg works fine again. And your poops can come out now anytime you are ready. But Mommy and Daddy will not make them come out anymore." Then, DROP IT. Really try hard to focus on anything BUT the pooping situation. Don't offer poopy-prizes or focus on his poop schedule at all. LET HIM HANDLE IT. If he asks for help, by all means, help him in whatever way he seems to want. But remember that this is a developmental hurdle that ultimately, only he can surpass.

This may all really be about a struggle to regain independence over his body. The leg injury was likely such a blow to his toddler's very important sense of mastery over his body. Now, he needs to struggle to get it back. Leaving it up to him is an important part of that process, since it is all about self-control, body mastery and independence.

I know you worry about his frequency of pooping, but believe me, helping him to regain this sense of self-control will be hugely important in the long-run. Again, check with the pediatrician to make sure what I'm suggesting is OK, and allow your son to hold it or struggle with it as long as you can. It will require some deep breathing on your part, in order to NOT interfere, but this is an important developmental process for you, too: learning to let go, as your son is now old enough to start to take over this function for himself. (And I hope you can enjoy a little sense of relief as you can let this worry lift from your shoulders as you begin to focus on other, more fun things with your son.)

It may be days, weeks, or even months as he takes steps forwards (AND backwards) toward progress. Don't let that get you down; it's normal. Big developmental gains don't happen all at once. Just keep your ultimate goal in mind and likely the power of his own normal developmental process will ultimately win out.

Not a fancy solution, I know. But one that respects his internal struggle, and the ultimate goal that he needs to achieve in order to surpass this internal dilemma of his. It's also good practice for Mom and Dad to see that he can ultimately be in charge of his developing body (and mind).

You can also read about another toddler's poop-withholding in this BabyShrink post.

Thanks for your question and let us know how it goes!

Aloha,

Dr. Heather The BabyShrink