Monday 11 December 2017

David Coleman: Childhood trauma is causing my daughter to withhold her poo

Library Image. Thinkstock Images.
Library Image. Thinkstock Images.
David Coleman

David Coleman

I have a three-and-a-half-year-old daughter who is bright, happy, loving and healthy. She is potty-trained for wees and it took about three days. Our problem, however, is her poo! She knows and understands what to do but simply won't.

At 15 months she was admitted to hospital with a virus and was very constipated. The doctor told me that she had suffered a tear and was probably withholding, which was leading to impaction.

I am not joking when I tell you I have tried everything – prune juice, no juice, no milk, no dairy, homeopathy, Bowen therapy, Movicol, Lactulose, Duphalac, Senna (all at once and in different combinations) and I have taken her to several doctors.

I am interested in exposing the behavioural side in relation to this issue. We have tried stickers, rewards, praise, no praise, talking – and I won't lie – shouting. I find the situation very stressful.

She can soil herself up to 12 times a day. Sometimes I feel like it is a challenge to her and she won't be beaten.

Excessive build-up of Movicol, etc creates an explosion, and I mean explosion.

Sometimes there can be eight days in a row with no bowel movement at all. Have you any ideas about what we can do?

She needs to work with a therapist to help process the feelings she had and the pain she felt

David replies:

WHAT a difficult situation for you and your daughter. It sounds like she had quite a traumatic time when she was 15 months old as I am sure that the tear in or around her anus was excruciating when she had to poo.

It is no wonder that she probably tried to hold it back. If pooing is painful, then it is quite a rational response.

Ironically, withholding poo intensifies the problem in that it all becomes hard and impacted in the bowel, making pooing even more painful and difficult, as the stools are larger and/or more solid.

As I am sure you are aware, the regular soiling during the day is probably a liquid, runny poo that is essentially overflowing any solid impacted mass of poo in her bowel. So she ends up leaking this liquid poo, a bit at a time, with little or no control (or even awareness).

Because her bowels are regularly full of solid poos she has probably lost a lot of sensitivity in the muscles of the lower bowel that she should be able to rely on to tell her that poo is building up.

I am not a doctor but I understand that the various medicines and products you have mentioned are typically designed to soften the stool so that it is easier to pass. However, I think your daughter has a significant fear of letting the poo come out as she has strong body memories of the pain that she felt as a smaller toddler.

This seems to me to be less of a behavioural issue and more of deeply rooted psychological block.

I don't think that behavioural training will have much success for your daughter. Indeed, you mentioned yourself that the use of reward charts and praise had little impact. I think she needs a combination of good medical supervision (to try to release the impaction and to keep her poos at a soft consistency) and good psychotherapy.

She needs to work with a therapist (a play therapist might be best given her age) to help her to process the feelings she had about that time when she had the anal tear and the pain she felt.

I would imagine that she feels nobody has a clue about how she feels and that nobody understands the real underlying anxiety she has about letting poos come out. She needs to learn (and believe) that pooing won't hurt (if the stool is kept soft with diet and/or medicine).

So, rather than passing on some simple behavioural tips for toileting, I urge you to go and find an experienced child psychotherapist, play therapist or art therapist who might help her with her fears of pooing.

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