Tuesday 20 February 2018

Dear David: 'My three-year-old son is afraid to excrete in the toilet'


Once a child has the habit of sitting you can then extend the reward system by giving him a treat, or a reward that he values, for actually using the toilet
Once a child has the habit of sitting you can then extend the reward system by giving him a treat, or a reward that he values, for actually using the toilet
David Coleman

David Coleman

My son is three and-a-half. He's potty trained nearly a year and attending Montessori. He can be a bit anxious by nature, but in recent months he's become very anxious about doing a poo in the toilet.

He hides, refusing to go to the toilet and holding it in. We are very supportive and encourage him. He eventually goes after many attempts of holding it in. He does soil his clothes from time to time. Currently he has been four days without going. I've tried lots of foods to help soften his stools. Have you any tips or suggestions to get him back on track?

DAVID: If I had a euro for every query about pre-schoolers and poo that has come my way over the years, I might not be rich, but I'd certainly be taking a nice holiday!

Given that your son has been holding back his poo, regularly, there is a possibility that some of his poo has become impacted in his intestine and bowels. So, your first step is to take him to your GP to get him checked out physically.

The occasional soiling that he experiences might be what is termed "overflow soiling". You can tell overflow soiling because it tends to be runny or liquid-like poo and may be more like staining in his underpants.

This overflow soiling occurs because poo is building up behind the blockage that may have been created by your son's holding back of his poo. Some of the poo, if it is runny, can leak around the blockage and into his pants.

The other kind of soiling he might be experiencing is that his lower bowel, the rectal part of his colon, can become distended as it is so full of poo waiting to come out. Normally when our rectum stretches, it gives us a strong signal and urgency to poo.

However, if he is deliberately over-riding the sensation of readiness to poo, by holding back, the extra stretching in his rectum can cause him to lose the sensitivity in that area such that he might not then be able to recognise the physical signal that he needs to poo.

In such cases, children can poo by accident without even noticing that there was poo ready to come out.

Your GP may be able to identify if any of these physical issues are present for your son, or she might be able to refer you to a specialist.

Once you get some insight into the physical effect of his withholding, you will be clearer about what to do next. Medication to help release blockages and re-establish a regular cycle of pooing might help.

However, medication might not be necessary as long as he is able to pass the withheld poo with ease.

It could be that, if he has held back poo for several days, it might then be quite painful when he does let it come out. He may just be avoiding this discomfort.

I am interested that this anxiety about using the toilet only began a few months ago. Can you recall anything distressing or disruptive that may have happened in your family or in his pre-school at this time?

Had he any soiling accidents or slips while sitting on the loo?

It may help to know why this anxiety developed, although he is probably best helped by introducing a positively focused behaviour reward chart for him and getting his toileting back into a regular rhythm.

With such a behavioural system, you sit him on the toilet about 20-30 minutes after every meal. He gets a small reward (a treat of some kind) for every occasion that he sits on the toilet, ready to do a poo (i.e. with his pants down) irrespective of whether he poos or not.

You can chat to him and distract him for five minutes or so, while he sits, giving him lots of encouragement and maybe reading to him to occupy him.

Having a relaxed experience of sitting on the toilet, with no expectations of him, may get him over the worry or anxiety that he seems to experience from simply sitting on the loo.

Once he has the habit of sitting you can then extend the reward system by giving him a treat, or a reward that he values, for actually doing a poo in the toilet.

Being patient and positive with him, and allowing him to feel comfortable to poo in his own time, should help him get this next developmental step of independence and control.


Our 13-year-old daughter has been upset since October. She became anxious, crying going to school and being unreasonable at home. We have established that it was the Christmas tests that brought it all on. She still has weekly class tests and they totally overwhelm her. She has dyslexia and we feel she is trying too hard. School and study have become all-consuming. It's torture watching her studying for these tests and being so unhappy. How do I get her to realise that exams are part of the system, and not to be so anxious over them?

There are a couple of things to consider for your daughter. It does definitely sound like she has become unbalanced in her approach to studying, dropping everything in favour of the books.

However, I also wonder about the explicit and implicit messages she is taking from her teachers and the school ethos. If there are weekly class tests it sounds like there may be a high academic focus in her school.

It isn't a bad thing for schools, parents or students to focus on academic effort, but it can become very negative when academic achievement becomes the focus.

I'd be interested to know how her new friends in school (I'm assuming she has just started in first year this year) approached the Christmas tests? Could your daughter have tuned into a wider-spread mini-hysteria that can develop in a group of students, especially girls?

But her own personal response (to work really hard), even if not matched by her friends, is still probably based on her perception of what is expected of her. Perhaps your daughter picked up an expectation, maybe unspoken, from her teachers or from yourselves.

This has then triggered something inherent in her and her own need, perhaps, to achieve. It is like she has internalised a set of really high standards for herself and this is motivating her to work too hard.

There is no doubt she is working too hard. The level of distress and unhappiness you describe suggests strongly that her perception of the work she must do is out of proportion to what is actually needed.

I don't know how your daughter did in her Christmas tests, but if she did well, then an ironic consequence (having worked really hard) is that she may be afraid, now, to let that performance slip and so is driving herself harder than is necessary. So, to rebalance things you need to help her to focus more on the effort she puts in than the outcome she gets.

I wonder how the school deals with the weekly tests? It is worth speaking with her teachers, to explain her anxiety, and how they might be able to help by reducing the importance of these tests and/or stop giving results back about the outcome of them.

It will also be a good thing if her year head, or vice principal, could, in agreement with you, give her strict "maximum" hours that she is allowed to spend on homework and study.

The idea of setting a limit on her working time is that she can then congratulate herself on the fact she is working to what is explicitly expected.

She will be doing exactly what is required of her and you have a stronger position to say "stop" to her at a set time each night. Without that kind of an external limit she can (and probably does) argue that she "needs" to work more because otherwise she won't be doing enough, or as much as everyone else.

With clear time allocated for school work in the evenings, you can keep her involved in other extra-curricular activities since that, too, will help to balance things for her. Sport, especially, or exercise of any kind, will help her mood and her stress levels.

So far, she doesn't seem to believe you when you tell her about the need for balance and for keeping things in perspective. If this continues after the school supports you in telling her to reduce her study time, then get other people in your extended family or friends to reinforce your message.

If she hears it from enough people, she may start to believe it!


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