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Help! Almost 4-year old is holding her BMs
maggiejiles posted:
A very close friend of mine has a daughter who is almost four years old. She is fully potty trained, until recently, after a vacation away from her parents (mommy had to recover from surgery and daddy works a lot), she has not been been going poo in the potty. She just refuses to go, like she thinks that if she holds it long enough, one day she just won't have to go poo anymore (this is her mother's suspicion). They've tried rewarding her with candy bars and prizes. They've given her laxatives, and she is still able to hold it in. It has gotten to the point now that they have to give her enemas about every four days. Her mother can't even bring herself to administer them because her poor little girl screams so much. She says that she's talked to the pediatrician, but I guess she didn't get any good advice. I think maybe some type of psychological intervention or technique would be required here, but I just don't know what that would be. My heart aches for the poor little girl and her mother, my friend, so I was hoping to help her find some answers.
Roy Benaroch, MD responded:
"I think maybe some type of psychological intervention or technique would be required here"

I don't think a psychological approach is going to work, at least not one applied to the girl. She's convinced poops hurt because they have in fact hurt, and the longer she holds them, the more they hurt. And enemas don't help her bottom feel a whole lot better.

Her mom is exactly correct that her daughter thinks if she holds in the stool long enough, she won't have to poo anymore. This is normal magical thinking, and no psychology is going to "fix" this. On television, some magic therapist or hypnotist could convince a 4 year old to stop holding her stool, but in real life that's not going to happen.

The fix is for the parents to use enough stool softener so the stools can't be held, and keep her on stool softeners, with pudding-like stools, until she's forgotten that it was ever a problem. The exact dosage and routine should eb worked out with a pediatrician, or if their pediatrician isn't helpful, a ped gastroenterologist. This will take several months, and it will be important for mom to NOT stop the stool softeners too early. Enemas need to be stopped ASAP, as do these food and prizes for using the potty.
lestersgirls responded:
My daughter is 7. She sort of has the same problem. She was constipated all the time and it hurt so much that she wouldn't go. Eventually, the stool started leaking around the blockage and she would soil her pants because she couldn't control it. Her doc is treating her with Miralax everyday to keep her constantly cleaned out until she can learn to control her BM again. He explained to us that it would take several months to clear it up.

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