Potty-trained 3.5 year old withholding B.M.s: Fecal Retention?

We have a bright, happy, three and a half year old that refuses to allow herself to have a BM.

Her pediatrician is aware, and all she can tell us is not to let Erin go longer than a week. So we give her a BabyLax enema once a week. We had her on Miralax and Fiber, but all that did was make a mess in her underpants as she then had no control at all over her bowels. There didn't seem to be a "magic" dose that would get her to move her bowels without leaving a streaky mess in her panties. It was holding up potty training...yet another reason we gave up on the Miralax and fiber.

I've talked with other moms that have children with this issue, and all they can offer is that she'll outgrow this eventually. I'm having a real hard time accepting that answer. My husband and I are wondering if we need to find a child psychiatrist or something. We've been dealing with this for almost two years now. Please help.

Dear Steph,
You are right to be concerned, and not to just wait for her to outgrow this. But I don't think you need a psychologist, I think you need a pediatric gastroenterologist. Let me explain.

At about a year and a half, well before potty training, your daughter stopped pooping in her diapers for some reason. (The most common reason is that kids become constipated and begin having painful stools.) Her pediatrician said that you should give her an enema if she withholds her stools for more than a week, so for the past two years you have been giving her a weekly enema. Otherwise, she won't poop. Is that correct?

My hunch is that your daughter's problem has moved beyond fecal retention, and she is physically as well as psychologically addicted to the enemas. That means that her body and mind don't know how to proceed normally to move her bowels without the enemas. That is not a situation she will simply outgrow. You will have to help her to be ready psychologically to move her bowels without the enema, but her body will also have to be weaned off the enemas.

To know how to help her psychologically, it would help to know how she handles her bowel movements right now. How does she respond to the enema? After the enema, how does she handle moving her bowels? Is she at ease about pooping now? The psychological treatment is all about helping her not to be afraid of having a bowel movement. Now that she is dependent on enemas, though, she also needs to learn how to be in control of her body (which the enemas have taken away), rather like a second potty training. The responsibility for moving her bowels needs to be returned to her.

Pediatric gastroenterologists see fecal retention with some frequency, so you should be able to find a doctor who has successfully helped toddlers with this issue. They usually have a team approach, and include psychological counseling as part of their treatment.

Please let me know if you have any problems locating a pediatric gastroenterologist, and if this situation doesn't resolve over few months of treatment. Good luck!

Peaceful Parent, Happy Kids

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