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Stool Retention

Stool retention is a psychological condition that affects toddlers and young children, particularly boys. Distinct from constipation—again, stool retention is a psychological condition rather than a physiological one—it tends to perpetuate itself, because the parental attention that it generates makes matters worse.

If you haven’t been affected by stool retention, it can sound like a joke. What child refuses to go to the bathroom? Trust me, this isn’t funny. The problem can take on almost operatic dimensions, as the entire family ends up obsessed with the kid’s bowel movements. It’s usually associated with constipation or high-pressure toilet training, which further reinforces the retention problem.

How does it start? Well, at the infant stage, defecating is relatively effortless and painless. Then the poops naturally get bulkier, and therefore pooping becomes slightly more painful and involved. This condition is even more pronounced in modern societies, thanks to the excessive starch in the average toddler’s diet. The pain of defecation is followed by relief; most kids remember only the relief, but some kids are particularly sensitive to this new pain and become afraid of defecating. They delay pooping to the point of urgency, which only increases their pain. The next time they have to produce a stool, they grow even more apprehensive, holding it in even longer. That’s how the cycle starts.

Parental intervention now comes into play. You naturally don’t want to see Jimmy in pain, so you try to help out any way you can: encouraging him to push, massaging his belly, giving him juice or another sweet substance as a laxative. This can actually worsen retention by rewarding the problem with retention. Urgency leads to pain, which leads to more urgency, which leads to retention, which leads to more retention. As time goes on, Jimmy will monumentalize the pain and fear of defecation, and these worries can persist for years if you don’t break the cycle.

As I have said, children with constipation are more prone to retention, as are children who are subjected to toilet-training pressure. In brief, anything that makes a child hyperaware of his own defecation can contribute. If you deal with the cycle reasonably at this stage, it should go away. Otherwise, you, too, may be in for a long and painful process.

How to Prevent Stool Retention

  • When Jimmy first experiences discomfort with bulky stools, let him figure out that he will have to endure some pain, either then or later, since there’s nothing you can do to make things better for him.
  • Do not pressure him during toilet training [See: Toilet Training].
  • Prevent constipation, which usually means avoiding bread, pasta, crackers, and dry cereal. My experience is that high-fiber starches won’t help kids, because they’re still bulky [See: Constipation].

How to Treat Stool Retention
If you are past the preventive stage and your child is already experiencing mild or moderate stool retention, it’s a bit of a challenge to reverse the cycle. To be successful, you need to remove yourself completely from this issue. Your involvement only validates his fears. Since you can’t defecate for him, stool retention is his problem, not yours.

WHAT TO DO

First, alleviate Jimmy’s constipation if he is prone to it. Keep the starch intake to a minimum. To help soften stools, your doctor will prescribe a temporary laxative, but as soon as the problem subsides, taper off the medication to avoid developing a dependence.

The next step is to ignore the problem. I know this is difficult. You may fear the intestine cannot take the strain of the distension, but rest assured, when Jimmy has to poop there is one outlet available and Jimmy knows perfectly well what to do to relieve the pain; he just has to overcome his fear. If you aren’t hovering or asking questions, he’ll notice that the drama has disappeared and start wondering why he made such a big deal in the first place.

WHAT NOT TO DO

Don’t schedule Jimmy to sit on the potty daily. If he doesn’t have to go, he won’t be able to, and the feeling of failure will become further entrenched.

Don’t reward or bribe him when he does go. This can become a source of reverse pressure; when he doesn’t earn the reward, he’ll feel like a failure.

Don’t greet the eventual appearance of stool with excitement or relief.If he doesn’t overcome his fear the next time and you’re no longer leaping with happiness, he’ll feel like a failure again.

Don’t get upset. This will only reinforce his mental block.

There is no quick fix for stool retention once it has set in. Arm yourself with patience, because it takes several weeks to improve this condition, and it can be very stressful for you and your child. This is one situation where the best parenting is no parenting: You have to keep up the appearance of a laissez-faire attitude even if you don’t feel it. But don’t fret; it will work itself out: by him, of him, and for him.