Constipation While Potty Training - A Power Struggle?

I wanted to post as much information on potty training as I can because I know this is such a big issue for parents. We all appreciate connecting with other parents going through the same issues. It's nice to know we are not alone. Here is the full e-mail conversation I had with one mom about her daughter holding her bowel movements until she felt pain.

Here is the in-bound email:

Alyson,

I'm actually writing because I have a question regarding my daughter who will be four in May. I have a second baby on the way, due in April, and a couple months back seemed to finally lick a couple of issues that I was anxious to clear up before the baby came. First, we finally got our daughter to willingly agree to getting rid of her soother back in November. Then in early December, she decided she didn't want to wear pull-ups to bed anymore and promptly began doing number-two in the toilet during the day instead of holding it in all day and waiting till early morning or late at night to go in her pull-up.

In the past, she has had some issues on and off with avoiding number 2, pushing it back in, and a couple of times going for days without having a bowel movement. I think it really turned into a cycle - the longer she went without going, it got more uncomfortable, to the point where when it actually did happen, it hurt so much that it only confirmed her fears. Why she would suddenly begin to resist a bowel movement out of the blue after weeks of no issues remains a mystery to me.

Anyway, about a week ago, we had been going for 6 weeks with no pull-ups at all and no issues with going to the bathroom. When suddenly one day, we could tell she was resisting a bowel movement and instead, went in her bed that night. For the next 6 nights, she went in her bed and on the 7th night we put a pull-up on her at bedtime. We're on about day 10 now and I have resorted to giving her a child's dose of ex-lax (which eventually does work - but at night only).

I'm afraid this has become a power struggle with us. She knows we want her to go on the toilet, and not in her bed. When she spends a whole day wiggling and whining to the point where she is clearly in pain and refuses to eat or sit up in a chair, it's pretty frustrating! We've had some bad-parenting moments when we've given threats, or promised rewards, we've also tried to just ignore it. I've tried to be angry and firm, or friendly and easy going. Nothing is working and we have no idea what to do! I hate to see her in pain, and have tried to explain what happens to your body when you don't let the poop out! Nothing works!

Just so you know, her diet is very good. She eats all vegetables, even broccoli and salad, meat, fruits, grains, whole grain cereal every day, milk, drinks water with meals, occasional watered down juice, etc... I can't imagine it's anything in her diet that's doing this... and our paediatrician has recommended a laxative jelly which softens stool but doesn't seem to break the pattern.

I thought we had it licked when she started going in the toilet, but I guess not! Friends have said this could be because there's a baby on the way, but she seems to excited about the baby, I can't imagine that being the case.

Can you help?

Thank you so much in advance!

Here is my reply:

Hi A,

As for your daughter - she is about the fourth 4 year old that I have helped out that holds their stool until pain. I had one little guy go once every 4 days or so, and he too would stop eating, sitting and he even would vomit from this... Amazing will over the body eh?

I suggest you continue regularly with a stool softener (nothing as hard as ex-lax though - milder - like prune juice or the one your doctor prescribed if she'll take it willingly without a fight).

That will keep the hardness of the stool passage from being a factor while we figure out the psychological aspect. Keep with it unless she gets the runs, but for now, nice soft stools are good.

I think you are correct that there is a power struggle happening. It wasn't power in the beginning, but it became one somehow - perhaps with the parental involvement in solving all the accidents that erupted.

We don't need to figure out the past, we only need to look at the present and the usefulness of the behaviour now. How does this behaviour serve her? In power, it re-asserts the message "You can't make me" and "I'll do it my way, when I want - I am the boss of me".

To use the toilet has now been established as what you want and so she feels like if she does use the toilet she will be "losing" the fight to you.

So - basically - back to square one: to end a power struggle we have to change our internal state. We need to decide that we are not concerned what choice our child makes, have faith that she is a typical little girl who sometime before the age of seven, will decide for herself the benefits of not sitting in her own feces and faith that she will come to prefer the toilet to a diaper in her own time and way.

She seems to not want to be potty trained at the moment. For _whatever_ reasons, she has taken a step back in the process, and you have to be okay with that.

Stop training

• Go back to pull-ups and changing poppy pants but NO talking about pooing or peeing.
• Don't ask her if she would like to go.
• Don't suggest she "try" in case it makes her tummy feel better, etc...

No talking / discussion / reminding / nothing ... It is a non-issue.

Put potty training in the "parking lot" for a year.

The idea behind this is that whenever parents really stop taking an interest, the child no longer feels you are "trying" to "make" them. They don't feel manipulated into behaving the way you want them to so the power struggle ends.

The baby's arrival could play a part, but usually it is after the baby is born when mom is busy changing the babies diapers that the older child mimics being "needy" and "helpless" like the baby, since the baby seems to be given such importance for his "inabilities" - the older child gives it a try too. Freud thought they "regress" - not true. They are experimenting with ways to be important. I hope this helps.

Her reply:

Hi again Alyson,

So I think it's been a week since I wrote you, and we have really put your advice into practice. Almost immediately, our daughter got back to going in the toilet and a few nights ago asked not to wear pull ups at night anymore because she goes poop in the toilet!

I don't know if it will stay this way, but our approach will remain the same!

I can't thank you enough for your advice!!

Comments

[Liz]

Hi Alyson - I have a 3.3 yr old girl - strong willed - she is potty trained to pee on the potty - but refuses to poop on the potty. She occassionally has pooped on the potty - praise praise praise - but regresses. She has struggled with constipation since she has started to eat food, i.e. 4 months of age. She is a good eater, salads, etc. - peppers and celery are two of her favourite veggies. She is in a pre-school where she will be moved into a class with 3, 4 and 5 year olds in January - all of whom use the bathroom, without reminders. I still remind her to use the potty, even for pees. Re constipation she refuses to take laxtulose anymore (doctor recommended) - her fibre has been increased.

I feel at the end of the rope - so frustrated - I am frustrated for her.

Any suggestions?

Liz

[Alyson Schafer]

Hi Liz,
The statement " I feel at the end of the rope" is very telling becuase those feelings of defeat is what signals to me you've been fighting with her over this, and that she has "won" by holding her bowels and not training! So, to her way of thinking, using the potty and progressing is some how, "loosing" the fight she's been having with you.

We want her to use the potty, and we have to show her its not "losing" or "submitting to your will" when she does. How do we do that? By dropping the topic ALL TOGETHER!

Keep up the water / fibre but don't MENTION or REMIND her about the potty again. Its not helping anyways, and in fact its part of sustaining the problem. So say nothing, and help her clean up accidents without talking about it. Stay pleasant.

After a few months, she'll probably be interested in trying again - if only to keep up with her classmates ( although, most kids will prefer to have their bowel movements at home rather than school)

Hope that helps!
Alyson

[Alyson Schafer]

Hi Liz,

No doubt the younger sibling is seeing her sisters resistance and notices that you would LIKE her sister to use the potty, so she tries to please you by showing you that she can!

I suggest you keep all potty training enthusiasm on the low-down, ie - no need for the HUGE PRAISE PARADE, just a simple high five or " You really know how to look after you body" is enough.

If she wants to potty train - let her. However, don't start asking and reminder her too! Its simple their right to use either their diaper, the toilet or the potty. If they want to sit on the potty, so be it. Help them learn how to pull their own pants up and down, but let them take the lead.

Hope that helps!
Alyson

[Claire]

Hi Alison,

My three year old has been peeing in the toilet for many months but continues to poo in her diaper/pull up during nap or at night. If I have seen her trying to hold her poo during other times, I will sometimes give her a diaper and other times just let her deal with it (I go back and forth about the right approach). If she ever asks for a diaper however, I always give it to her, I don't want her withholding and getting into constipation issues. Now she is starting to really soil her panties. First it was just a little, now quite a lot, a few times a day. It is like she tries to withhold but can't and ends up with a few little accidents a day in her panties. Not sure if I should just go to pull ups for a while and not make a big deal at all. Just try to be completely disinterested and be pleasant but not really even comment about the accidents like you suggested to others? The other thing which is kind of bizarre is that she only seems to go poo standing up in a very clenched position. Going poo, even if the bowel movement is soft, seems to be such an effort and can take numerous tries over a period of an hour maybe more. She stands with her little legs very stiff and cross legged and leans over on an angle. I have seen her do this at night, while sleeping, she will stand up into this position, go poo and then lie back down. I wonder if the position makes it even harder. When I have asked her about pooing on the toilet she often says she doesn't know how.

Your thoughts would be greatly appreciated.

[Alyson Schafer]

Hi Claire,

This is one for the pediatricians first. I would want to rule out some kind of bowel obstruction. Moving one's bowels does require activation of pelvic floor muscles and toddlers who are accustom to pooing standing up can find it hard to figure out what is happening physically when they are trying to move their bowels in other positions. That is why its recommend they have something to plant their feet on when having a bowel movement. I do recommend you go back to the pull up so she is free to manage this anyway she seems fit until you get her check out at the Dr.

Let me know what they say and we'll take it from there!
Alyson