Let’s talk about withholding. If your child holds in their poop, you probably know this scene all too well.
You know they need to go. They know they need to go. And yet, they are resisting with every fiber of their being. They hide in the corner. Clench up their body. Ask for a diaper. Run away or have a meltdown at the mere suggestion of going poop.
It’s maddening, heartbreaking, and exhausting all at once.
But when it comes to withholding, there is a reason behind it. Let’s figure out why your child is withholding and how to help them poop regularly and comfortably.
Why do children hold in their poop?
There are several reasons a child may refuse to poop and there may be more than one reason happening at the same time.
Pain
Perhaps your child had a really painful bowel movement in the past, and now they’re afraid the next one will hurt too. This is very common, especially with children that have had constipation.
Sensory discomfort
For many kids and especially kids with autism, this is a big factor. Maybe the bathroom feels chaotic. Especially in a public place (like school) with people in and out, loud noises, big smells, automatic flushers – lots going on.
I also want to mention the sensory overwhelm that can come with toilet training. Your child might feel unstable on the toilet seat. They might prefer standing up to poop. Big changes like potty training can be stressful and lead to withholding.
Embarrassment
This can be another big factor when it comes to withholding in public places like school. Many kids really need privacy in order to relax enough to poop.
Pelvic Floor Dysfunction
Many children and especially kids with autism, have trouble relaxing the muscles needed to actually get the poop out. They may try to go but their body can’t coordinate the process well.
Ignoring or Not Noticing the Urge
Some children, including many autistic children, have trouble sensing their body’s internal cues. This is called interoception. These children may not recognize the feeling of having to go or may only feel it when it is urgent.
This can also happen after a child withholds for a while. The rectum stretches and because of the increased space, the sensation of having to poop is less strong. The rectum can go back to normal size if constipation is resolved.
If you have a child that gets very engrossed in what they’re doing, they may not recognize that they need to go- or they may do their best to ignore the urge.
Did you recognize your child in any of these? Most parents do, and that’s why typical constipation solutions don’t work. Withholding requires a different approach.
My Guidebook to Lasting Constipation Relief shows you exactly what to do when:
- They scream, cry, or run the second you mention the potty. Learn how to take the pressure off without losing all your progress.
- You can’t tell if it’s pain, sensory, or something physical. Spot which type of withholding you’re dealing with, and how to address each one.
- Their whole body tenses up, and they just can’t let go. Help them regulate and relax so pooping finally feels safe.
- They’ll only poop in a diaper, in one bathroom, or at home. Gently build flexibility so they can go anywhere.
- They hold it all day at school. Learn how to overcome this, so they’re not miserable by pickup.
What happens when a child holds in their poop?
When a child repeatedly withholds stool, it sits in the colon longer than it should. The colon continues to absorb water from the stool and it becomes harder, drier and more difficult to pass. This can lead to painful bowel movements.
So pain may not be the initial reason your child is holding their poop. But it can certainly become a major contributor.
And chronic constipation has far reaching effects. I hear from parents so often: their child is uncomfortable, not hungry and not eating well, not sleeping well because their belly hurts.
All of this affects their ability to learn and get the most out of school, activities, and therapies.
It can cause massive stress for parents and greatly impacts family life.
When to call your child’s doctor
- Your child hasn’t pooped in a week or more or their poop looks only like small rocks or pebbles
- Pooping seems painful, or your child cries or is afraid to go
- Withholding has been going on for weeks or months
- You see liquid stool or smears in underwear (this can indicate that there’s a hard, compacted mass of stool in the rectum and soft, liquid poop is leaking past it)
- Your child has a swollen or very sore belly, a poor appetite, or is losing weight
Go to urgent care or the ER if your child has severe belly pain, repeated vomiting, a fever, a large amount of blood in the stool or black, tarry stools.
What the doctor may recommend
Your child’s doctor may suggest an at-home clean out, to clear out backed up stool, followed by daily Miralax (polyethylene glycol) to keep stools soft. This is the go-to approach for many doctors in order to get the stool soft enough to pass easily and avoid further backups.
If you’re not comfortable with Miralax, or you’d like to know what else is available, there are other options which you can talk through with your child’s doctor. In Your Guidebook to Lasting Constipation Relief for Your Child, I explain natural ways to soften stool, when Miralax may be appropriate and how to wean off it without backsliding into constipation, which supplements can help and when they’re appropriate, and how to help your child poop comfortably in a diaper or on a potty. You can also read more in my post on natural alternatives to Miralax.
How can you help your child to poop comfortably and regularly?
The first step is to figure out why they are withholding. I’ll use an example here and walk you through the steps.
Let’s say you notice your child holds their poop because they struggle with transitioning away from an activity they really enjoy. Let’s also say that you’re trying to potty train and they refuse to poop on the potty, so they hold it in.
This has been going on for months and now pain is a factor too.
What can we do?
1. Reduce the pressure.
Take a step back from potty training. We need to make pooping feel safe again. We want to praise any poop that’s happening, even if its in a diaper. We can slowly try again with potty training later and maybe attach perks to the process – some extra tablet time during potty sits.
2. Make sure the stool is soft and easy to pass.
If pooping hurts, your child will continue to hold it in. This step is essential to breaking the withholding cycle.
DO NOT automatically increase fiber. Fiber is not always the answer! Increasing fluids is far more important and if you increase fiber without increasing fluid along with it, constipation will get worse! There are many ways to soften stool and I share these in this blog.
3. Create a predictable pooping routine.
We can’t force them to poop. But we can give their body and brain a predictable opportunity to do it. This helps with transitions as well because the child knows what to expect and when.
4. Work on transitions.
This could mean giving advance notice, using visual schedules and timers to help the child understand that we can come back to our fun activity (play, poop, play). I also love rewards for moving from one activity to the next. Occupational therapists can be incredibly helpful with working on this skill.
You may be thinking, “Ok yeah…but how do I actually do this for my child?
How do I soften the stool?
What should the poop schedule look like?
How do I tackle potty training when the time comes? How do I know my child is ready?
What do I do when my child refuses?
I need details.
This is why I created Your Guidebook to Lasting Constipation Relief for Your Child.
It takes these concepts and walks you through exactly what to do and how to do it.
You don’t need to spend thousands of dollars to get to the bottom of this struggle and how to resolve it. You need a plan. You need both the steps and the explanations.
And you need to know what to do if something doesn’t go according to the plan. (Yes I include lots of troubleshooting because what kid follows the exact plan?)
That is what’s in this guide. [Get the Guidebook →]
“As a mother of a 17 year old severely autistic son with chronic constipation, Elisa’s guide was life-changing. We were able to pinpoint what was behind my son’s withholding and learn how to fix it. He needed a combination of extreme privacy, more fluids (which I never expected because he drinks lots of water) and stool softening help. Elisa’s compassionate approach to this delicate problem is a testament to her dedication. I’m so grateful for this and my son is feeling better and regular.” — Adriana Hall, NY
Childhood constipation is extremely common and withholding is a major piece of the puzzle for many children. We need better understanding and better solutions – and that’s what I’m hoping to provide you.
Don’t let constipation hold your child back.
If you think withholding is only a piece of your child’s constipation puzzle, take my free constipation root cause quiz to find out what else may be driving your child’s constipation. Once you understand the cause, you can build a targeted plan to best help your child.
