This post may contain affiliate links. Read more on my disclaimers that is listed at the bottom of this page.
Oh my gosh, mama. If your child won’t poop in the toilet, I feel for you. I really do. I have so much compassion for you because I know how hard it is to have this particular potty training issue. In fact, it’s the reason that potty training is my single, most hated milestone. I guess it’s a love-hate relationship, really. I mean, I want to stop buying diapers and changing them. But the challenge I have faced when potty training one child in particular has been exhausting, to put it lightly.
I have been in your shoes; scouring the internet for the reasons why my son won’t poop in the toilet and how I can encourage him to do so. I tried sticker charts, cheering and celebrating small victories. I tried having reward parties and toys lined on the mantle he could earn. And I even tried going back to pull ups. It felt like I tried anything and everything.
None of my other mama friends understood, either. They would suggest one of the many things I had already tried and I could see the disconnect in their eyes. I don’t think they believed me that I had already tried what they suggested. It was obvious they couldn’t comprehend just how challenging our experience was proving to be. This is probably because it last for over two years.
During those two years I cried a lot of tears and I cleaned up a lot of poop. At times I got angry at my son. I was sure he was choosing to make things this difficult. But then the look in his eyes would remind me that he was having just as hard of a time as I was. More so, in fact, because no one wants to go through what he was going through.
At the doctor
As you can imagine, I was at my wits end. I had mentioned our challenges to my son’s pediatrician and we had discussed his diet. I agreed this was a great place to start, but from our discussion, it seemed like we were doing pretty well in the diet department. However, I kept trying to figure out how to make dietary adjustments to encourage his ability to poop.
I found a description that gave me some insight as to what might be happening with my little boy. It included:
- Inability to poop even when the urge is there
- Lack of awareness when a bowel movement is happening
- Poop smears in underwear because poop is leaking out
- Lack of success pooping on the toilet despite compliance, effort and rewards
- Extreme discomfort and pain due to constipation (we had even been to the hospital during one episode when he was in a lot of pain for 12 hours. 12 hours! My poor boy!)
This is a list of symptoms for a condition called encopresis. (source) After reading about it I made an appointment with our pediatrician again and suggested we were dealing with this. And we were!
What Is Encopresis?
Result of holding stool
Encopresis is the result of holding stool. This usually occurs when a child has had a bad experiencing, like having a painful bowel movement. This can happen before or during potty training. In our case, it was likely while potty training right after turning two. For children who deal with this, after the painful experience, the child chooses to hold the stool instead of pass it. Or, the child experiences constipation and instead of pushing the painful stool out, they hold it. The child then gets into the habit of holding stool long after the constipation or the painful experienced has passed.
After doing that for a rather long period of time, the colon is actually enlarged because it is continually holding stool. When this happens, the child loses the natural urge to pass a bowel movement. This makes it very hard for them to know when they need to even get to the toilet to poop. This was probably one of the most frustrating parts of our experience. I would regularly take my son to the toilet and we would sit there…for a looooong time. Nada. He’d get up and sometimes within only several minutes, he would have pooped his pants. It was driving me crazy and I felt so discouraged. More importantly, it was so defeating for my son who was trying so hard to not disappoint me. But it was actually out of his control.
Another challenge of the condition is that as the hard, withheld stool is sitting at the bottom of the colon, fresh and looser stool seeps around it and leaks into the underwear. Many parents think that this is the result of poor wiping on the child’s part and often throws parents off of finding out the real problem. In our case, I actually thought it was my son trying to withhold his stool purposefully. That wasn’t true but at the time, I couldn’t figure out what else it could be.
Other articles you may enjoy:
Treatment Of Encopresis
Typically the treatment of encopresis is done at home, but under the advisement of your child’s pediatrician. The good news about this is that there is no big medical event or expense. The bad news is that encopresis takes quite a long time to sort out as you allow the colon to shrink back to normal size, for the anus to regain ability to know when passing stool is needed AND for the behavior of withholding to change. It can take several months to get your child on track. It will obviously take longer in younger children than in older.
The real challenge is that encopresis is not only a medical situation nor is it only a behavioral situation. So, you have to come up with a combination solution, really. You have to deal with the medical situation of a stretched colon and possibly constipation as well as the behavior that led to the problem (withholding stool).
Empty the colon
The first step is to deal with the compact stool that is sitting at the bottom of the colon. This can be done with an enema or suppository (or a series of either one).
Establish regular soft and painless bowel movements
Next you need to help ensure the child will have soft stool so as to avoid any painful bowel movements. In our situation, our pediatrician put my son on a Miralax protocol. We found this did not soften the stool enough and even after months of the protocol, we were struggling. So, I added in a daily dose of Ex-lax and Benefiber after learning this was a normal protocol in some other cases. This did the trick and helped keep my son’s stool soft enough that it wasn’t painful for him. It also made it very hard for him to withhold stool, which was the goal. Gotta keep that colon cleaned out!
Once we had the soft stool happening for a few months, I didn’t want to continue putting all of the above mentioned items in my son on a daily basis. I knew his little system needed to be able to do what was required on its own for long term success. So, we transitioned to fiber gummies. We did this for a few months and as my son was totally successful. So, I weened him off the gummies and he is rocking it! As is his colon!
Keep a good routine
Finally, you must focus on the behavioral side of things. Withholding stool led to the problem so you must deal with that behavior after clearing the colon and helping the stool remain soft. One way you can do this is by establishing a good routine of sitting on the toilet 10 minutes after each meal. This is a time the body naturally wants to have a bowel movement, so capitalize on it. We would give our son a couple books and I would even sit with him during this time. On occasions when I couldn’t sit with him I would allow him to watch a show on my phone. This was a real treat for him.
By the time you’ve reached this stage in the treatment process, you can also try a reward system. Offering a three part reward system could be a great option.
An example of this could be with M&Ms (source)
- 1 M&M for sitting on the toilet
- 2 M&Ms for peeing
- 3 M&Ms for pooping
You could use any treat your child really loves to do this. You could also do any sort of reward system that would motivate your child. In our case, little reward was needed, really. My son hated pooping his pants and not being able to use the toilet like he knew most 4 year olds did. For the most part, that was his motivation. However, we still used the methods I mentioned above (book, my company, show on my phone) to both encourage him and reward him for how hard he was trying.
I’m so happy to report that as you read this, we are no longer dealing with encopresis. My son is able to tell when he needs to use the toilet to poop and never passes a full bowel movement into his underwear. He will occasionally not make it quite as quickly as he needs to, but this is more so a normal response of not wanting to stop playing to use the toilet. So, this is a behavior issue and no longer a medical issue.
If you have a child dealing with this, I know how frustrating it can be. There was a time I cried over my son’s situation on a daily basis. He is the third of four children, so I have many other things I’d rather be doing than cleaning up poop after a 3-4 year old. I was also changing the baby’s diapers and had an expectation that I should not be dealing with any one else’s bodily functions by that time!
Despite the challenge you may be facing in dealing with a child who is experiencing encopresis, I want to encourage you! Look down at that sweet child and take a moment to consider how they are feeling. They can see how frustrated you are. They likely know they shouldn’t be pooping their pants and feel frustrated by it, too. And their body is basically betraying them in a way. They don’t have the control they need to get to the toilet when they need to poop. So, be gentle.
Once I had a better understanding of what was going on with my son, I explained it to him. I told him that his body was made to eat food, get all the good stuff from it and then put it into the toilet to make room for the next meal. He understood that and worked really hard on the behavior side of things while we let the various fiber supplements do their job over several months.
I also told him that we were a team. I told him that he and I would be able to make this better by working together. He really liked being a team about it. I wanted him to understand that even when I got frustrated cleaning up poop for the third time in a day, I still loved him. I still wanted to be on a team with him. We were going to figure it out together! That went a long way with my son. He didn’t feel alone or ostracized because of the situation. We used it to come together and it strengthened our relationship while we strengthen his colon! Ha!
Alright, mama. I hope this has been both informative and encouraging! I know what you are going through and I feel for you. Use this information and story to know that there is light at the end of the tunnel. You’ll both be ok. And hopefully you can be your child’s biggest supporter during a time they probably aren’t enjoying either.