Q. Our 3-year-old daughter was recently potty trained. She has done well with the process overall, but she is no longer having daily bowel movements. She also cries when she feels the urge to stool and says, “No poo-poo.” What can we do to help her through this?
>A. Constipation is a common complication of potty training. Before toilet training, toddlers will typically allow stools to pass as soon as they feel the urge. Once the toilet training process begins, they often begin to hold their stool, either out of fear of the potty or because they do not want to stop playing to go potty. When the stool stays in the last part of the colon and rectum, water is resorbed into the body, creating hard stools that are painful to pass.
Once a constipated child finally has a bowel movement, it can be painful, and this creates a fear of future bowel movements. The situation is self-perpetuating because anxiety about having bowel movements will result in more holding behavior. Over time, the colon can become stretched and lose elasticity, leading to worsening constipation.
The treatment for constipation is a multifaceted approach. First, your child’s diet should be reviewed for excessive intake of constipating foods such as milk, cheese and bananas. Dietary fiber and fluids should be increased. Parents need to remove any pressure or stress related to potty-training. Never use punishment or physical force in the potty-training process. Encourage your child to sit on the potty, particularly after meals. Provide a more positive potty experience by reading books or working puzzles with her as she sits and rewarding her with praise.
Many times, constipated children will also need a stool softener as a part of their treatment plan. Stool softeners work by increasing the amount of water in the stool, and this makes the stool easier to pass. Stool softeners should be continued until your child is consistently having one or two soft bowel movements per day.
Children who are experiencing chronic constipation or constipation with fever, vomiting or irritability should seek medical treatment.