Children of all ages may resist the urge to poop.  This may cause back-up of stool, causing constipation or a stool impaction.  Stool holding may be due to fear of pain with stooling, a power struggle with the parents, or embarassment using public toilets.  When the child becomes constipated, difficult & painful passage of stool becomes worse and this in turn makes the stool holding behavior worse.  Here are some tips to help with this common problem.

1.  Assign frequent "potty times."  The child must sit on the toilet for about 10 minutes 2-4 times per day.  This should be done within 30 minutes after meals, since the body has a natural reflex that increases movement of the bowels after meals (the gastrocolic reflex).  Remind the child that this is not a punishment.  It is the childs "job" to make poop everyday.  Make the potty time a fun time... let the child hold a book or a toy.  The potty should be comfortable and the child's feet should touch the floor (use a bench to rest the feet on, if necessary).

2. With the help of your doctor, make sure there is no fecal impaction.  Fecal impactions must be cleaned out completely with medicines prior to treating stool holding behavior.

3.  Keep the stool loose.  See Constipation.  Treatment with a medicine (like GlycoLax™ or MiraLax®) may be necessary for several months.

4. Don't pressure or criticize your child.  Avoid the power struggle.  Give incentives for using the toilet.  For young children, try food treats such as marshmellows.  Or make a "Poop chart" to put on the refrigerator or wall.  Give the child a star and a lot of praise for stooling in the toilet.

5. If the older child is leaking stool in the underwear from a fecal impaction (See Constipation), have the child help with the laundry.  Sometimes becoming involved in the clean-up process is helpful.  Many children will hide soiled underwear.  Don't punish this behavior but talk about it openly.  Remind the child that this is a very common problem, but you need the childs help to make it better.

6.  For early potty-training children, it is frequently a good idea to postpone potty training for several months to take the pressure off the child.