QUESTION: I have a three-and-a-half-year-old daughter who I have been potty training for the past year. Although we have made good progress with her doing her wee, we are facing constant setbacks with her doing her poo.
She gets herself into a situation whereby she holds it for as long as she can, which results in her becoming very anxious. She can last up to three or four days without going and can often soil herself a little bit. She only goes when she really has to.
We are strict with her diet and don’t believe that this is a factor. We have tried reward charts, letting her sit on the potty with a book to help her relax, but nothing seems to really work.
When she was two years of age she got badly constipated, which resulted in a doctor having to give her an enema. This, I believe, is where her fear stems from as her problems with doing her poo began around this time.
She is starting Montessori next month and I really want to address this issue before then as I don’t want it affecting her in school.
Can you please help? I don’t know what else to do.
ANSWER: Soiling problems are quite common among children. Encopresis is the technical term used to describe it. Primary encopresis refers to a situation where a child has never really learnt to use the toilet for poos. This is most often because of the way the training was handled, or because a child built up some negative association with the toilet and so never liked to use it.
Secondary encopresis refers to the situation where a child had successfully trained and learned to use the toilet without accidents and then at some later age begun to soil. It is more commonly caused by some emotional upset or emotional difficulties that a child experiences.
Your daughter seems to have a mix of the two kinds.
Irrespective, her difficulties doing her poo sound like they are entirely psychological and emotional and linked to the enema that she experienced.
The issue is not with using the toilet, rather it is with the act of pooing. Her problem seems to be a psychologically maintained constipation. It seems she consciously refuses to pass a stool, creating a blockage.
The soiling is probably of a very runny consistency and is essentially a leakage of faecal liquid that has managed to get past the blockage. Consequently she will have little control over the soiling.
So I think your focus should be less on the soiling and more on trying to help her get past her emotional response to the enema.
Imagine what the experience of an enema was like for her at age two.
She probably had some pain from the constipation and then she had some strangers putting a tube up her bottom and then the feeling of uncontrolled purging that comes with an enema.
I would imagine that, psychologically, her response to that feeling was to tighten everything up and to try to be as controlled as possible in the future. It is as if the experience of the enema has led her sphincters (we have two in the anus) and bowel to shut tight.
At age two, she may not have had much language and so would have been limited in the way in which she might now remember and describe the experience.
However, I do believe that she will have a strong and unpleasant “body memory” of the enema.
I assume you were present while she received the enema and so hopefully you will now be able to talk about it with her. It will really help her to hear about the intricacies of the treatment, including descriptions of the room, the people, the tubing, the collection vessels, the sounds and everything else associated with the experience.
Then, when she is able to re-experience the event in this way, you can empathise with how distressed, upset, invaded or out of control she felt. This will involve you having to guess for her at how she may have had these feelings.
So you might say things like, “yes you really didn’t seem to like the tube going into your bottom, I think it may have been sore or uncomfortable” or “you seemed quite scared when the liquid poo and water came gushing out” (if that fits with her experience).
She may have had other feelings too, so do guess at any that seem to fit with what you observed while the enema was happening.
It is hard to contemplate effective relaxation exercises for a three-year-old, so I won’t suggest any. But by showing you understand how distressing her poos seem to her, you should also find that she allows herself to be reassured that pooing in the toilet will not be like the enema. – Irish Independent