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Friday, April 18, 2014
My friend`s daughter is 2 1/2 years old, not potty trained and is having difficulty with bowel movements. She holds in her bowel movements for days successfully. She has waves of being very uncomfortable but persists in tightening her bum to hold it in. Her mother has tried prune juice which has only added to the problem by causing very liquidy feces, creating a angry diaper rash. She does have a history of constipation, could that be the problem? Is there a possibility of further complications due to her holding it in? What is the best action to help her be more successful at having bowel movements?
Thank you for your question regarding constipation and stool withholding in young children. These are two very common problems that can be a source of concern for many parents and on rare occasions can be a sign of more serious problems. Constipation is defined as infrequent passage of stools with pain and hard stools occurring with bowel movements. Stool withholding can occur a as a result of constipation. Children learn that it is painful or difficult to have a bowel movement and hold the stool in to protect themselves from this pain. Unfortunately this often results in more pain. Stool withholding can also occur because of behavior. Children nearing or around potty training will at times have fear or embarrassment at having bowel movements, so withhold in result.
In most cases of constipation there is not a medical problem associated, however in rare cases there can be a problem with the development of the nerves that help children have bowel movements or medical problems such as under active thyroid. I would encourage you to discuss with your doctor the child's habits of stooling since birth to see if there is any concern as well as look for clues of normal growth and development. Children with this problem should have a physical exam, but most do not require further tests.
Many things can be tried for constipation and range from adding more fiber to medications that cause regular bowel movements such as laxatives.
Allison A Macerollo, MD
Clinical Assistant Professor of Family Medicine
College of Medicine
The Ohio State University