Is Your Child Stool Withholding? Recognizing the Signs

At the end of Decem­ber (new year’s eve)  Dr Daum (www.doctordaum.com) began con­sult­ing by tele­phone with a moth­er in Cal­i­for­nia about her 4‑year old daugh­ter. With­in just a few days, her daugh­ter was self ini­ti­at­ing poop­ing in the pot­ty and she was able to return to school, free of acci­dents, after win­ter break.  The moth­er’s goal was to time her daughter’s bow­el move­ments for 5:00 pm, a time when her daugh­ter would be home from school and all activ­i­ties.  This goal was achieved!

Our Cal­i­for­nia mom shared a few pho­tos with us and has per­mit­ted us to share those with you.  As you can see in the first pho­to, the child’s abdomen is large and dis­tend­ed.  This pic­ture was tak­en on day 1 of treat­ment, pri­or to the clean out.    

Pre-treat­ment (doctordaum.com)
Typ­i­cal appear­ance of child who stool with­holds
Note: dis­tend­ed abdomen
Print­ed with permission

By day 3, the mom had noticed a sig­nif­i­cant dif­fer­ence in her daughter’s appear­ance and sent us this pho­to, exclaim­ing:  “How’s this look for a cleaned out bel­ly??:)”      

Post-treat­ment (doctordaum.com)
Typ­i­cal appear­ance of child NOT stool with­hold­ing
Note: flat abdomen
Print­ed with permission

Rec­og­niz­ing that your child is with­hold­ing is an impor­tant first step in find­ing an effec­tive solu­tion and pre­vent­ing the pro­gres­sion to enco­pre­sis or soil­ing. To help you know if your child is with­hold­ing, we have list­ed below the com­mon phys­i­cal and behav­ioral signs. 

Phys­i­cal signs of stool withholding

• A dis­tend­ed, swollen abdomen which is some­times vis­i­ble in pho­tos of child in a bathing suit
•  Increased flat­u­lence or pas­sage of foul smelling gas
• Small amounts of bright red blood around the stool, on the toi­let paper, or in the toi­let water.  This is usu­al­ly the result of the pas­sage of a hard and/or large stool that has caused a cut in the anal area called a fissure
• Pas­sage at any time of a stool that is large in diameter
• Rapid full­ness after eat­ing solids (ear­ly satiety)
• Reflux symp­toms includ­ing nau­sea, burp­ing, heart­burn and regur­gi­ta­tion.  Reflux is the result of delayed emp­ty­ing of the stom­ach in asso­ci­a­tion with a large colon filled with stool, gas and liquid

Behav­ioral signs of stool withholding 

• Hid­ing while poop­ing (often behind fur­ni­ture, under a table or behind a closed door)
• Pos­tur­ing includ­ing straight­en­ing of the legs or cross­ing of the legs
• Hold­ing onto fur­ni­ture with but­tocks squeezed togeth­er and legs straightened
• Hold­ing onto mother’s legs while cry­ing and agitated
• Danc­ing the  “doo­dy dance” ‑because of dis­com­fort and pres­sure in the rear end, the child gets up on his or her toes and dances around in obvi­ous discomfort
• Press­ing the heel of the foot into the anus in an effort to ‘hold in’ stool