Toilet Refusal Syndrome (TRS) is characterized by diaper dependency and refusal to use the toilet for defecation. Toilet Refusal Syndrome is a common problem that eventually brings many families to seek care. Parents seldom recognize that their children are withholding as they have a bowel movement once or twice daily. These children are considered to be stool withholders because, without a diaper, they will withhold for days and eventually soil stool. Typically, children with Toilet Refusal Syndrome withhold stool during the daytime, including during school hours, with eventual expulsion of stool in the afternoon, early evening or during the night. Children may scream and tantrum for the diaper and parental exhaustion results in the children obtaining the desired diaper.
Parents seeking help from professionals are usually surprised to learn that their child is withholding and has encopresis, defined as stooling anywhere other than in a toilet after the age of 4 years. Diaper dependency should not be equated with effective toileting and represents a significant behavioral need for control.
Intervention is a must, as without intervention, this behavior may continue indefinitely.
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