Reward Charts Need to Be Visible: Q&A with Dr. Tom
Probiotics and Constipation

Enemas as Incentives to Cooperate

Positive incentives such as stars/stickers on a Good Pooping Chart, time on the computer or small pieces of candy (e.g. M&Ms) are almost always necessary to get children to cooperate with the long-term treatment of functional constipation. However, I have found that some children reach a point in treatment where positive incentives alone are not enough. With these children I will sometimes recommend a negative incentive, telling a child that they will be given an enema if they do not poop by the end of the day. The following is a case in point:

“Thanks for recommending that if Peter doesn’t poop we give him an enema. That advice worked great as that night his dad put the enema on the bathroom counter and said, “It’s ready to go if you don’t poop” and, viola, Peter pooped right away. I have had to do the same thing a few times when I can tell he’s not really trying and it always works. Ever since the day we started doing this Peter has been pooping consistently every night. We still need to tell him to go but he does poop on the potty.”