A mother I know recently became so exasperated with her 6 y/o daughter’s off and on cooperation with treatment that she told her, “I’m done! You know what you have to do to stop having poop accidents so you take care of it yourself!”
Up until then, this smart, usually compliant but shy first grader always needed to be told to take her laxative, sit on the toilet after meals, listen to her body and not hide her soiled underwear. When she complied she had daily bowel movements and no accidents, sometimes for as long as a month or more. However, when her parents tried to reduce their own involvement, these “good” months would always be followed by a period of two or more days between poops, having accidents and hiding her soiled underwear.
What happened after her mother said, “I’m done!” is amazing. On her own initiative, her daughter now takes her laxative every morning, goes into the bathroom to poop when she feels the urge, and has no accidents. In my experience, this strategy generally does not work with most children (see my post here about the inefficacy of negative approaches) but it’s worth a try with older, independently minded children who generally want to please their parents.
Parents who try this approach cannot use these kinds of statements lightly or often, or their effect is lost. Parents will need to remain committed to what they have said, at least for a period of time that is long enough for the child to recognize the parent's seriousness. This may mean the child will have accidents again. Remember, it is always okay to change your approach, especially as extended stool withholding can cause real physical harm. It's also okay to change if your child requests your help again (for example, they have an accident at school and are embarassed).