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March 2016

3 y/o Will Only Poop While Standing in a Pull-Up

Many children with encopresis will only poop in a diaper or a pull-up. The longer this continues the more their parents worry that it will become a habit.

Here is what one mom recently said to me:

"My daughter is 3 years old and has been standing to poop with a pull-up on for 3 months now. She is fully potty trained for urine. Would you recommend that I keep trying to get her to poop while sitting on the toilet for a few minutes every day (even if she doesn't push) and only then let her stand to poop in her pull-up? Or, should I wait if she doesn't seem ready? I am concerned that the longer the habit goes on the harder it may be to break?"
 
Here is my response:

"No need to worry about her developing a habit of standing to poop. She will sit to poop when she is ready. She must first unlearn the habit of withholding. This requires many, many experiences of having a medium to large bowel movement every day, that is softer than normal (e.g. applesauce or pudding consistency) and that does not hurt or cause her discomfort. Unlearning the habit of withholding is a very slow process. The length of time is different for each child, especially for 2 or 3 year olds. You cannot and should not rush her.

While she is unlearning the habit of withholding (in order to avoid an uncomfortable or painful stool even if she has not had such a stool in a very long time!), I suggest that you help her begin to relax on the toilet by making a game of having her sit bare-bottom on the toilet for a minute or two once or twice a day just "for practice" with no expectation of pooping.  This would be in addition to when she sits to urinate.
 
It helps if she is being reinforced for her bare-bottom practice and urination sits with stars or stickers, etc. Don't force her to practice if she resists now and then. Make it a fun game and encourage her with prizes, e.g. stars and stickers and perhaps an occasional treat for good measure.  Be patient! This is going to take quite a while."