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March 2019

My Son's (4yrs) First "Real" Poop in the Toilet!

"Hello Dr. Tom. I purchased your book "The Ins and Outs of Poop" and I have to say that the simple suggestion of teaching him to push resulted in his first "real" bowel movement in the toilet. Twenty one days later, he is not only pushing out his poop and pee, but he continues to do it in the toilet! After 2 years of struggling with withholding, I thought he would still be in diapers going into kindergarten in the fall. He still does not completely empty but at least he is going. Thank you for writing such a helpful book and for bringing information and attention to a struggle that you don't hear much about."

Parents assume that their child naturally "pushes" when they are sitting on the toilet to poop. However, children with encopresis often think that all they have to do is sit on the toilet long enough and the poop will come out on its own. Not surprisingly, these children frequently end up having either no bowel movement or an incomplete bowel movement both of which keep their rectum stretched and increases the likelihood of poop accidents.

Teaching your child how to push may at first feel unnecessary because it is not usually something we need to teach our children to do. For most children pushing happens naturally. But children with functional constipation often need to be taught or retrained how to push.

Toilet Training Can Cause Constipation

In the second edition of my book, The Ins and Outs of Poop, I encourage parents to consider whether their child is ready to be trained before beginning training. Typically, when a one to two-year-old develops constipation during toilet training (potty training), it is because his or her parents have not correctly taken into account their child's physical development, temperament or the potential negative impact of stressors inside or outside the home. For example, a child's physical ability to control their bowel and bladder sphincters (muscles) does not occur all at once, it develops over a period of time which varies in length from child to child. Some toddlers are temperamentally anxious and fearful of change. Some toddlers are quite stubborn and defiant and are perfectly happy to walk around in wet or soiled diapers.

Before initiating toilet training, parents are well advised to think about their child's unique temperament and how strongly they think he or she will resist. This is because children who repeatedly resist or refuse to poop on the toilet during toilet training will often withhold their stool which can, fairly quickly, cause them to become constipated. Therefore, if you expect or you see strong resistance, the wise thing for you to do is to postpone toilet training to a later time.