Fear of Pooping

Fear of Pooping: Treat With "Exposure Therapy"

The fear of pooping is like a phobia. Parents will often ask why their child continues to be afraid to poop and, therefore, refuses to poop even after their child's poop stops hurting. Continuing to fear pain in the absence of pain seems irrational. Although there was a reason to be afraid in the past, that reason no longer exists. Just like a fear of bees can persist long after the first sting, the fear of pooping can persist long after the first painful poop. Such fears require treatment with exposure therapy.

In exposure therapy, phobic fears are neutralized by gradually and repeatedly exposing people to the object or the situation that evokes that fear. In the case of a fear of pooping, the child's fear of pain decreases little by little each time he passes stool and does not experience pain. The number of pain-free bowel movements needed to neutralize or extinguish the fear varies from child to child depending on various factors such as the age at which constipation began and the child's current level of maturity and cooperation.Regardless of these individual differences, however, the number of painless bowel movements required is always going to be large, which is why the treatment of functional constipation takes so long.


Children Who Withhold Poop Are Afraid It Will Hurt

Children who experience pain or discomfort when pooping quickly learn to withhold their poop because they are afraid that the poop will hurt. They learn that the pain or discomfort can be avoided by simply contracting the muscle (sphincter) around their anus whenever they feel the need to poop. Withholding begins as a voluntary response (a conscious decision), but if the painful or uncomfortable bowel movements continue, withholding can become involuntary. This means that the anal muscle "closes" automatically whenever the rectum contracts which is what causes the feeling of urgency, the need to poop. Withholding is no longer a conscious decision. It has become a habit which leads to functional constipation--also called encopresis.

Exactly how long it takes for withholding to become a habit varies with age and temperament. Some infants and children begin to withhold involuntarily after just one painful or uncomfortable bowel movement whereas others are able to tolerate a number of painful bowel movements before becoming habitual withholders. The difference between the two groups is most likely related to the degree of discomfort or pain they experience. The more intense the discomfort the more quickly withholding becomes involuntary.