Ask Dr. Stoll

Information About Combining Conventional &Alternative Medicine

Stool Withholding and Constipation in Children

Kathleen Diehl Book

This is a terrible problem as anyone who has had a child with it will attest. It is an excellent example of how a comprehensive approach is nearly always effective when the conventional medical approach almost always fails.

First of all, this problem usually begins with a large constipated stool that causes a painful bowel movement. The child then tries to avoid another painful experience by withholding stool--something even an adult might do with that much pain. Since, conventionally, little is done to deal with why the child was constipated in the first place, s/he continues to be so. If the child is successful at withholding for even a few days, the stool can get so large as to split the anus and cause a fissure (a semi-permanent split in the skin of the anus). Then you really have problems!

Even without this history, stool withholding is a common problem in 3 year-olds for complex psychological reasons not yet well understood. However, with most, it is a passing fancy and is not a problem that requires serious intervention. With a history like above, it can be a terrible problem.

First of all, every physician knows how to solve this but it takes a lot of time in the office, explaining, and insurance classically will not pay for education (even though the word "doctor" means teacher). The doctor can make a lot more money if this time is not taken. We just tell you anything to get you out of the office so we can get on to the next patient (and the next insurance reimbursable fee). If we MDs did not have a monopoly over the system in this country, we would not be able to get away with this kind of sloppy service. No matter which MD you go to, you will likely get the same simplistic advice you have already tried, unsuccessfully--apparently, since you are reading this note. If that kind of advice had worked, you wouldn't be asking a perfect stranger for better advice. If your primary provider had been a Naturopath, and you were wise enough to follow his/her advice, you would not be facing this problem at all.

There is only one approach that I have found universally effective, once the problem has reached this phase. It is completely harmless but takes considerable understanding, attention and learning on the part of the parents. Remember, this is no longer a simple physical problem but has the psychological overlay of the child's experience of significant pain every time s/he has a bowel movement.

First, we must establish a stool that will be soft enough, and lubricated enough, that it will still be easy to move after withholding for 5-7 days. You must be prepared for some accidents since the child will still TRY to withhold for months after the stool is in this condition (s/he will still be "waiting for the other shoe to drop"). However, constipated stool is a lot easier to withhold than a soft, lubricated stool--as you can imagine. S/he may not be able to do so and so might have an accident. BE UNDERSTANDING! S/he will be embarrassed enough for both of you.

A combination of mineral oil (for softening and lubrication) and sugar-free Metamucil (for bulk) is necessary for this to work. Neither one, alone, can do the job once things have reached this point. There is a tremendous variation in the individual dosage threshold (in both of these) from person to person so that will have to be determined in each case.

The risk of mineral oil (MO), in children, is inhalation into the lungs during resistance of the child to swallowing it. If the child will not cooperate in taking it, you must not force it. This, of course will seriously complicate total resolution to this problem and will require a knowledgeable and caring professional to help figure out an alternative to the unique advantages of the Metamucil/mineral oil combination. All doses of MO must be taken at bedtime since fat soluble vitamins might be carried out with the oil if given at any other time of day. The child's effective dose will be the highest dose BEFORE you see oil floating around on the top of the water after stooling. Just cut the dose back about 10% when that happens.

MO must be given every day without fail since it works by mechanically mixing with the stool made that day. Since it is NOT a laxative, you have to wait for the "transit time" to determine what the dose you gave does. Transit time is that time it takes for something swallowed to reach (and pass) the anus. Since once things reach this stage the child is withholding, you will have to estimate that time for now.

Once the effective dose of MO is determined, it will be time to add the second step.

The effective dose of Metamucil is when he is having about 2 stools a day. Again, you will have to change doses based on the effect you see after the transit time from whatever dose you gave. Start off with one tablespoon three times a day. Urge fluids since the way this works is by taking internal fluids and holding them inside the colon. Continue to double the dose until you see results. It is during this time that you will run the greatest risk of a stooling accident. If the stools get too loose, just cut back the dose about 50% to the dose s/he was taking just before they got too loose.

NOW, you have enough bulk AND the stool is soft enough (and lubricated enough) to assure relatively pain-free movements even if s/he succeeds in withholding for 5-7 days (actually even if s/he would succeed in withholding for 2 weeks). Of course, the child will not know this and would not believe you if you told her/him. S/he will just have to have enough pain free movements to know that it is safe to have a stool without pain before the psychological factor in the stool withholding will start to recede.

You will have to continue this for about 6 months after s/he stops withholding to be sure the psychological part of the problem does not overwhelm him/her. It would only take ONE recurrence of a painful stool to "jump-start" the problem all over again.

Finally, remember that the average, refined, American diet has caused constipation to be present in more than 50% of the "normal" population. Therefore, a good whole-foods diet will go far toward preventing a recurrence in the future, as well as speeding up progress right now. So long as you have influence over his/her diet, you would be wise to offer him/her only whole foods. Once s/he gets to be a teenager (when you will have NO influence over her/his diet) if s/he chooses to be constipated and have severe pain, you will have to let him/her make that choice.

Once the problem has been solved for about 6 months, you could cut the dose of one of these substances 50%. Wait a month to see what happens and then cut the dose of the other one 50%. Continue doing this till s/he is off everything. Since neither one of these are laxatives, there is no laxative habit to worry about.

If you have questions as you go through this, please share them with us here on the BB. This is a more common problem than you might imagine--and becoming more common with each passing year as the American diet continues to deteriorate. Others can be spared the heartache you have experienced if you will share your experiences as your child gets well.

Good Luck! Not because this is not likely to work, it will! Good Luck because it is going to take patience, perseverance and understanding for you to help yourselves out of the hole your present medical advice has gotten you into.