It’s essential to understand the various challenges children face, including the often-taboo topic of poop withholding. This behaviour can be distressing for both the child and the caregiver, and it’s crucial to approach it with empathy and understanding. In recent years, research has shed light on the reasons behind poop withholding and effective strategies to support children through this experience. This blog aims to provide caregivers with valuable insights and practical tips, particularly considering the diverse needs of neurodivergent children.

What is Poop Withholding?

Poop withholding occurs when a child consciously or unconsciously resists the urge to have a bowel movement. This behaviour can lead to constipation, discomfort, and a cycle of anxiety surrounding toilet use. While occasional withholding can happen, persistent behaviours may indicate an underlying issue that needs addressing.

Why Do Children Withhold Poop?

1. Fear and Anxiety: Many children experience fear associated with bowel movements, often due to a previous painful experience. This fear can be particularly pronounced in neurodivergent children, who may have heightened sympathetic nervous system activation and/or anxiety related to bodily functions.
2. Control: Children often withhold poop as a way of exerting control over their bodies and environments. This is especially common during transitions, such as starting school or moving to a new home, where they may feel a loss of control.
3. Discomfort: Some children may find the sensation of needing to poop uncomfortable or unfamiliar. This discomfort can lead them to avoid the experience altogether, especially if they are not yet fully toilet trained.
4. Postural Immaturity: Children with postural immaturity may struggle to sit comfortably on the toilet, which can hinder their ability to relax and effectively use their pelvic floor muscles. A lack of stability can make it challenging for them to adopt the proper position for a bowel movement, leading to withholding behaviours.
5. Poor Pelvic Floor Activation: The pelvic floor muscles play a vital role in bowel movements. Children who have not developed proper pelvic floor activation may find it difficult to relax these muscles when it’s time to poop. This can create a cycle of tension and withholding, as the child may feel unable to let go.
6. Interoception: Interoception, the awareness of internal bodily sensations, is crucial for understanding the need to use the toilet. Many neurodivergent children may struggle with interoceptive awareness, making it difficult for them to recognize when they need to poop. Recent empirical research supports this, indicating that improving interoceptive skills can enhance emotional regulation and self-awareness, which may help children better respond to their bodily cues.
7. Routine Changes: Changes in routine, such as travel or changes in diet, can disrupt a child's regular bowel habits, leading to withholding behaviours.

The Impact of Poop Withholding

Poop withholding can have significant physical and emotional consequences for children. Physically, it can lead to chronic constipation, abdominal pain, and even faecal impaction, where hard stool becomes lodged in the rectum. Emotionally, children may experience shame, frustration, and anxiety, which can further exacerbate the cycle of withholding.

For neurodivergent children, these impacts may be magnified. They may struggle with communication, making it difficult for them to express their feelings about bowel movements. Additionally, sensory sensitivities may make the experience of using the toilet overwhelming.

Supporting Children Who Withhold Poop

• Create a Safe Environment: Ensure that the bathroom is a comfortable and safe space for your child. This may involve using a stool for foot support, a toilet frame, providing a favourite toy or book, music, and natural lighting. A comfortable environment can help reduce anxiety associated with toilet use.
• Encourage Regular Bathroom Breaks: Establish a routine that encourages regular bathroom breaks, even if your child doesn't feel the urge to go. This can help them become accustomed to the idea of using the toilet and reduce the anxiety associated with waiting until they absolutely need to go.
• Celebrate success: Celebrate small successes when your child uses the toilet or expresses the need to go. Sincere appreciation of their growing maturity will help build their confidence and reduce anxiety. Avoid punishment or negative reactions, as these can increase fear and shame.
• Educate About Bodily Functions: Teaching children about how their bodies work can demystify the process of bowel movements. Use age-appropriate language and visuals to explain digestion and the importance of regular bowel movements. This knowledge can empower children and reduce fear.
• Educate About Toilets and Plumbing: Similarly it is important to satiate curiosity about where the poop is going, exactly how powerful the toilet flush is (not very - you aren't going anywhere it's just the poop etc.)
• Address Sensory Needs: Sensory sensitivities can play a significant role in toilet use. Consider sensory preferences when addressing the environment. For instance, your child may prefer a quieter bathroom or specific textures for toilet paper. 
• Consult with Professionals: If poop withholding persists, consider consulting with a healthcare professional, such as a pediatrician or occupational therapist. They can provide tailored strategies and support based on your child's unique needs.

The Role of Diet and Hydration

Diet plays a crucial role in bowel health. Ensure your child is consuming a balanced diet rich in fibre, including fruits, vegetables, and whole grains. Adequate hydration is equally important, as it helps soften stool and promotes regular bowel movements. Encourage your child to drink plenty of water throughout the day, and consider incorporating high-fibre snacks into their routine.

Strategies to Improve Interoception for Bowel Control

1. Body Awareness Activities: Engage children in activities that promote body awareness, such as yoga, dance, or martial arts. These activities can help them become more attuned to their bodily sensations and movements.

2. Mindfulness Practices: Introduce mindfulness exercises that focus on bodily sensations. Simple practices like deep breathing or guided imagery can help children tune into their bodies and recognize the signals related to bowel movements. Be mindful of your body and their body, just talk about what your bodies are experiencing as much as possible. 

3. Sensory Play: Incorporate sensory motor play wherever possible. Slow down play experiences and make space for your child to make sense of what they are sensing. Include whole body experiences, movement, tactile play, crashing, jumping, crawling, and swinging.

4. Interoceptive Games: Use games that encourage children to identify and respond to their bodily sensations. For instance, you can play a game where they have to guess different sensations (like hunger, thirst, or the need to go to the bathroom) based on their feelings.

5. Routine and Consistency: Establish a regular bathroom routine. Encourage children to sit on the toilet at consistent times each day, even if they don’t feel the urge to go. This can help them become more familiar with the sensations associated with needing to use the bathroom.

6. Visual Supports: Create visual aids that depict the process of digestion and the sensations associated with needing to poop. This can help children understand their bodily signals better and recognize when it's time to go. Use a sensory story.

7. Open Communication: Encourage open discussions about bodily sensations and the importance of listening to their bodies. Normalize conversations about bowel movements and reassure them that it's a natural process.

Conclusion

Poop withholding can be a challenging issue for children and their caregivers. By understanding the underlying reasons for this behaviour and implementing supportive strategies, caregivers can help their children navigate this experience with greater ease. Remember that every child is unique, and what works for one may not work for another. Be patient, stay informed, and seek professional guidance when needed.

TL;DR

Poop withholding in children can stem from fear, control, discomfort, or routine changes. It can lead to physical and emotional challenges, particularly for neurodivergent children. Caregivers can support their children by creating a safe bathroom environment, providing supportive equipment around the toilet, encouraging regular bathroom breaks, using positive reinforcement, educating them about bodily functions, addressing sensory needs, promoting proper posture, and improving interoceptive awareness through mindfulness and body awareness activities. These strategies can help children feel more in control and comfortable with their bowel movements.