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Children's Health

My grandson`s bowel problems

11/09/2007

Question:

My Grandson has lived with me most of his 7 years, so I know him quite well. He didn`t see to have any obvious problems being toilet trained. He has been out of diapers since he was 2. For about 3 years now, he literally refuses to have a bowel movement until he has the choice of soiling his pants or using the bathroom. When he feels the urge to go, he will leave the room and go somewhere and sit on the floor. I guess he can prevent a bpwel movement thios way. When he finally goes, the stool is so large it can`t be flushed. I`m sure it must be uncomfortable for him. His Mom has had to take him to the doctor a few times because he has been hurting. I am very concerned that this has gone on for such a long time. This Halloween we had to get trick or treating because he had to sit on the lawn to prevent going. As soon as we arrived at my house, he went to the toilet, but seemed tense and unhappy for a few minutes. I wasn`t to concerned about this at first, but I think something is wrong. He has had xrays taken and his doctor says he has no physical abnormalities. He is being treated for ADD. He isn`t hyperactive, is a well behaved child and does well in school. He will enter classes gor gifted children in his public school after Christmas vacation. My daughter has recently married, but he hasn`t lived with me for almost a year. Though, he lives in the apartment next door, he gets very unhappy that he no longer lives with me. If his problem had started after he moved out I could understand his behaviour might be from stress and change, but I am really baffled about this. I have suggested he should see a psychologist but that hasn`t happened.I would appreciate any information you could give me. If he does need help, maybe the suggestion coming from someone besides me would be more persuavive. Thanks so much for your much needed help.

Answer:

What you are describing is classic "encopresis" or stool with holding and constipation. Many children start down this path in grade school because they are embarrassed to have a bowel movement at school. They may have been razzed in the bathroom at school or bathroom breaks are too infrequent or brief to allow for a bowel movement. Some teachers actually give extra points towards grades to children who do not ask to use the bathroom, a very unhealthy practice for children. This leads to stool becoming dry and hard to pass, which results in painful bowel movements. Children then do their best to avoid the pain by never having a bowel movement. Your grandson is lucky that he does eventually have an unaided bowel movement, although the resulting huge stool is no picnic for the adults to deal with.

My suggestion is to talk with him about the problem or to have his doctor talk with him. Find out what is happening at school and why this problem has arisen. Has he been teased by other kids or refused time to go to the bathroom by the teacher? It sounds as though it was with entry into kindergarten and use of school bathrooms., so it does not sound as though he has had a problem with constipation all of his life. This would suggest an issue with bowel function from birth. 

He needs a diet rich in fiber, preferably from fruits and vegetables and whole grain foods. This can also be accomplished with fiber supplements recommended by his doctor. A regular laxative such as Miralax will also help keep bowel movements regular and therefore less painful, and, eventually, not painful at all. He should drink at least 8 glasses of fluid each day and play actively for an hour each day, in bouts of activity. It does not have to be all at one time, although it can be.

Changing living arrangement is very hard for all of us. We are not conscious of the physical and emotional regulation our lives with others exerts on us until things change. It is natural for him to feel "at sea" with a new stepfather and new home situation. It may be helpful for him to go to counseling with his parents to help him cope with all of his feelings and be successful in school.

I hope this information helps. I am sure having a loving and caring grandmother is a wonderful resource to him as well.

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Response by:

Mary M Gottesman, PhD, RN, CPNP, FAAN Mary M Gottesman, PhD, RN, CPNP, FAAN
Professor of Clinical Nursing
College of Nursing
The Ohio State University