Stool Withholding in School-Aged Children

By Melissa Yapp

School. It is meant to be a word that evokes excitement, anticipation, a rite of passage and (dare I say?) a new freedom for dedicated, committed parents. But for children with chronic constipation, encopresis or stool withholding challenges, the thought of school can trigger feelings of worry, anxiety, fear and even downright dread.

Many parents go through varying degrees of stool withholding and constipation when their children are embarking on the journey of toilet training. For a large percentage of toddlers, this is a short hurdle that is easily overcome. A few stickers on a reward chart, some awesome Spider-man undies and the lure of a chocolate reward usually see children conquer this milestone with a minimum of fuss.

But for many families, stool withholding and constipation is a chronic, stressful and challenging condition that can persist well into the primary school years. 

What Is Stool Withholding? 

Simply defined, stool withholding refers to holding in a bowel motion instead of passing it out of the body (Ferguson, 2015). If done for long enough, stool withholding removes the “urge” to poo. The child then feels short term relief that they have avoided their fear. The child then repeats this action the next time they feel the urge to poo. This vicious cycle then causes a build-up of old, hard stool in the colon, which then presents like constipation.

Imagine Your Biggest Fear

Imagine your biggest fear. Let’s say it’s a fear of heights. Would you like to talk about it with others? Probably not. Would you like to live on the 25th floor? No way. If your friends were going hang gliding, would you go or make up an excuse to avoid it? Imagine if you were told that you HAD to go hang gliding after dinner every single day. No doubt you would feel quite worried or scared and perhaps even experience physical symptoms such as a racing heart or feel the urge to ‘run away’.

For some children, both typically developing and those with additional needs, pushing out a bowel motion is like facing their biggest fear. Every. Single. Day.

What do these poor children do when they feel a poo is on the way? They react the same way as adults do when faced with their biggest fear – they try to avoid it.

When left untreated, stool withholding can become an ingrained, habitual and ‘normal’ response for your child. The longer the cycle continues, the more difficult it is to break.

What Can Stool Withholding Look Like In My School-Aged Child?  

Whilst every child is different, there are some subtle signs that your little one may be experiencing fear around pushing out a bowel motion:

  • Fear of using the toilet, particularly at school, at friend’s houses or school camps 
  • Hiding soiled underwear  
  • An increase in wee accidents or bed wetting, as the full colon is pressing on the bladder 
  • A noticeable odour which your child does not notice (as they become accustomed to the smell) 
  • Physical signs such as stiffening the body, crossing their legs or turning red-faced to attempt to hold in their poo 
  • Withdrawal behaviour, such as social isolation, withdrawal or reluctance to attend school 
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