Kathleen@Navigating the Shock of Parenthood

To Poop withholding woes:
What you are describing is constipation based encopresis. There are several things you need to know about this situation. First, some mechanics. When we don’t poop regularly the stool backs up into the rectum and colon where it dries out and gets hard. It also builds up and stretches out the tissues of the rectum. Over time this constant stretch on the muscles makes the rectum into a loose flabby balloon. This flabby balloon is unable to feel the normal stool pressure and thus the urge to defecate is lost. Over time this can also lead to soft liquid stool from far up the colon dripping around the hard stool and leaking out. The child will be unable to feel or control this leakage. Once you’ve gotten to this point the treatment is to keep stools very soft often for 6mns to a year. The goal is daily bowel movements so that the stretched rectum can shrink back to normal size and the child can regain sensation and control. It is a long and challenging process and often involves carrying around clothing changes for a long time. So, you do want to interrupt this process before your child reaches the point of a stretched out rectum and fecal leakage.
As for Mirilax. It is the darling of pediatrics. I didn’t like it and found it hard to control. Before they used mirilax they used SennaKot. That is what is in chocolate ExLax. These are small chocolate squares that can be broken into whatever dosage is needed. I’d discuss this alternative with your pediatrician. Mirilax has a delay in action. You also have to constantly adjust the dosage and you’re looking at the dose you gave 3 days ago. Which is crazy hard to manage. It creates stool softness without creating a bowel movement. ExLax is dosed once a day to produce a soft formed non-painful bowel movement. And they get to eat a tiny piece of chocolate, yay! The movement to mirilax from sennakot was partially motivated by old theoretical concerns about regular use of sennakot over time. These concerns have not panned out and the data is now clear that long term usage is safe. Nevertheless many pediatricians still cling to mirilax.
Next, the term “withholding” is often used for this situation. I personally avoid using it because it holds connotations of “spoiled child.” I prefer to use “hurts to poop” or “afraid to poop” or “fears loss of control”. Something that you feel reflects more accurately what is creating a block for your child. One place for help with figuring that out is the book I mentioned in my other post: Stress-free Potty Training: a common sense guide to finding the right approach for your child. This book helps you identify your child’s individual temperament and thus where her particular barriers are. Then you can address the emotional core of her challenges more precisely.
You are in an early window of opportunity to maybe nip this problem before it gets big. Take a deep breath and release some stress, focus on her emotional well being, don’t avoid the stool medications but do consider sennakot over mirilax. Hang in there! You’re not alone in this. It is a common but unspoken challenge of parenthood.

First for mom with 4 y/o:
I have twins. When we potty trained the issues and challenges for each child were different. To adults it’s all straightforward and we often think that what works for one kid should work for another. But they are individuals from day one. What helped me was a book called: Stress Free Potty Training: a Common Sense guide to finding the right approach for your child. This is not a book with a prescription to do specific steps. It goes over 4-5 different personality temperaments and how they each can pose different issues when potty training. Then it takes you through how to address them. For my daughter, she wanted to be in charge and in control. So I set everything up and showed her and then waited. 6 months later she initiated it herself and potty trained in a week. Her brother had some sensory fears and little interest in learning self care. So I made flushing the toilet fun and let him play with this mechanical thing that I knew intrigued him. After watching his sister self train and get rewards and attention he wanted in too. But for him it was a longer time frame because once the initial excitement was over he lost interest. So you see, whatever is challenging your daughter is unique to her. I’d encourage you to read the book, back off the pressure for a bit, then with new insights from the book make another plan of approach. Hang in there this is a hard one. The pressure on adults to have their kids potty trained by certain age or for school situations can generate a lot of angst.

Parenthood opens our eyes to a whole new way of seeing the world. At the same time it brings these small helpless people deep into our hearts. I remember when I realized I’d step in front of a train to protect my children. I’d do anything to save them from harm. This deep love and our new lens for seeing the world is what can causes us so much angst.

I think two things can help us navigate this time. First is to recognize that this new view of the world is important. If the only voices heard do not have this parenthood perspective then it will be harder to generate change. So where you can, vote with you pocketbook, your signature, your voice.
A statistician once told me that humans have a hard time evaluating relative risk. Driving your child to school has far, far more risk than feeding them from a plastic container. But we still get in the car with our kids every day. We mitigate the risk with a car seat and safe driving. Then we let it go and get on with our day. We can do the same with chemicals in our daily life. Learn about it. Mitigate the risks as you feel you can and then let it go.
We can none of us protect our children from all hazards in life. Step back and look at the relative risk. Mitigate and let it go. I discuss this topic further in my navigating parenthood book and a mini-book on navigating chemical toxins in family life. Looking for rational sources of information such as Emily’s Parentdata is also important.