Stool Withholding: How to Help your Child Let Go

If you know me, you know I love to talk about bowel movements (BMs). The shape, the size, the frequency. Yes, I know you’re probably cringing right now (as most of my patients do when I ask them to point out what their stool looks like on a chart) but perhaps I can convince you why bowel movements are today’s hot topic. And if you’re a parent, this blog is especially important for you to read.

Having healthy bowels should start when you are a young child. Very often when an adult has any sort of gastrointestinal problem they date it back to their childhood. I encounter many parents who will say to me that their child always holds in their bowel movement and are unsure how to resolve it.

Children often withhold stool because they’ve had one painful experience and are fearful of it happening again. They are unsure how to vocalize it and instead they may say they don’t like the feeling of their bottom being wiped by the teacher or that they feel they may fall into the toilet. Other times they may deny the feeling of needing to have a bowel movement at all. As parents, you may think your child is being stubborn and will grow out of it. However, I would recommend that you take this as a warning sign. The longer stool sits in the rectum, the more water is absorbed from it, making it drier and harder to pass. When the child eventually passes this large stool, it may become even more painful and even cause tearing or bleeding, making the child even more fearful for the next bowel movement. Eventually, new stool being formed begins to leak around the old stool. If your child’s pelvic floor muscles have become weak by this point, leakage of stool can cause staining in the underwear (known as encopresis), which can lead to embarrassment and isolation at school. Other issues may arise from constipation, such as daytime and nighttime urinary leakage.


Did you know that Sandra is one of only two paediatric pelvic floor physiotherapists in Toronto? If this information resonates with a situation you’ve been dealing with at home, book a consultation with her to come up with a concrete and actionable plan to manage symptoms and help your child resolve the problem.


If this sounds like your child, here are some things you can do to help them alleviate their constipation:

  1. Be aware: Children often do not vocalize that they haven’t passed a bowel movement all day at school or that they ignore the urge to have a BM because they don’t want to stop playing. Talk to your child’s teachers at school to ensure your child is not withholding. Keep track of the number of BMs they have at home (children should have between 1-3 bowel movements/day)
  2. Talk to your child: Reassure your child that bowel movements won’t hurt as long as they continue to pass them regularly. Explain to them what a bowel movement is and why it should not stay in the body. The more regularly a child learns to pass a BM, the less it will hurt and the quicker they will overcome their fear
  3. Monitor your child’s diet: Soy and dairy products can sometimes lead to constipation. Fill your child’s diet with lots of veggies to increase fibre. Increasing water intake and introducing prune juice can help with constipation as well
  4. Visit your family doctor: Depending on the level of constipation, some children may require medications to soften their stool. Your doctor will also assess for any underlying medical conditions that could be contributing to your child’s constipation
  5. See a Paediatric Pelvic Health Physiotherapist! This is one of the quickest and easiest solutions to relieving your child’s constipation. A paediatric pelvic floor physiotherapist will help you and your child identify underlying causes of their constipation and offer suggestions to help your child pass stool, including toileting techniques, behavioural modifications and diet suggestions.  Your physiotherapist should also assess your child’s pelvic floor muscles and teach exercises to ensure optimal strength

SANDRA GHALY

Pelvic Floor & Paediatric Physiotherapist

Sandra graduated from Dalhousie University with a Masters degree in Physiotherapy after completing her Bachelor of Kinesiology degree with honours from McMaster University. She has worked with a variety of clientele but has developed a true passion in working with both the paediatric and women’s health populations. Sandra has extensive experience assessing and treating a variety of paediatric conditions and most recently has become certified as a pelvic health physiotherapist. She also has additional training in acupuncture and kinesiotaping. Sandra finds great value in guiding each individual through a tailored rehabilitation program to optimize their function and quality of life. In her free time, Sandra enjoys yoga, pilates, traveling and spending time with family and friends.

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