Toilet fear? When children hold back the chair

What are the reasons for toilet refusal syndrome and how can affected children be helped? Who is the right contact person in such cases – pediatrician, gastroenterologist or child psychiatrist?

That’s what the pediatrician Dr. med. Nadine McGowan

Recently, a case of refusing to use the toilet caused a sensation: a – presumably – autistic girl would have had been defecated for eight weeks and had died of heart failure as a result. Due to the massive mass of stools in the abdomen, all organs had been pushed upwards and in the end had resulted in heart failure – the heart had been "pushed", so to speak. At least that was the preliminary explanation for this dramatic death. This is certainly a particularly difficult and exceptional case.

That children the Holding back bowel movements is not that rare. Often the children have been without a diaper for a long time, they usually make pee without problems on the toilet, but they require a diaper for bowel movements. There are also cases when the children have never been to the toilet or only a few times.

Painful bowel movements: constipation as the reason for refusing to use the toilet

The so-called refusal to use the toilet is roughly distinguished in cases where there is severe constipation (constipation) and in cases without it. There are children who Deliberately restrain bowel movements due to constipation and avoid the toilet. The stool is hard and painful and is therefore delayed as long as possible, which only makes the stool harder – a vicious cycle arises.

These children need to be helped with stool softening medication and toilet training. The chair is slowly made mushy-soft so that the defecation (stool) no longer hurts and the children become after the three main meals on the Toilet set.

This is how toilet training works against restraining bowel movements

Toilet training takes advantage of the fact that defecation after meals is usually easier.

It is important that the children sit on the toilet in peace, the legs should not dangle freely, but should be placed on a hump and the children should spend five to ten minutes there without external pressure.

It doesn’t matter that there is always a bowel movement, the children allowed to doing something pleasant in time – reading, listening to an audiobook, painting, whatever you enjoy.

It is only important that the toilet or bowel movements are slowly freed from the negative image and the fear associated with it. Normalization often occurs after a short time.

Which doctor helps if children hold back their bowel movements?

For some children, increased hydration (an important part of constipation therapy!) And toilet training can be successful.

With toilet training it is not important that a bowel movement is always carried out. During this time, the children can also read, listen to an audio book, paint – whatever they enjoy. Photo: imago

Once the vicious cycle has been broken, the measures should be continued for at least six months to avoid relapses. If there is no constipation, toilet training should also take place, and the child should be asked exactly what is keeping them from using the toilet. Some children are scared of the toilet, so they hold back your bowel movements for fear, or the seat is too uncomfortable for you – there are cases that can be solved easily.

Stool softening agents should not be given. They usually only make the problem worse.

In both cases: The first course should lead to the pediatrician. He looks closely at the child, examines the abdomen and also the genital region. Are there any painful tears there from the hard chair? Is the anal region red? If the pediatrician has carefully listened to the problem, initiated the aforementioned examinations and the first measures have not been successful, a pediatric gastroenterologist (specialist in childhood gastrointestinal diseases) should be consulted. In some cases there is also a child psychiatric problem – at least as an accompaniment. Then it makes sense to work together in an interdisciplinary manner to help the child in the best possible way.