Constipated Child Won’t Push Her Poop

Today I was emailing with a mom who had a 5 1/2 year old that would hold her bowels until she was in pain. Her solution was to have her sit on the toilet and for about 20 minutes. They would sit together and read a book at the end of the time if no bowel movement had come yet mom would urge her daughter to "push" and "try". She emailed because she felt that maybe her daughter was doing all this because of all the individual attention she was getting and was worried that her daughter didn’t have regular "urges" to push and go without being told to push consciously.   Here is my reply:

Have you spoken to the doctor? I would want to rule out megacolon which can result from prolonged constipation. The urges can fad with continual holding. If she is healthy- and you are keeping her diet and water on track – I would suggest you let her know with great confidence, that you trust she will figure out her body and learn to listen to it’s little signals and that you will no longer be with her in the bathroom "your body is your job – and I am sure you’ll do fine with this". If she uses the toilet on her own you can be encouraging by saying "you are really learning to manage your body all on your own!". If she holds again so long she is in pain – you can still be encouraging and say "its okay – your learning to manage to body on your own and it takes some time to learn – don’t be upset – what do you think you might try differently?" These statements let her know that SHE has the responsibility of looking after herself, and that you are supportive, encouraging but not dominating or taking charge of the problem and enforcing your idea of solutions. With time she will come to see the merits of moving her bowels as well as she will no longer be gaining any benefits from holding: namely receiving your un- due attention and feeling she is winning a power struggle.