Sensory Processing Disorder and Elimination

Since Aiden was a baby, we've been dealing with drama surrounding elimination. When he was a toddler, this morphed into an unwillingness to defecate.

This is a post I've been debating whether or not to publish, and one I might take down at some point as Aiden gets older and needs more privacy. For now, I've decided to post it, because: (a) You're not alone if you're dealing with this same issue, and (b) there's nothing shameful about toileting issues, no matter what age. It can be really worth it to talk openly about struggles with going.

There are many reasons a child might have resistance to eliminating — some physical and some psychological. It's appropriate to rule out physical reasons first, and I am not a doctor, so check with your own medical providers for advice on any physical obstacles. We ruled out any sort of issues with physical structure or internal disorders with Aiden, so we were cleared to proceed with examining other causes.

The most common cause suggested for trouble pooping was not what Aiden's problem was. To whit, he does not suffer from constipation. Any time we brought up his hesitance to poop, we got advice on constipation — whether it was with his pediatrician or other well-meaning parents. But Aiden's stools are soft and well-formed and come along with regularity. Constipation was not his problem. So what was?

Based on my own research and our growing knowledge of our child, we've come to the conclusion that Aiden's resistance to pooping is sensory-based. That is to say, he hates the sensation of pooping.

He has to poop; he feels the need. He chooses not to.

What he does, then, is known as stool withholding or bowel withholding.

(It can also be a type of encopresis, which is a fancy name for underpants soiling.)

I thought we were alone in this until I started looking online, and lo and behold, there are many children and parents going through this same struggle! Many of the children have Sensory Processing Disorder. Since I now know pooping resistance is more common that we thought, and yet it's not often talked about, I really wanted to write this post and share a little about the whys, hows, and what-to-dos concerning a sensory resistance to pooping.

My husband and I got worried. We got anxious about the health concerns of holding in poop for too long. We got irritated that Aiden wouldn't just — be — normal. What kid holds in his poop in such a dedicated way for so dang long?

Well: Yes, what makes some kids do this?

Why some children won't poop

For some kids, pooping is painful. Maybe they are constipated ; maybe they have some sort of bowel obstruction or irritable bowel syndrome. Maybe they have undiagnosed food sensitivities that make passing poop like passing fire.

This didn't seem to be the case with Aiden, and when we tried to talk with him, he said that he either gets too busy or he is at school and there are too many people there. The best we could determine was that he didn't like how it feels.

In fact, he didn't like it so much, he would rather feel the (for me, far worse) sensation of needing to clench-clench-clench those sphincter muscles for days or even weeks than the sensation of poop coming out.

In the end, if your children have a sensory aversion to pooping, it doesn't really matter why they have it — what I've come to learn is that it's important to accept that they do and it's very real to them.

For some children, pooping is tolerable in some situations but not others. For instance, many kids (and mammals in general!) crave privacy and solitude when pooping, even if they're otherwise social creatures. It all has to do with sphincter law.

Plus, many children will accept pooping in a diaper or pants but not relish the sensation of the drop of poop into a toilet. They might also be afraid of balancing on a toilet, the loud flush, or bad experiences they've had with either.

For the purposes of this article, I'm going to assume that (a) you've thoroughly ruled out any physical problems and (b) you've determined your child is practicing stool withholding for sensory reasons.

What helps — and what doesn't

Be patient and understanding. Here's a newsflash: Berating them doesn't make them want to poop. No, seriously, I needed that newsflash. Dean and I would take it in turns to get so frustrated with the years and years it's been (so far) of pooping problems that we would want to just make Aiden poop. But it's obviously not the way to go. As the parent of a six-year-old who is getting better, I will give you this message of (mitigated?) hope: Things will change. It might take years, but your child will learn to poop. Even if poop aversion continues into adulthood, your child will have figured out a way through it. It just takes time. (Be patient with yourself, too: Take it from me — I know how frustrating and icky poop problems can be. It's all right to feel what you feel.)

Talk about it. Read children's books. (I have some recommendations below.) Talk to your child about your own poop habits and sensations. Point out when you notice your child is exhibiting signs of needing to poop, and talk about what that feeling is like. Keep it nonjudgmental and factual. Ask your child what it is about pooping that's so distasteful — does it hurt, or does it feel weird, or is it scary, or what? Kids might have trouble answering precisely, but it might help you at least weed out the things that aren't a problem. (For instance, we learned it doesn't cause pain for Aiden; he just doesn't like the feel.)

Insist on trying, but not on pooping. It's like your mom's favorite phrase before a car trip: Everyone has to go try. Don't make it a punishment; just make it a habit. It can be a regular thing (every night before bed, or after a meal, or whatever routine works for you guys), or it can be when you see your child clenching, but make a deal that your child will sit on the toilet and try to go. With Aiden, we set a time limit, and he'll negotiate us down. It's never more than ten minutes, and is sometimes as few as three. Don't express (try not to) frustration or disappointment if no poop is achieved; simply try again the next day. A good portion of the time now, Aiden's trying will translate into going, and we'll be done with it again for the next few days. Speaking of which:

Acknowledge that every body is different. I personally poop multiple times a day. (You totally wanted to know that, didn't you?) Dean poops every few days, I think. (He totally wanted you to know that.) Aiden seems to need to poop every few days as well. Even if you're a daily pooper, your child might not be, and that's all right, assuming there are no constipation issues. (Again, check with a medical care provider if you have concerns.) Trying to force Aiden to poop as often as I do would do neither of us any good.

Let the reward be intrinsic. I've read some books that suggest rewards like stickers for pooping, so you can give it a try if that floats your boat. For us, we wanted the relief of pooping to be its own reward. When Aiden has finished his pooping session, he gets a big grin on his face and comes over to give me a high five. We've talked a lot with him about how not-pooping limits his ability to play and have fun. We discuss that the feeling of pooping, however uncomfortable it makes him, is fleeting, and point out that afterward, it feels so good and light to be poop-free.

Make the pooping situation comfortable. If kids are afraid of the toilet, you might need to suck it up and use a little potty for awhile, even though I realize it gives you one more thing to clean. Even if a kid's older and is reverting to being untoileted, you could offer the potty as an option; its familiarity might keep you from no-poo-nightmares. You could offer other solutions as well: perhaps squatting over a cloth prefold, or squatting in the bathtub over a receptacle. Putting a seat reducer, a step stool, and even a handrail onto the big toilet can help a child feel more secure. For public toilets, hold your hand or place a sticky note or other barrier (diaper, wipe, flap of toilet paper) over the auto-flush sensor until your child can get up and away and cover ears.

As for giving kids privacy, that's worth mentioning here as well. Aiden is not by nature a private person. He will cheerfully barge in on me when I'm trying to poop. But for the past year or so, he's needed his own space and to be left alone when he's pushing, and we honor that need.

Also, if your child is having problems pushing and your child's legs are long enough, I'd also recommend a Squatty Potty or some other way of squatting while pooping (little baby potties are actually a pretty decent position for older kids).

Nutritional support will help but probably not cure. It's not a bad idea to emphasize non-constipating foods and limit the constipating ones and offer your child a lot of natural fibers (vegetables and most fruits). Make sure your child gets plenty of liquids. Avoid foods your child has an intolerance to. You can offer daily probiotics to support gut health. It's wise to do what you can to keep stools soft and regular, since a hard and painful stool can set matters back even further. However, if your child's not constipated and is poop withholding, there's likely something else at play, and even the best nutrition won't work miracles.

Use medical interventions judiciously. A lot of people whose children struggle with pooping will at some point be recommended the use of fiber supplements, laxatives, stool softeners, or enemas. I'm not going to recommend what you should do for your specific situation, I am not a doctor. I'll just tell you based on our own experiences:

First of all, stool softeners make sense if your kid has hard stools; ours does not.

Secondly, the stool softeners we could find for kids (i.e., not pills you have to swallow but something chewable or drinkable) were gross; the main kind we could find was fruit punch flavor that you were supposed to mix in with juice or — gag me — milk. Fruit punch milk? We're trying to make the kid poop, not vomit.

Thirdly, we tried a laxative, it was a powder we would mix with juice. He took it for a few days and ended up having diarrhea. They might have a little bit of psychological effectiveness because you can talk up that they make it easier for you to poo, honey, and you could suggest that your child will need to poop and then hope that's actually true.

Fourthly, enemas seem just wrong to Dean and me. I say that with no judgment on anyone whose kid has medically required an unwanted enema or suppository. If your child's poop withholding leads to medical problems, though, medical solutions might be the best call. Children with severely impacted stools, for instance, might need manual or even surgical removal. Again: me = not a doctor. So use your own parent sense and the guidance of medical professionals.

Things get better

I will say this again: It might be worse for a long, long time, but your child will learn how to poop. Without cajoling, without coaching, without threats or bribes or tantrums (yours or your child's).

With understanding, love, patience, and a good dose of common sense, you will all get through this, together.

Wishing you all good pooping!

Further reading

When researching this topic, I came across some children's books and articles that address the phenomenon of never-poopers. Some of these are directly related to sensory issues, and some more broadly encompass a range of physical and sensory obstacles to pooping. I'm not necessarily whole-cloth recommending them as just telling you: There's not a lot out there when looking for children's no-poop books, so you take what works and adapt what doesn't!

It Hurts When I Poop!: A Story for Children Who Are Scared to Use the Potty

I Can't, I Won't, No Way!: A Book For Children Who Refuse to Poop

Super Pooper!: A cute story on how to bring fun and laughter to potty training

I Don't Want To Go To The Toilet

Scared to Poop: A Guide to Overcoming Constipation and Stool Withholding in Children — I have not read this one and am not sure about it after reading the reviews, but I wanted to include the single book I could find for parents that deals primarily with poop withholding.

Everyone Poops — oh, you may laugh, but this is an important message.

"Learning to Poop in the Potty" at DrGreene.com

The Poopsmith Song because every good bowel movement deserves a soundtrack

You have to read Teresa's poem under Pottytunity. Have to. See: We're not alone. Also worth a read: "Will Poop for Chocolate." Jennifer at Hybrid Rasta Mama also has a roundup of general books about poop that might be handy to get the poo-poo conversation started!

End of Year 2014

Merry Christmas to Friends and Family Near and Far!

Here is our year in review letter. Our family witnessed many ups and downs like any other family. Sometimes we wondered how we could keep pressing forward, but forward we have come. Perhaps your family is like mine, when times are tough we are more likely to pour into God's word and desire a stronger relationship with God. 2014 proved to be difficult in more ways than one.

I am not going to lie, the financial stress of the last year or so has taken its toll on our family. My husband's health continues to deteriorate. He is no longer able to sustain a job. He can barely drive his car more than a few miles. He experiences debilitating nerve pain on a nearly daily basis that is a result of having shingles in 2010. In addition he has various other health ailments. He walks with a walking stick or cane everyday because he also has vertigo. He most likely experienced a trans-ischemic attack in November. Getting the MRI done was an uphill battle given that he saw his PCM the Friday before Veteran's Day weekend. He ended up waiting several days for the procedure to be completed because Tricare would not authorize the procedure.

We have also received many blessings this year. We did not lose our home. We have been blessed with some good news regarding our financial situation. Our son has graduated out of all therapies. He is doing great, still has sensory issues. He is six years old and is doing very well in first grade. He loves his teacher. Dean's daughter will be graduating from UCCS in May with a Bachelor's degree in biology with a minor in American Sign Language. She is completing her undergraduate sequence in three years. She has been accepted to Bastyr University in Kenmore, Washington to begin pursuing her lifelong dream of becoming a doctor. She will be studying naturopathic medicine.

I continue to work 2-3 jobs. I work part-time at School Crossing. It is a teacher supply and toy store. I also provide child care at the church. In addition I also provide tutoring services mainly during the school year. In addition to all that, I write a blog, volunteer in my son's classroom, I am assistant den leader for his Cub Scout den and serve on the PTA board at his school.

Life keeps us busy. Hope you and your family are enjoying the holiday season. Please take time to pause and reflect on what Christmas is really all about.

Much love and blessings from the Warren Family!