Might a Toddler's Painful Constipation Be Something Serious?

Often, painful voiding during the potty-training years is a result of fear.


My 3-year-old has severe pain and says he is "pooping." But his stool seems soft and there is often "diarrhea" in his diaper. He will be fine for a couple of days, then it starts again. Could this be a sign of something serious?

Judith Palfrey, M.D.

This is a very common situation and one that concerns parents and frequently brings them to the doctor. Alison Schonwald, a developmental-behavioral pediatrician at Children's Hospital, Boston has a great interest in helping families with problems like these. To help families, she has written The Idiot's Guide to Potty Training Problems. She kindly gave me her thoughts on this.

"Most likely, this is nothing serious, but it probably is something that needs the involvement of your pediatric healthcare provider. On the way to toilet training, some children become derailed by constipation, which seems to be the case here. After an episode of painful stool, a child may "hold it in" to avoid re-experiencing the pain, only to worsen the constipation. The backed-up stool then becomes harder and more painful to pass, while loose stool slips around it and into the underwear, masquerading as diarrhea. This child seems to pass just enough soft stool every few days to relieve himself, but he probably is not fully evacuating. He then gets filled up, his stomach hurts, he tries to hold it in (we call it the 'doody dance'), but eventually he lets enough stool out to feel better. Then the cycle repeats.

"If a more extensive history and physical exam are consistent with this explanation, then treatment starts by cleaning out the constipated stool. A variety of dietary and over-the-counter medications can be effective and may need to be continued after the backed-up stool is evacuated in order to 'keep it moving.' Families should remember that punishment has no role in this scenario and that increased pressure to attain continence could very well strengthen a toddler's resolve to continue withholding stool. Once the child is having soft, formed, comfortable stool on a regular basis without intervening stool leakage, toilet training can be considered."

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