Parents often monitor their toddlers’ toilet habits to ensure they are having regular bowel movements and, yes, to check the consistency as an indicator of health. If you aren’t finding evidence of a bowel movement and your child seems to be constipated, functional fecal retention might be the problem. Those ominous-sounding words simply mean that your toddler is intentionally preventing himself from having a bowel movement.
Functional Fecal Retention
Although fecal retention can have physical causes, functional fecal retention occurs when a child’s attempts to prevent bowel movements results in fewer than two movements in a week. Functional fecal retention can result from toilet-training struggles, but the problem usually starts after a painful and scary bowel movement. Now that your toddler knows how to control the muscles that help him go, he can use them to not go. Some children can prevent bowel movements for weeks. The avoidance starts a cycle of constipation and related symptoms, a large painful bowel movement and renewed avoidance.
The next time your toddler feels the urge to defecate after a painful bowel movement, she tightens her pelvic floor muscles and squeezes her buttocks together to prevent passage of the stool. If she holds it long enough, the urge to go will pass as his colon stretches to accommodate the stool mass. Your child might be pushing and trying really hard to have a bowel movement, but her fear is making her continue to clinch her buttocks. Her inability to relax the muscles makes her pushing useless.
A child who engages in functional fecal retention might begin to complain of gas and stomach cramps because of constipation. Fecal soiling can occur when passing gas causes seepage. The constipation can lead to urinary tract infections in girls and bed-wetting. Fecal retention causes loss of appetite and irritability in some toddlers. Once your child has a huge bowel movement, the symptoms go away immediately. Large stools that result from fecal retention can stretch the rectum, cause tiny tears called fissures, impair rectum functioning and lessen the sensation in the rectum. The effects on the rectum can make it even harder for your toddler to have a bowel movement and increase fecal soiling.
When your pediatrician examines your toddler, he will be able to feel the stool mass on both sides of his stomach. The doctor’s examination is designed to ensure no serious causes exist for the constipation. Your doctor can recommend a variety of treatments to resolve the problem. He will decide how to remove the stool mass and he might recommend lubricants and stool softeners. Some doctors use parent education, attention to diet and behavioral modification techniques to help your toddler relax and resume normal bowel movements.