Fear of going to the bathroom in children

Learning to go to the bathroom alone is one of the first challenges a child has to face. Sometimes it happens that, despite knowing that they need to go to the bathroom, they prefer to delay or avoid it. One of the consequences of turning this procrastination into a habit is the appearance of constipation. As a result, children may increase their reluctance to go to the bathroom even further, thus entering a cycle.

This fear is relatively common in childhood, but that does not mean it should be ignored. Maintained over time, it can lead to more serious problems, such as encopresis -with constipation or retentiveness- or functional megacolon.

How is the vicious circle “constipation – fear of going to the bathroom – increased constipation – increased fear” produced and aggravated? What are the consequences of avoiding pooping? How can we help a child who is afraid to go to the bathroom?

The vicious circle that aggravates the fear of going to the bathroom

Some of the reasons why children may avoid going to the bathroom are not wanting to interrupt the activity at hand, fear that something internal and dirty will come out of their body, or reluctance or embarrassment to go to the bathroom outside of a familiar environment. or known, among others.

Given this, The child resists the urge to go to the bathroom and the feces remain retained in the colon. What occurs in the colon is a reabsorption of water, which hardens the stool. And when the child tries to go to the bathroom, a lot of pain appears and even anal fissures and small bleeding may occur. In this way, pooping will become a very unpleasant situation that the child will try to avoid.

As with the rest of the phobias, fear leads to avoidance. In this case, the fear of suffering pain again causes the child not to want to go to the bathroom and holds back the urge to poop even more. Although the goal of avoidance is to “get rid” of the problem, it only makes it worse.: Avoiding pooping to avoid suffering, aggravates constipation, and this will cause more suffering.

The consequences of holding back the urge to poop

One of the most frequent consequences in children who retain stool is encopresis. This disorder consists of the emission of feces in inappropriate places. When the emission of feces is involuntary, it is usually associated with constipation, fecal compaction and fecal retention. The retention of feces ends up producing an overflow. That is, an “escape”.

This type of encopresis is known as retentive encopresis or encopresis with constipation and overflow incontinence. In this case, the stool is usually poorly formed and the loss or leakage usually occurs continuously during the day (rarely during the night).

When encopresis is not treated and the child continues to retain stool, distention and loss of sensation of the rectal wall may occur. This causes the child to lose the feeling of needing to go to the bathroom. And as a consequence, what is known as psychogenic megacolon occurs.

Megacolon consists of a dilation of the colon in which feces are retained (becoming increasingly compact) until it reaches the limit of its capacity and overflow occurs.

How can we help a child who is afraid to go to the bathroom?

We have focused on the voluntary behavior of holding in poop as the source of constipation. However, also It may happen that due to lifestyle, eating habits, or another disease (such as hypothyroidism) the child suffers from constipation. primary and this causes pain when defecating and, as a result, the fear of going to the bathroom develops.

Therefore, the first step to address the problem, Whether the constipation is primary or secondary, it is about solving the constipation to “break the circle.”. The pediatrician may recommend that the child increase fiber intake or give laxatives.

Make the child participate in the problem and the solution

It can be very helpful to explain to the child what feces are, how and why they are produced, and why it is important to expel them. Also make you understand the importance of maintaining a good bowel routine and paying attention to your body’s signals, as prevention of future constipation problems.

If the child understands what the cause of the problem was and that he himself can work to prevent it from happening again, he is more likely to get involved in solving it.

Establish a “pleasant” defecation routine against the fear of going to the bathroom

If the child has chronic constipation, the objective will be to modify certain habits that improve it. However, when constipation was the result of a bad habit, the next step will be establish a good bathroom routine. We must not forget that for the child, going to the bathroom has become a very unpleasant moment.

Let’s try make going to the bathroom more enjoyable to decondition fear. It can help us to surround the experience with positive elements, such as a story or simply a moment in which we pay attention to them.

Sphincter exercises

It must be ensured that the child does not engage in stool retention strategies (due to fear of trying to expel them), or paradoxical defecation dynamics. These consist of the tendency to strain the sphincter or pelvic floor, instead of relaxing it, which prevents defecation.

It can be done with the child some muscle relaxation exercises so that you learn to become aware of movements and sensations. Another way to facilitate defecation is to place a small step for the child to place his feet on to adopt a position similar to squatting.

Reinforcement, reinforcement and more reinforcement

Both in each attempt and in each defecation, positive reinforcement is more than necessary. You can make a card on which the child can put a sticker as a reward for each time he complies with the routine and for each time he manages to poop. He should be praised every time he sits on the toilet, whether or not he manages to poop. Even more so when she gets it.

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