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The Informed Parent

Questions & Answers: Painful bowel movements

by Louis P. Theriot, M.D., F.A.A.P.
Published on Jan. 01, 2000

Question: I have a 3 year old daughter. As an infant, she had problems with painful bowel movements. I had to give her juice and mineral oil to straighten this out. She was fine until 2 weeks ago when the same thing started up. She cries and says her bottom and tummy hurt although her stools seem to be soft and regular. We've been trying to start potty training for a few months but are not real forceful about it. Why does she seem to have fear all of a sudden about going potty? What should we do?

Answer: This is a difficult question to answer without more history and the ability to do a physical exam. Generally speaking, from the little information that I have, I would want to be sure that...

1)...your daughter is truly ready for toilet training. It may be more than just coincidence that you instituted potty training a few months ago, and the problem surfaced a couple of weeks ago. Most children are ready to be potty trained between 2 and 3 years of age, but it is a very individual process. A child must be willing and want to start the process. This usually begins when the child is able to communicate that they have voided or had a bowel movement. Then they will develop the awareness that they "have to go". If they are not ready, potty training will lead to frustration on the part of the child and the parents. It can lead to power struggles or issues of "control". It will most certainly delay the process. The child has to take the lead with the parents playing a supportive role. Invariably, when the parents take the initiative, or are too aggressive, this is met with marginal success.

2)...your daughter is not truly constipated. You mentioned that she is having "regular" bowel movements and they are soft. Some children can become constipated to the point that their entire left colon is full of stool. It becomes stretched and dilated. As the intestinal contents passes from the stomach and small intestines, it is very "liquidy" when it reaches the right side of the colon (large intestine). As it passes along the colon, water is being reabsorbed causing the stool to become "formed" by the time it reaches the rectum. When a child is constipated and the left colon is "full of stool", the liquid stool from the right side can leak around the area of impaction giving the false impression that the stools are soft. Parents are often surprised to find out their child is constipated because the child has been having 6 stools a day, and having "accidents" in their pants. This is a correctable problem but one that must be identified first.

3)...your daughter doesn't have a rectal fissure. A fissure is a little tear that occurs at the outlet of the anus. It is like a tiny "paper cut" and is usually due to straining or passing a hard stool. The fissure can cause painful bowel movements for the child. As the fissure tries to heal, the child has another bowel movement which reopens the fissure. Before long, the child associates bowel movements with pain, and is reluctant to go to the bathroom. This can lead to constipation, which can, in turn, lead to stomach aches. It is a self-perpetuating, vicious cycle. This too, is a correctable problem.

There are a number of things that can be done to facilitate your child having a bowel movement, especially as they make the transition from the potty chair to the toilet. Chances are, when she sits on the toilet, her feet do not reach the ground. If this is the case, get a foot stool for her so she can plant her feet to stabilize her. It will also allow her to plant her feet which will enable her to use her abdominal muscles when she strains.

As you can see, the answer to your question is not an easy one. I suggest you make an appointment with her doctor to specifically address this problem. I am confident that after a detailed history, and a thorough exam, you will have your answer and a course of action.

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