By Steve Hodges, M.D.
A mom in our private Facebook support group, treating her 5-year-old for encopresis, posted a good question to fellow parents:
“Has NOT nagging your kids about toilet use ever helped? I am trying to get my daughter to sit after meals for 5 minutes and to just generally take a moment before jumping off the potty. However, she is very upset by our constant reminders. I don’t want to do her a disservice, but we also need to maintain a positive relationship during this process.”
Several parents weighed in, which I’ll get to shortly. But first, I’d like to offer my own perspective: Nagging is counterproductive.
For one thing, it is indeed important for parents to maintain a positive relationship with their children during treatment for chronic constipation, the root cause of encopresis and enuresis. Pestering a reluctant child to comply with any aspect of treatment usually just makes the child more reluctant.
Also, the treatment strategies this mom mentioned — sitting on the toilet after meals and sitting for an extended period — just aren’t that important. Enemas and laxatives, the key components of the Modified O’Regan Protocol (M.O.P.), are exponentially more helpful.
Certainly, regular “potty sits,” as we call them, can be useful. In the M.O.P. Anthology, I recommend kids sit on the toilet for 5+ minutes after meals, because that’s when the body is most primed to poop. I even provide guidance on effective pooping posture.
But I also state: “If your child isn’t amenable to potty sits, don’t force the issue! When a child’s rectum lacks tone and sensation, a potty sit may be futile, so try not to perceive your child as ‘refusing’ to use the toilet. Drop the issue for now.”
Chronic constipation is, of course, chronic, not a situation that develops overnight. By the time a child starts having accidents, the rectum has likely been stretched for many months, likely years. The child kid simply cannot sense the signal to poop.
If the child has enuresis, the bladder’s signals to pee have gone haywire, too, because the enlarged rectum has aggravated the bladder nerves.
To a child who can't feel the urge to poop or pee, sitting on the toilet seems pointless. This notion can take time for parents to accept, foreign, as it is, to the adult experience.
As one mom in our support group posted, “I have had to teach myself to really believe my kids when they say they can’t feel it. Sometimes my son says he gets a small feeling, and he
doesn’t believe he really needs to go unless it’s a strong feeling. I tell him it’s important to respond to even small urges, but it’s hard for him because the sensations are not consistent.”
For kids like this boy, remaining seated for a full 5 minutes can feel like an extreme waste of time. Try it yourself by setting the time on your phone. Five minutes is a long time!
In the early stages of treatment, when the child is still having accidents, enemas and stimulant laxatives such as Ex-Lax render voluntary potty sits almost irrelevant.
Enemas will trigger a bowel movement within a few minutes, so the child won’t need to “decide” whether to sit on the toilet. The enema sends the child directly to the toilet. Likewise, stimulant laxatives, when dosed and timed correctly, will trigger a bowel movement within 5 to 8 hours — no nagging needed.
In my experience, many parents place outsized emphasis on potty sits because they worry that if their child uses enemas or laxatives to poop, the child will experience “lazy bowel” and lose the ability to poop on their own.
But this is a false assumption. “Lazy bowel” is fiction, as I explain in the Anthology.
When a child is chronically constipated, the bowel is already not working normally. Once the rectum retracts to its normal size and regains full sensation, the child will no longer need enemas or laxatives. I promise!
Children with Encopresis and Enuresis Deserve the Best Treatment, But Most Aren't Getting It
In the meantime, if the child can poop only after an enema or Ex-Lax, this is not a sign of dependence. It is a sign the child’s rectum remains stretched and requires continued treatment.
It’s also a sign that nagging a child to spend more time on the toilet won’t help. Your time and energy are better spent on the components of treatment that do the most good.
Of course, once the rectum begins to clear and heal, habitually sitting on the toilet, in a relaxed manner, will become more useful.
On this front, parents in our private support group offered helpful advice to the mom who posted the question about “nagging.”
One popular strategy is a vibrating potty watch, set to buzz every 2 to 3 hours. The watch, a neutral party, relieves parents of the job of reminding.
One mom posted: “The urologist showed our 6-year-old the vibrating and explained what it would do and asked her if she would wear it. She now wears it with no issues and will get up and go to the bathroom when it goes off (every 3 hours) with no fight. Occasionally we have to say, ‘Did your watch go off?’ Her teachers and after-care teachers know what times the alarms go off, so if she does ignore them, they can give gentle reminders.”
As for keeping children on the toilet longer, many parents turn to entertainment or distractions — books, videos, even art supplies.
“We sat and read books with my son,” one mom posted. “When we kept him busy with activity book, he would sit longer. Building it as part of the routine helped.”
Another mom wrote: “My kiddo was allowed to play games on my phone during potty time. It was something he looked forward to, since he doesn’t have a ton of screen time.”
Some parents set timers or provide timers for their children to set for themselves.
One mom posted: “We have a pinwheel and a bottle of bubbles for our daughter to blow on at least 5 times to relax her pelvic floor to pee.”
When strategies like these work, that’s great. But sometimes, they don’t, and that’s OK.
“We gave up on the potty watch and charts, bribes — nothing works,” one mom posted. “It became a real power struggle, but we finally stopped arguing. I don’t think he knows what it even feels like to ‘need’ to go.’”
That’s exactly right. And until he does regain the sensation, cajoling won’t help.
Another mom posted that she, too, concluded pestering only backfires.
“We just let our kids go as they felt the need. It definitely reduced anxiety and helped avoid relationship problems."
She continued: “Kids don’t have accidents regularly because they don’t want to use the toilet. They all really want to. Making it a pleasant place and explaining how their body works and why sitting on the toilet after meals is a good idea helps, but I wouldn’t be forcing anything.”