“But don’t speech pathologists just fix lisps?” is one of the most asked questions I get when I tell my friends that I often support children with stool withholding and encopresis. And whist tackling those pesky ‘s’ sounds is definitely part of a speech pathologist’s regular caseloads, our skill set goes far further!
Speech pathologists also have the knowledge and expertise in supporting children with elements of toilet training, which can include stool withholding (sometimes referred to as ‘withholding poop’ or Encopresis). Speech pathologists also have extensive understanding of a range of different conditions that can co-exist with stool withholding, including Autism, ADHD, developmental delays and language difficulties.
And for frustrated families who feel like they are getting nowhere with tackling stool withholding, consulting a speech pathologist can be a great next step.
Wait - What is 'Stool Withholding'?
Firstly, some basics! Simply defined, stool withholding refers to holding in a bowel motion instead of passing it out of the body (Ferguson, 2015). If done for long enough, stool withholding removes the “urge” to poo. The child then feels short term relief that they have avoided their fear. The child then repeats this action the next time they feel the urge to poo. This vicious cycle then causes a build-up of old, hard stool in the colon, which then presents like constipation.
How Do I Know if My Child Is Withholding Poo?
Whilst every child is different, there are some subtle signs that your little one may be experiencing fear around pushing out a bowel motion:
- Fear of using the toilet or potty
- Hiding when asked to use the toilet or potty
- Soiled undies, either small stains or whole bowel motions
- An increase in wee accidents, as the full colon is pressing on the bladder
- Physical signs such as stiffening the body, crossing their legs or turning red-faced to attempt to hold in their poo
I see so many frustrated families who just don’t know who to turn to in order to support their little ones with stool withholding – they have visited doctor after doctor or are currently on a l-o-n-g waiting list to see a Paediatrician or other specialist. But like any parent wanting to help your child, I am often asked – ‘what can I do RIGHT NOW to help my child?!’
And my answer is the same: “Check in with a speech pathologist”.
How Can A Speech Pathologist Help a Child Who is Withholding Poop?
Let’s take a closer look at how speech pathologists can support your child with encopresis /stool withholding:
1.Speech Pathologists Can Introduce and Establish Visual Supports to Help with Stool Withholding:
Visual supports are a visual item that help to support communication. Examples of visuals include:
- Physical items, e.g. a book
- Photographs
- A picture symbol
- Written words
Visual supports are great for children who are reluctant to pause their play to have toilet time and as a result, withhold their poo, like this ‘First-Then’ chart:
Visual supports are also great for breaking down the overwhelming toilet process into smaller, more achievable steps:
2. Speech Pathologists Can Develop Appropriate, Meaningful, Encouragement and Reward Systems to Help You Tackle Stool Withholding
Stool withholding can be a long and sometimes frustrating journey for dedicated families. It is so important that parents remain encouraging and positive for their little ones.
One way to encourage and motivate your child to tackle stool withholding is through creating and implementing a reward chart. “But I’ve tried reward charts” is something that I hear a lot! But – speech pathologists can work with you and your child to create a reward system that is both motivating and is tailored to your child’s specific interests, increasing the likelihood that your child will participate.
Also – speech pathologists can help you figure out the specifics of the reward chart system, including:
The goal – what is the specific goal of the reward chart? It could be sitting on the potty; pushing out a poo into a nappy; doing a poo into the toilet.
The number of times required: How many times does your child have to complete the goal? Make this clear on the reward chart so that your child can see their progress over time (this also helps maintain their motivation!).
The reward: Your child has to know what they are working for! This will help increase their motivation and participation:
3. Speech Pathologists Can Create and Implement Specific Social Stories to Address Stool Withholding:
Social stories (often referred to as ‘Social Narratives’) are simple stories that describe a social situation. Social stories are fantastic at showing your child not only what is expected of them in a particular social situation or routine, but also what THEY can expect – helping to reduce anxiety and overwhelm.
Some common examples of social stories include:
A Social story related to Encopresis is a great tool to:
- open the conversation about stool withholding with your child.
- show your child what is expected of them during the toileting process.
- validate their fears and hesitation around the toilet process
And, like visual supports, a stool withholding social story is permanent, meaning that it remains long after your verbal messages have disappeared. This allows your child to reflect on the concepts in their own time and space, increasing the likelihood that they will internalise the messages.
The Teaching Speechie Approach to Stool Withholding:
If you’re looking to talk to a speech pathologist about stool withholding, be sure that they have specific knowledge in this area! At The Teaching Speechie, I pride myself on bringing my knowledge of both teaching and speech pathology, plus extensive experience working with families tackling this confusing issue (plus, did I mention that I’m a mum too?!).
BOOK IT: Complete the Consultation Request Form Here
WORK IT: On the scheduled day, we’ll dive deep into your child’s stool withholding journey and discuss specific, interest-based strategies to help you through the dark tunnel of stool withholding.
USE IT: By the next day, you’ll have specific resources and strategies ready to support your child.
Sounds like something you need to help your child?
