I am right in the middle of toilet training my 3-year-old son. He seems to be very interested -- at least, that’s the feeling I get when he urinates in the toilet, puts half of a roll of toilet paper in and then swishes it around with both hands before I can stop him.

My oldest son, on the other hand, hated the toilet. Because he is our first child, we didn’t realize we were pushing him before he was ready. We just assumed that at the age of 2, you had to get him into a routine -- no matter what. Two weeks of sitting him on the potty and constantly telling him how he was supposed to perform (even though we did it nicely) began a long and horrible two and a half years of stool withholding, chronic constipation and encopresis (where a child holds his stool for so long that a build up of loose stool slips past the large stool and causes “accidents” or “staining”). We later found out that stool withholding is actually quite common, especially in boys.

The American Academy of Pediatrics (AAP) released a study in January of 1997 that revealed some surprising results. When researchers studied 482 healthy children between the ages of 18 and 30 months, they found that 106 children refused to have a bowel movement in the toilet, but would urinate in the toilet. Of the 106 children who withheld their stools, 29 of those children, like our son, needed the help of a pediatrician.

Our son was so afraid of releasing a stool into the toilet that he would hold it until he had a diaper on. In the beginning, we refused to give him a diaper because we felt it would be “back sliding.” Without a diaper, he would hold it for days until he suddenly became sick to his stomach and the urge to have a bowel movement was so great that he could no longer control it. By this time, he would have such a large, hard stool to pass that he would scream and be in incredible pain while passing it. Coaching him through one of these movements was like coaching a woman in labor -- you knew the pain was incredible and there was nothing you could do. Sometimes, these constipation episodes would make little tears in his anus, called fissures, which would hurt all of the time -- not just during a movement.

Needless to say, just one traumatic movement like this was enough to frighten him into a cycle of never wanting to have a bowel movement again -- with or without the toilet. He went through months of chronic constipation, training his muscles to hold the stool, not release it. He went through a period of encopresis when his body finally had too much stool and liquid would slip past and leak out of him. We had to keep his stools soft with diet and medication until he could get over his fear, while allowing him to have healthy movements in diapers for another year before we could even consider training again. He was not fully trained until a little after his fifth birthday.

Withholding can be as traumatic as it was with our son, or a simple as a child who withholds from the potty, but feels comfortable having a bowel movement in his underwear or diaper. Take the advice of a parent who’s been through the worst of withholding and chronic constipation: If you see signs that your child is holding stool back, or if your child suddenly becomes constipated frequently, be sure to talk to your pediatrician and decide whether you should post-pone training until your child is ready.