Case Study: Refusal to Use the Toilet to Poo

Master 4 first presented to our clinic as a delightful, quiet and co-operative boy, who was toilet trained for wees, but refused to sit on the toilet when needing to poo. When his parents tried to encourage him to sit on the toilet, he would become increasing agitated and anxious and would hold on for as long as he could, before hiding behind the couch and pooing in his pants.

As part of therapy to overcome his anxiety, a behavioural modification program was established in the first session. Master 4 was required to sit on the toilet to do “practice poos”. The emphasis to him and his family was practice, so that there was no implication of pressure to pass a bowel motion as that would only increase his anxiety. He was also set up with a reward system for complying with the practices and a reward system for achieving his goal.

After only two consultations over a period of six weeks, he was pooing in the toilet routinely with no distress. His mother was extremely pleased with his success, but still concerned that he would only pass a bowel motion in her presence and in his own toilet. After introducing incentives to try other toilets and gradually exposing Master 4 to many other toilets, he began pooing in other toilets and without the presence of his mother. It was recommended to continue using rewards and incentives until he was confidently using toilets for one month and then to gradually phase them out.

Upon follow up, his mother reported that he continued to use the toilet successfully with no accidents and had “not looked back”. She felt that there had been a significant improvement in other areas of his life as well, including eating better, being less anxious and more settled. His mother emailed me this final correspondence;

“Rebecca, thanks again for all your help. It was a pleasure meeting you and watching Master 4 form such a strong (and immediate) bond with you. Thanks for not only helping him, but for allowing me to see some of the ‘mistakes’ I was making with him as he was growing up (overall – not only in relation to his toilet training issues). I have highly recommended you to all my friends. And we may be in touch again as he and his sister both grow up….”