A few years ago, my psychologist colleague asked me if I could help a young child who was withholding their stool for 7-8 days. My colleague had reached the end of therapy with the boy, but he still was unable to have regular bowel movements.
During our first meeting, I could barely examine the little boy, whom we'll call Ben. He clung to his father's pants. He was very thin, with sunken eyes. After much persuasion, I managed to get him to let go of his father's trouser leg and sit down next to me on the carpet.
If I remember correctly, all of his examined reflexes were present. However, at that time, I tested only eight reflexes. Fortunately, among those tested were some that were relevant to Ben's underlying problem.
The parents were present during the examination. I'm not sure if they fully understood my explanation, as they were both very worried. Ben was 6 years old and was due to start school the following year. It seemed unimaginable to them that he would attend school while still unable to go to the bathroom. What if he has an accident and soils himself in school? He already feels anxious. Such an event could shatter his fragile self-esteem. They preferred to postpone the school year somehow. It was not an easy decision because Ben was already a year behind in school. Despite all the excitement, anxiety, and worry, the parents understood very well that although Ben would need to perform only a few exercises daily, it would still require commitment every day.
I remember exactly, that it was the beginning of October. We agreed to meet again in January. Just a few days before Christmas, I received a text message saying that Ben had been having bowel movements every day for the past week. At the end of January, when I saw the little boy again, I hardly recognized him, even though only a little over four months had passed since our last meeting. His little face was round, he was smiling, and there was no problem with the examination. By then, five of the eight reflexes had "disappeared". There was a slight setback around Easter, but after that, the child had a bowel movement every day.
Two weeks ago, I ran into the family at the train station. The mother greeted me. Ben is doing the entrance exams for one of the best rural high schools this year. He's 180 cm tall, plays basketball, and only remembers that he had to spin in his father's chair every day.
It is rightly questioned how the persistence of certain infantile reflexes is related to stool withholding.
The vestibular system (the three semicircular canals, the utricle, and the saccule located in the inner ear, also known as the balance-sensing organ) plays a role in coordinating the muscles involved in defecation from the perspective of bowel function. If the vestibular system does not function normally, children may have difficulty with defecation, meaning that they may withhold their stools.
Our balance-sensing organ is not fully developed at the moment of our birth. In order for it to "mature", it needs movement of the head in all directions of space. An infant whose muscle tone is too tight or hypotonic, meaning "loose", is not able to move their head enough or in the right way for this tiny organ in the inner ear to receive the appropriate amount and quality of stimulation. This leads, on the one hand, to the persistence of certain infantile reflexes and, on the other hand, to varying degrees of immaturity of the vestibular system located in the inner ear.
After birth, gravity affects us completely. In the gravitational field, our muscles need to maintain our body and even the smallest muscle must have enough tone to ensure the optimal functioning of the given organ. Whether it's our eyes, ears, or even our intestines and rectum.
Therefore, children with vestibular dysfunction may experience difficulties with bowel movements. The resulting fecal retention is often accompanied by discomfort and pain. This affects the normal functioning of the vestibular system through body posture, leading to further muscle tone and postural problems. Fear of the pain caused by retained hard stool can also contribute to this vicious cycle. How can this very unpleasant condition be resolved?
On the one hand, by eliminating immature reflexes through regular performance of appropriate exercises, and at the same time, by stimulating the vestibular system.
For vestibular stimulation, I recommend rolling, spinning, somersaults, cartwheels, monkey bars, and of course, swings, slides, merry-go-rounds, trampolines, and see-saws found on playgrounds.
As with so many other problems, physical activity is one approach that can help treat fecal retention.