Seattle's Child

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A child struggles with constipation — the books "The Ins and Outs of Poop" may help.

Potty training, constipation, encopresis: Hope and help

The book 'The Ins and Outs of Poop' offers a path through

When I started thinking about potty training my oldest son (he was just about 3 years old at the time), he was showing no inclination to use the toilet. I didn’t want to rush him – I had heard that boys sometimes catch on to potty training a little bit slower than girls, and my daughter hadn’t fully potty trained until she was 3 ½. But I decided to start working on it with incentives: stickers and M&Ms and big boy undies he got to pick out himself.

He liked the incentives; the potty training was a disaster. He had accident after accident after accident. And the accidents were awful – messy, smelly, gross. Over time, his teachers started to ask questions, the kids in his preschool made comments about his odor, and he started acting out at school. We went through one pediatrician, two pediatric gastroenterologists, two pediatric dietitians, one social worker, one child psychologist and a whole array of tests before we finally found a pediatrician that had the living memory of the now defunct encopresis clinic at Children’s Hospital. She referred us to a nurse who used to work at that clinic and who now runs her own encopresis clinic in Edmonds. That whole process took two years.

If we had only had the book, “The Ins and Outs of Poop“, back then. We could have saved our son and ourselves a great deal of frustration, embarrassment and time. Written by Thomas R. DuHamel, Ph.D., a clinical child psychologist who has successfully collaborated with parents and pediatric health care providers about functional constipation for over 40 years, it is an invaluable resource for doctors and teachers and parents alike.

I talked with “Dr. Tom” about his work. Here’s what he had to say:

What was the impetus for writing this book?

Parents have frequently asked me if there are any books they can read or if there is any place on the internet they can go to learn more about functional constipation. What I have said to them is that I’ve read a lot of books and articles about childhood constipation, but that most of them are written for professionals and do not address the day-to-day decisions and struggles that parents have to deal with. As for the internet, although there’s a lot of information about constipation and encopresis out there, I do not recommend it to parents because so much of it is contradictory or just plain wrong. So, unable to find anything in writing for parents that I thought was accurate, easy to understand and provided practical advice, I decided to write a book for them myself.

Constipation seems to be a really frequent issue with kids at the potty training stage, yet many doctors and potty training books never mention it. Why do you think that is?

In our culture, people are generally uncomfortable talking about “poop,” “poo” or “bowel movements.” Unfortunately, this includes many doctors. Talking about poop is considered by many to be in poor taste. Parents and teachers tell children from early on not to use “potty talk.” Another reason why constipation is not mentioned very often is because many doctors do not know how serious constipation can be for children. Like most people, many doctors think that there is only one kind of constipation, occasional constipation, the kind that comes and goes in a matter of days. If they don’t know about encopresis, they can’t talk about it. Hopefully, my book will help to bring this problem out of the shadows.

What are the most common mistakes you see people make with potty training?

The two questions that parents always ask, especially new parents, are: “When should I start toilet training” and “What method should I use.” Some parents try to train too soon, before their child is developmentally ready. Most children are developmentally ready between 18 and 24 months. Trying to toilet train much before then can be stressful for everyone. Other parents wait until their child is 3 years old or older before they begin training, which can make training much more difficult than necessary because, by that time, their child has become dependent on diapers or pull-ups and resists giving them up. Another mistake parents make is to use one or another of the now popular potty-training-in-a-day training methods, not because their child shows signs of readiness but because they want to get toilet training out of the way as quickly as possible. There are some 18-20 month old children who can be trained in a day, but most cannot.

What is the most important thing parents can do to try and avoid encopresis?

I think the most important thing that parents can do to prevent encopresis is to look at their child’s poop at least two or three times a week to check for the early signs of constipation. In my book, I describe what a normal stool looks like (light brown, banana shape with a smooth surface) and what a constipated stool looks like (dark brown, sausage shape with a lumpy surface). I even provide pictures! The reason parents should inspect their child’s stool frequently is so that if he or she develops occasional constipation (which most children will), they can treat it quickly with natural remedies before it turns into encopresis.

What words of encouragement would you give to parents who have been through the encopresis diagnosis and are looking toward the lengthy process of clean out and retraining?

The first thing I often say to parents, after confirming what many of them already knew before they came to see me, is this: “Take a deep breath, relax and rest assured that encopresis is curable. It may take up to a year or more and there will most likely be many ups and downs, but your child will eventually stop withholding and will stop soiling. The keys to success are to stick with the treatment plan, share your questions and concerns with me along the way and to be patient. This too will pass!” (Pun intended.)

Finding doctors, therapists and other resources can be difficult for parents with an encopretic child. Do you have suggestions for where a parent should turn for help in our community?

I always recommend that parents talk with their pediatrician or pediatric nurse practitioner. I have found that most pediatric specialists in and around Seattle are knowledgeable about encopresis or know of someone who is. This is not the case in many rural areas of the state. In those cases, I sometimes recommend that parents read my book and then ask their pediatrician to read the chapter titled, “Constipation Guide for Pediatric Healthcare Providers.”

Dr. Thomas R. DuHamel, PhD is a clinical child psychologist who has successfully collaborated with parents and pediatric health care providers about functional constipation for 45 years.

Dr. DuHamel retired in 2015 after almost 40 years of private practice at Associates in Behavior and Child Development, ABCD Inc, in Seattle, Washington and now devotes most of his time to helping children with functional constipation through his books, speaking engagements, blog and telephone consultations. Dr. DuHamel is a former Clinical Associate Professor in the Department of Psychiatry and Behavioral Sciences at the University of Washington School of Medicine. Prior to private practice, Dr. DuHamel was Chief Psychologist at Seattle Children’s Hospital. Go to for more information.

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About the Author

Erika Bigelow