Toilet Anxiety

Alex, Boy, 3 years old

First clinic meeting with parents: 6th September 2018

Alex has been sleeping with a diaper but has full bladder control during the day. His parents constantly remind him to poop in the toilet but Alex restrains himself causing him to have bouts of constipation lasting three days. The constipation results in an Alex eventually soiling himself.

That situation has been lasting for four months since parents removed diapers. Alex’sc’s parents, teachers, and grandparents have all gotten involved and each have different theories as to what could be the answer. Alex’s kindergarten teacher and his grandparents try to persuade him to sit on the toilet. His father thinks Alex should just go back to using diapers and postpone the whole issue of training. Alex’s mother thinks they should take a professional advice.

I outlined to parents the rules of treating toilet anxiety and they left the clinic with a clear, detailed action plan.


On 30th September 2018 (three weeks after the clinic meeting) Alex’s mother reported a major improvement in his bowel movements, which became more frequent, with less constipation.
1st November 2018 (two months after the first meeting at the clinic) Alex’s mother reported another big improvement and this is what she wrote:
“Since our meeting at the clinic two months ago there has been a super significant change for the better! Unbelievable! From a child who would soil his pants several times a day, with constipation of two to three days consecutively, he’s now sitting on the toilet every day. And it’s all his initiative and under his control. In the past month, soiling incidents have decreased to once a week only. It’s an awesome method, that gives parents a well-structured format; totally practical and super professional. It’s hard to believe where we were just two months ago. Huge thanks to you from the bottom of our hearts.”


Rotem, Boy, 8 years old

First clinic meeting with parents 8th August 2018

He has complete bladder control day and night.
He only poops in the toilet when he’s really forced to. He does several bowel movements in his clothes during the day. He walks around with soiled clothes. That behavior has been lasting for years. Pediatricians have ruled out organic problems. He receives medications to alleviate ODD (Oppositional Defiant Disorder). Parents have consulted with various psychologists. He’s a very smart, sensitive child; outstanding in math; a football fan. He is highly competitive, with a very low frustration threshold. His parents are at their wits’ end about the pooping issue.

I instructed his parents about how to apply the disciplinary treatment.


On August 29th , 2018 (two weeks after the clinic meeting), we decided that the first disciplinary measure had not been sufficiently effective. We decided to replace it with a different rule.

On September 5th , 2018 (about a week after the rule change), his father described a significant change in Rotem’s behavior. He was actively working at emptying his bowels in the toilet, and at keeping himself clean and tidy. Over time, the need to implement disciplinary principles dissipated.

On January 21st , 2019 (five months after our first meeting), his parents got in touch to report a deterioration in Rotem’s behavior. He’d gone back to his old habits. They started reapplying the disciplinary principles. Within ten days he resumed functioning properly—doing full bowel movements in the toilet and staying clean.

On June 20th, 2019 (ten months after the first meeting), Rotem’s parents reported that he was persisting with his perfect cleanliness habits and there was now no need to implement the disciplinary rules.

Soiling and constipation

Rebecca, girl, 11 years old

First clinic meeting with parents: June 19th , 2017

She does not wet at night. There are intermittent periods when she wets her clothes during the day. She does bowel movements in the toilet once every three weeks; and even then, they are very small and partial poops. She is constantly withholding and constipated.

In the past few years, on several occasions, her parents have had to take her to the emergency room to have feces removed. The doctors had to anesthetize her and manually remove huge chunks of feces. Gastroenterological tests ruled out any organic reasons for the problem. Her parents have tried various therapeutic interventions. She takes large amounts of MiraLAX. Every so often they’ve tried enemas, as well as different kinds of psychological treatment.
Rebecca was already constipated and retained feces while she was still nursing. At age 18 months she started getting MiraLAX. Her diet is varied and balanced, with good amounts of nutritional fibers.

Rebecca is described as a sensitive girl; delicate and smart. She’s very popular with her friends. In some areas, she avoids responsibility.
According to mother, the issues of holding in, soiling, and continuing constipation, are ruining so much in Rebecca’s life, and the lives of her family members.

I instructed her parents to start the intensive method, plus behavioral treatment and to use micro-enemas.


On June 27th, 2017 (a week after the clinic meeting), her parents reported that Rebecca was moving her bowels every day in the toilet—a full evacuation, helped by enemas. She was cooperative and it was clear there had been a great improvement in her mood and her general daily functioning. Consequently, we reduced the dose of enema.

On July 10th, 2017 (three weeks after the first meeting), Rebecca’s parents described several events in which she managed to poop in the toilet without having used an enema. She didn’t go of her own accord, but after her parents reminded her. Consequently, we cut the dosage to a quarter bottle.

On July 20th,, 2017 (a month after our first meeting), her parents reported the new and welcome pattern that was developing. She no longer pooped as soon as she was given the enema. She went about her affairs and, only a half-hour later when she felt pressure in her stomach, she went on her initiative to the toilet. Now and then she was going to the bathroom to evacuate without having received any enema at all.

On August 25th, 2017 (two months since the clinic meeting), her parents reported that she was going more and more to poop in the toilet independently, and there was far less need to remind her: the use of enemas had dropped significantly.