Arielle is aged three. Her parents came to the clinic on 11th June 2019. She’s still bedwetting but controls her bladder during the day. She has one or two small bowel movements, in her underpants. They occur anywhere and everywhere. This situation has been carrying on for almost a year. During that period there were two isolated incidents in which she had a bowel movement on the toilet. She can sit on the toilet but isn’t capable of pooping there. So far her parents haven’t looked for any professional help. They’ve tried again and again to persuade her, using gifts, explanations, examples, and all sorts of bribes. Occasionally she reacts with tremendous anger. Her kindergarten teacher and her grandparents are involved in the matter, and try to put pressure on Arielle. In general she functions well in various life aspects.

I explained to Arielle’s parents that this is a question of a powerful anxiety that has taken control of the child. In fact there are two anxiety factors at work here. The primary anxiety was having a bowel movement on the toilet bowl. Following reactions from people around her, the lack of understanding that anxiety is the problem here, and the demands placed on her to poop on the toilet, another form of anxiety developed – about pooping in the toilet bowl. It’s expressed in small, partial bowel movements that reveal she’s withholding and trying to prevent any bowel movements at all.

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

On 19 June (five days after the clinic meeting) I phoned her mother, Hodaya. She related that they’d started applying the approach, Arielle was cooperative about sitting on the toilet bowl after having soiled her underpants. She had started announcing, after dropping poo into the toilet, that she’s got more poo, and asked to continue sitting, without underpants, on the toilet bowl. Her mother was astounded to see that Arielle was doing it – of her accord – in the toilet, but that’s what happened. Arielle was so delighted and asked to phone her father and her kindergarten teacher and tell them the news.

This is the letter I received from her mother, after that phone call:

Our story started ten months ago. We started toilet-training Arielle following urinary tract infections caused by diapers. Arielle wasn’t so ready but we had to take that step. In terms of peeing, Arielle started to pee in the toilet but not pooping… She stubbornly refused to poop on the toilet, only in her underpants. We tried everything: we encourages, promised gifts, we were angry, we read stories absolutely everything, but nothing helped. That’s how we’ve spent the past ten months, and as parents we experienced immense frustration. As a result, Arielle grew frustrated too, and disappointed in herself. We came to Dr Kushnir totally unoptimistic, but he gave us hope – asked questions about Arielle’s problems, and finally the problem got a name – toilet anxiety. He said we shouldn’t talk to Ariel any more about the bathroom and the toilet bowl, and every time that she soils her underpants we should say “Great – the main thing is that you pooped.” He said as well that we should change her when she sits on the toilet bowl, pull aside her panties and let the poop fall in; we should laugh at the splash! created by the falling poop, and get rid of her anxiety that way. In addition he said that if it happens and she does poop in the toilet, we shouldn’t be too thrilled, just say words of reinforcement and that’s it. I was surprised when he said not to involve the kindergarten staff because I’m a kindergarten teacher, but he told us that this was so that Arielle will feel comfortable at home and not so much in the kindergarten. As we left the meeting, we started implementing the method, and then once there was soiling in her underpants we did as he said. Arielle was entertained by the splash when we changed her on the toilet. The second time we changed her she continued pooping in the toilet, and said to us “I’ve got more” … we were in shock, but only inside, we didn’t reveal how delighted we were. We remembered that Dr Kushnir said to curb our enthusiasm, so all we said was “Way to go, Arielle!” Later she pooped a little more in her underpants and then went onto the toilet bowl. And today I could have almost screamed with joy… Arielle came to me and said “Mom I need to poop.” I asked her “And where do you want to poop?” She said in the toilet. I took her hand and she sat on the toilet bowl and suddenly there it was – poop. At that moment I wanted to burst with happiness but again remembered to be restrained, and said “Well done, Arielle, you’re a champion!” She looked at me and wanted me to be more overjoyed and then she said “Mom I’ve pooped in the toilet!” I reacted by just saying “Yup, you’re a champ.” She said “I deserve a present, Mom, and I want you to phone Dad and the kindergarten teacher and tell them I pooped on the toilet.” I phoned them, and Arielle shared the news with them. She got encouragement from her teacher, who promised that the next day she’d  get a medal from her. I phoned Dr Kushnir to let him know and asked his advice what we should about the gifts she’s expecting and – more than this – how to continue. Dr Kushnir said to tell Arielle that the biggest gift is that she successfully pooped in the toilet, but she’ll get a gift because she asked to poop of her own initiative. And he also said we should still restrain our enthusiasm with her, when she poops again in the toilet, and to give her reinforcements. Even if she does it again in the toilet we should say “The main thing is that you did a poo,” but not to remind her about the toilet.

From here on we’re continuing the process… and there’s no doubt we’re totally thrilled.

Dr Kushnir, thank you so much for everything, we’ll let you know what happens ahead.

Good night and loads of thanks.

Sincerely,

Hodaya