In this counseling answer:
” I don’t think it is a matter of stubbornness, this boy may be having some difficulty in controlling his motions, an itching or burning sensation, pain or fissure in the anus could prevent him from controlling his motions, and these are simple and curable medical conditions. But needs proper and fast intervention to prevent any psychological impact as people are usually zero tolerant to it.”
As-salamu `alaykum dear sister,
May Allah bless you and your children and help you through this problem. Normally children learn to defecate in the toilet before they can control their urine, but every child grows at their own pace and is unique in some way or other.
In this case, your son is doing very well as far as urination goes, and ma sha’ Allah, he doesn’t wet his bed which is a good achievement at his age. Only 80% of children are reliably dry by the time they are four years old.
Before getting deeper into answering your question I would like to give you some information about the defecation process:
Normal defecation requires several processes to work properly.
First, the two rectal sphincters: the internal sphincter which works automatically and is not under our conscious control. The external sphincter, on the other hand, is under voluntary control, and is tightened at will. If we have the urge to move our bowels, this is the sphincter that we can control until we reach the bathroom.
Second, we must have normal sensation, to be able to tell when the rectum is full, and also to differentiate gas from stool so that we can safely pass gas but not stool at the same time.
Third, there should be a normal food movement in the colon.
Fourth, there must be no obstruction or blockage to the movement of stool.
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Most parents who begin toilet training their children at about the age of two years, would get good results by the age of 4 years, whereby more than 90% of children are reliably clean and dry during the day. But sometimes children especially boys may have some defecatory problems, mostly soiling or those who refuse to go to the toilet, and you have to be able to differentiate between both.
Toilet refusers are developmentally normal, but for some reason have a strong aversion to using the toilet. They prefer to pass their motions into their pants, often in a special location such as behind a couch or door.
Underwear soiling is a problem that arises in children commonly as a result of chronic constipation, where the child continually avoids passing stools, which may be due to painful motions, or because they feel anxious or are too busy playing (or being teased in bathrooms if he attends school or day care).It is most common in children aged 3-7 years, and also affects boys more than girls.
Sometimes when a child becomes constipated he ends up passing very large movements which cause considerable pain, with overflow of softer material around it .Sometimes they can even cause small tears around the anus (anal fissures), and this can further frighten children from wanting to go to the toilet.
What should you do?
Try this dietary, and behavioral scheme for 1-2 weeks:
- Don’t scold or embarrass him, try to be patient and positive rather than angry or disappointed, as this can be totally involuntary, he needs your encouragement and support.
- Regular toilet times are important, especially after breakfast, lunch and dinner as our bowels tend to contract after we eat. Let him sit on the toilet for 5-15 minutes, and not for an hour as you mentioned, this is not fair.
- Keep a record of when accidents occur, so that:
a) You can observe if there is a pattern. b) Any sign of bowel activity/clues should be considered.
- Try to ensure that your child’s diet contains adequate fruit and vegetables, fiber and fluid (water and fruit juice). Good sources of fiber are cereals, brown rice, bran, prunes and high-fiber breads.
- Reward his successes with hugs, and various forms of praise for clean pants.
- Try to eliminate any stress around him as this may be psychological.
If these steps failed then I strongly urge you to seek medical advice.
From my experience, I don’t think it is a matter of stubbornness, this boy may be having some difficulty in controlling his motions, an itching or burning sensation, pain or fissure in the anus could prevent him from controlling his motions, and these are simple and curable medical conditions. But needs proper and fast intervention to prevent any psychological impact as people are usually zero tolerant to it.
When you get him to the doctor, do your best not to make him feel embarrassedand don’t give him the feeling that he is a sick person, so as not to take the excuse in doing it in his pants again.
When you rule out any medical conditions, you then give him another two weeks of training, and I am sure in sha’ allah that you will find a great progress.
Last but not least always arm yourself with du`aa’ and pray two rak`at (Salat-ul Hajah)and ask Him to help you and your beloved son.
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