3-year-old hysterical and crying while pooping

My daughter is 3 and over the last several months she has become quite hysterical while pooping. We think it started with a bout of constipation a while back and we gave her Miralax. We started giving her Miralax every day when we realized that this was a constant problem. We were told that she'd calm down once she forgot that it ever was painful for her. But we have had her on daily Miralax for over 6 months and she is not better, she is actually worse than she used to be. She withholds her stool which of course doesnt' help. We have had her evaluated by her pediatrician as well as a pediatric GI and they don't think anything is wrong. The GI suggested we start putting her on the potty to poop to finish up our potty training and although she is allowing us to do this, reluctantly, this doesn't seem to change the pain of it for her. In the last week she has gotten poops in to the potty but not without a lot of screaming and crying both before it comes out and during. Even if she poops in a diaper, she screams and cries just as much. The poop that comes out is extremely soft so I don't know how it could be painful but she screams that it hurts all throughout the process. Sometimes it takes as long as an hour or more. We explored the possibility of sensory processing disorder but the few occupational therapists I've talked to don't think she has that even though she seems hypersensitive to the feeling of needing to poop and the feeling of it coming out. She has a few other symptoms of SPD including extreme sensitivity to cutting her toenails, and doesn't like to have her hair washed in the bath. But our main problem is the pooping. We are wondering if the Miralax could be making her poop acidic which is painful for her as it comes out? But I'm afraid to stop the Miralax because every time we let up on it a little bit, her poop is harder and she freaks out even more. One thing we are not totally sure about is whether this is actual pain or is it anxiety about possible pain? We have started her in play therapy but we are desperate for things that could help her. The daily struggle of going through this with her is taking a major toll on us and we are desperate for anything else that we could try. If any of you have suggestions, or have gone through this with your children, we'd appreciate any tips. I know sometimes autistic kids have trouble with pooping, and we'd love suggestions that have worked for them too as it might be something we could try with her. Thank you for any help or encouragement you could provide!

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miralax has polyethelyne glycol, a petroleum based product...  found in anti freeze...  the fda has done no studies for long term use of miralax... but i would not give this to my child...  I think flax meal works great with alot of water and pure concord grape juice...  you can sprinkle flax meal on everything...

for the emotional part, we used jin shin jyutsu, an energy healing and it worked very well....  for small kids you only need a 10 minute session or so....

I'm so sorry to hear you're all going through this.  If you're feeling up to it, I would try offering flax seed meal in some baked goods (you can use it as an egg replacer in baked goods-- google the ratio on minimalist baker-- it's great!) or try mixing a little bit into some orange juice just to alternate between miralax if you're suspecting taking that is affecting her stool.  You may have already checked in with her pediatrician, but checking to see about any food allergies might be helpful-- it took me 18 years to get diagnosed as Celiac (this was a long time ago!) but the pain she's experiencing sounds familiar.  

I wanted to respond because we lived through the same thing - 10 years ago! My son is a teen now and it's long behind us, but it was truly one of the hardest periods for us. Please google encopresis and start learning about it; doctors aren't very knowledgeable about this issue. My son suffered from encopresis from age 3-5. We tried EVERYTHING in different combinations:homeopathy, miralax, probiotics, magnesium supplements, fiber supplements, diet vigilance, reward charts, little presents, shouting (I don't like to admit that one, but it is so frustrating at times), and saw Meg Zwieback. None of that really worked. What did work? The Soiling Solutions protocol (https://www.encopresis.com/). It absolutely changed our entire family's life. The manual costs $75 online and I was very reluctant, since it sounded weird/quackish etc, but this program was the only thing that worked. (I'd give you the manual but I already gave it to someone else on BPN.) Anyway, the program is tough in the beginning and we didn't get results for the first 2 months, because my son was five before we tried it, but it works. I'm sorry you're going through this. Many kids have this issue, but no one talks about it, so you feel totally alone! And most pediatricians recommend Miralax but that's not the answer to this complex physical/emotional/behavioral problem. For several years after finishing the program, my son kept drinking a product called Juice + Fiber, because that was critical to continued success. The insoluble fiber in that is key - and discussed in the Soiling Solutions protocol - and it's the same as acacia fiber (Heather's Tummy Fiber), so you can just buy that and mix into smoothies instead. It gets better, I promise! Good luck!

Could she have an anal fissure?  Here's a description:

Anal fissure Anal fissures are a common problem in toddlers and pre-school children. They are caused by the passing of hard feces which tear the delicate anal lining. Defecation becomes very painful. Your child may scream when doing a poo and have bright red blood on the feces and toilet paper

My son started holding around 2.5 years old, hugs to you! First, are you sure she is "cleaned out" from the constipation? If she's impacted (hard mass of stool stored up in the rectum) you might see poop that is ribbon-like or very thin - it's the softened stuff coming out around the hard mass. You can talk to your doctors about how to do a clean-out, but for us it has involved ExLax and magnesium. We did use Miralax briefly but we've had better results with magnesium - first Milk of Magnesia and then Natural Calm and also a Renew Life product called Gentle Move. Again, I'd talk to your doctor as dosages can vary a lot. Ultimately we chose to use a protocol called "Soiling Solutions" to help my son, and it's been a miracle for us. Our developmental pediatrician thinks it's great - it involves doing consistent "sits" on the toilet and using suppositories and enemas when my child can't or won't go, which helps train the muscles to go after a long time of being stretched out or desensitized. You can find it online. Other tips - have her blow bubbles or blow on a recorder, even blow raspberries into her elbow; make sure her feet are supported (we use a Squatty Potty); wipe her anus with a lubricant before pooping and explain that it will help the poop to slip out. Is it possible she has an anal fissure? Those are very painful! The lubricant might help until it can heal. My son was recently diagnosed with ASD and has SPD as well, he says he just "doesn't want to poop" - obviously that is not an option, but having to be in charge of his defecation is no fun. Good luck to you, I know how hard this is!

I'm so sorry to hear that your little one is having such a hard time! Our guy, who is four now, has had a similar issue. His constipation turned out to be caused by a gluten allergy, which is hard to test for at this age. It's something you might want to look into-- it might be causing general bowel pain and inflammation. Our guy was on Miralax for a while and after working with a functional medicine/ nutritional specialist, we switched him a Magnesium Citrate powder in apple juice. It's much more gentle on their little bodies and has the added benefit of being a calming supplement (the actual brand name is Calm and can be picked up at Whole Foods. we give him 1/4tsp in diluted apple juice per day, but please consult with an expert for your own child). He also recommended a fiber supplement that we add to smoothies, etc. Once he was gluten-free for a few weeks and had a few normal, formed stools he started to feel much better. His resistance to going on the potty remains, but that's another thing...

I read some anecdotal stories about Miralax causing rages and tantrums in children, who knows if it's true...

I hope you find some relief for your little girl!


I'm so sorry for your triouble.  That is super stressful.

After having tracked down a lot of GI and poop doctors we ended up at Stanford GI.   

Their advice was that miralax makes it soft. But exlax controls the timing.  Give exlax before bed.   I'm not a doctor but they told us to keep in as long as 6 months. 

It was Kathy Cox at stanford gi and ken Cox.  Kathy is the nurse practitioner and you can get in faster and she brkngs Ken into the appt if needed.  Los Gatos has more appts that stanford.  

We also read books.  "It hurts when I poop" and a few others to try to normalize it for the child. And reduce the stress. (I know easier said than done).  There are 3 or 4 books on Amazon about it that were worth their weight in gold.  It was a way to have a lighter conversation about it. 

Then we also had an old fashioned doll and playdough.   Showed how the playdough was easier to squish though a hole with more water.  Let the child be involved.   (Sorry to be so specific but we were feeling desperate so I empathize). 

all of the pain can be more serious because it can (not always) mean there is a blockage. And so what is happening is the top part of the poo is hard and won't let anything pass but the bottom part is breaking off or some sort stuff is squeezing around. 

Our ped. Said If we went to the ER they would do an enema and it was easier done at home.  

They can do an X ray to confirm blockage. So you can request that first before enema route.  

Also if there is a blockage you will want to get that out first before you do exlax.  But you still keep giving miralax which loosens from the top down.  

If your child starts to vomit go to the ER.  I would try request X ray.  Then enema if needed. Then exlax to keep it moving.  It might take a few weeks.  You have to deal with the Pain first and make sure not a blockage. 

I'm so sorry you are going through this.  My daughter also went through this and my MAIN ENCOURAGEMENT is that she is 10 now and doing just fine.  I know with Chloe (my daughter) she became fearful of the sensation of the poop coming out.  There was nothing biologically wrong.  It started with a bout of constipation and then went from there.  She would resist and hold to poop even on the Miralax although it would eventually come out (which scared her).  Keeping the poop as soft as possible does help avoid constipation.  You may also want to make sure there are not other food sensitivities that make her bowels acidic or cause constipation.  Chloe is lactose intolerant.  All I can say is that she eventually made peace with the feeling of pooping (we had taken were off the Miralax by then).  We gave her some Epsom Salt baths which have magnesium which helps.  Lots of comfort and no forcing the pooping.  Soft stools will come out, but you don't want her to feel it is a power struggle.  Again, I know this is hard, but I wanted to respond to let you know my daughter made it through this stage and I believe your daughter will too!

Hi there...my son also at 3yo had constipation and would scream on the potty like someone was slitting his throat!! We have managed to keep the constipation at bay with a number of things (and NO miralax!) 1. Cut out her dairy...dairy is like a big plug to the system. SERIOUSLY. NO JOKE. 2. I started at 3 to give him 2 prunes a day (we called them giant raisins lol) and he continues to have 2 a day at lunch. 3. At least 1 apple a day. They are full of fiber and yummy!! If she doesn't like prunes or apples, there are a TON of ways to blend them or hide them in some way. Hope that helps :) He just turned 5 and is constipation free now...

My daughter had the same problem due to constipation. She would cross her legs and get all sweaty fearing to let the poop out. We had her take prune puree (from the baby foods) and although her poop softened, she still had the same crying sweating leg crossing resistance. The potty saved her. If ur kid is still in diapers, I think she also doesn't want to feel her poop in there so my advice is the potty. We got her the one that sing when she poops in it. I had her sit there when I knew it was maybe time to poop and had her read her favorite book - it takes time and even if she doesn't go then, she got accustomed to it. When it was time, I cheer lead her thru it, reassured her and promised her she will feel so much better after. When she finally did it, I rewarded her and right after sincerely asked her if it was all that bad. She eventually got the hang of it.
If no doc finds an underlying problem, I think all u need is patience and encouragement. She will get over it - good luck!

This was my daughter at 3 and the GI specialist was no help...nothing was wrong they said and their only suggestion was more Miralax.

What I discovered on my own via an elimination diet was my daughter was gluten intolerant. This was later confirmed for me via alternative medicine. When we cut out gluten, her crying and pain in pooping totally stopped. She's been gluten free 7 years now and to this day if she eats gluten, she will get constipated and get a tummy ache.

Definitely cut out all gluten and see what happens! Your daughter may have other food sensitivities too--other common ones are cow milk dairy, soy and corn. You may need to try an elimination diet if cutting out gluten doesn't work.

My daughter is also high sensitive but that was independent of all her tummy problems!

Good luck!

Okay, I have a child who struggled in similar ways (but less hysterics) for YEARS - until he was about 8 actually. He is perfectly normal now. I am going to advise going off Miralax. Docs don't know everything - we tried it semi successfully for 6 months, stopped, then tried again and again and again - and he vomited uncontrollably every time we tried to use it again. It crushed a whole day. I am not a fan. It is not "benign" as docs love to tell you. We also didn't have great success using a GI - he just hated the whole experience so much. I doubt your kid has a sensory issue - a TON of kids have issues with this. And lots of kids hate getting nails cut and hair washed. That's super common. I think anxiety is the culprit and therapy is great idea. What helped for us (sorry): 1) you guys allow her to see you poop without drama and understand that it's normal. Our family poops! etc. Ditto any of her friends who are okay with this (all of my son's were). 2) bribery - figure out her currency and give her a gift every time she poops for a few weeks. Then give her a gift if she poops quietly. Then a gift it if she doesn't have to be asked. Max 1 gift per day (bc they work you and this gets expensive). Tiny cute things. If she has a great week, have a poop celebration - like a tea party with cake. I'm serious. Make it funny and fun. BTW - kids do not need to poop more than 2x a week - start asking your friends with older kids, you will hear many stories!  Also - it took me ages to figure this out but magnesium deficiency can be a culprit. You can give a tiny amount of powder in water - ask your doc. It helped eliminate the Miralax need. Also beans - beans are so helpful. Good luck - I think it's a mental game! 

Keep in mind this is an armchair diagnosis, FWIW.

I'll just say that finding the source of abdominal discomfort can be incredibly difficult, even with adults.  I'm sure anxiety is making this worse, but for some reason, I don't have the impression that the cause is SPD or autism or curable with therapy.  I think she's in physical distress and a doctor needs to work with you on a different approach.

The pain may be from cramping and spasms higher up in the colon, rather than in her rectum. (If you've ever had them, they're ghastly.)   There could be an underlying cause or infection. (A partial bowel obstruction can cause pain and be masked by the use of a laxative .... I don't know what kind of testing was done, so this may have been ruled out.) 

Or maybe the Miralax has screwed up her digestion.  If you read up on Miralax side effects, they include: cramps; gas; more frequent bowel movements; nausea; stomach pain or bloating, abdominal distension and pain, abdominal cramping; perianal inflammation and soreness.  I know Miralax is widely prescribed and regarded as safe, but there are adverse opinions (entirely anecdotal):



In any case, whether it's Miralax or something else, I think you need a fresh medical perspective on the problem, since something IS wrong: a normal body function is causing her a lot of pain!  The current routine is NOT working. I don't know if you should switch her to a different laxative; change her diet; add probiotics; use analgesics to stop the pain cycle, give her a cola drink, or what. So you need a doctor who has more insight into the problem and possible solutions (maybe Stanford? or UCSF?), and not someone who essentially says she's fine, it's in her head.  There's a lot you can try, but you want someone who can advise you so you don't cause her more pain.

This sounds so difficult for all of your, but I'm sure you can find a way to make it better for all of you.  Good luck!

Please research Miralax, not safe and she will never get off of it. Try natural softener, my daughter likes the prune and apple juice mix, it is made for infants- baby juice sweet, it is a treat. Not sure how to help with the stool time, poor baby. Maybe reading to her while she goes or doing what provides her comfort.

When we cannot understand why a child acts the way they do, we sometimes look for a psychological explanation. That is not always the best option. 

When my daughter was in kindergarten and primary school, almost every day she would complain after breakfast that her tummy hurt, and she could not go to school until she had a bowel movement or her tummy stopped hurting.  When we mentioned it to a nurse practitioner at Kaiser, she dismissed it saying that all the children do that at that age. As a result, I dismissed her symptoms as discomfort due to school anxiety. I now wish that I had insisted that the doctors at Kaiser do exhaustive testing and exploration until they found the true cause of discomfort. Today my daughter is a college graduate in her mid twenties and continues to be plagued by all sorts of digestive problems, allergies, chemical sensitivities, neurological symptoms, etc., to the extent that she is now basically disabled. 

The last doctor she had, about 2 years ago, ordered some routine blood tests and told her that there was nothing wrong with her, that she just needed to eat more. Since then she has gotten sicker and sicker. Doctors should not use psychology to explain away things that they cannot understand or cure. And they should not recommend a laxative for a child that has a digestive problem. A laxative can be useful occasionally, but it doesn't strike me a as a long term solution for a medical problem.

I would advise you to take your daughter to the best specialists you can find and insist that they do exhaustive tests until they find out what is the true source of the problem. It may well be that she has an abnormal digestive system,  and that that is the real source of the pain. 


My heart goes out to you. My son went through something similar off and on for a few years. Miralax seemed to worsen his symptoms. He was withholding for up to a week, had skid marks on his underwear daily and would do the "poopy" dance daily while crying, trying to hold it in. His abdomen would become quite distended until he eventually passed his bowel moment. His body would occasionally wait for him to fall asleep to "sneak" out a soft BM- I would hear him calling for me about 20 minutes after he fell asleep, and he would be there, standing on the carpet passing a BM without any apparent pain, as calm as could be. Near the end of this years long ordeal, he would awaken several times at night,crying when he would sense his body trying to pass a bowel movement and he would be consciously holding it in. It is when it began to interrupt his sleep that I took him in to see his doctor again. He had a healthy "normal-fibered"diet, drank plenty of water, avoided the foods to avoid. It was taking over our lives and causing a great deal of stress for us both and tension between us. No coaxing or offers of a reward worked. He would refuse to even sit on the toilet.

I finally requested that he receive an enema at his doctor's office. Of course it didn't go well at the time but since then, initially with daily then weekly rewards for pooping at the same time each day, it became a habit. The transformation was like magic, to be honest. No more crying, no more gassiness,  no more distended abdomen, and no more poopy danceI I have no idea what changed but our lives were transformed by this doctor's-office-administered enema. My generally happy boy returned and he didn't spend the greater part of each day in a great deal of discomfort. No more Miralax for us, ever. It works great for some but not this child.

His BM's were never that hard but he did seem to become gassier with Miralax. Please talk to your doctor. Perhaps an X-ray to see the extent of the constipation may help guide treatment. Best of luck to you all.

I feel your pain! Both my daughters (now 5 and 7 and grown out of this) had similar poop issues/anxiety. We had some success with the book "It Hurts When I Poop". In addition, with my younger, we found that she was not anxious if she pooped in a pull-up, so we let her do that for some time then gradually weaned of that in baby steps...pull-up in bed, pull-up in bathroom, pull-up on potty, small hole in pull-up on potty, etc. Each transition was difficult but she grew more confident with each step and eventually it became a non-issue.

Good luck!