Dr. Sejkora and The Poop Group

The classic story we hear from a lot of families is that they had a stubborn 2-1/2-year-old who was potty training and then decided they were not going to poop in the toilet because they just weren’t. And they start to get backed up, as happens when you hold your stool for too long. Then they have a really big, hard, scary poop that might hurt when it comes out, and they decide that they are definitely never going to do that again because it hurt last time. So we get into this cycle of ongoing constipation and fear avoidance. If you’re 6 or 7 or 8 and it’s been hurting every time you’ve had a bowel movement for four years, that’s a lot of learning that we have to walk backwards.

How common is this?

It’s a lot more common than folks think it is, but a lot of parents feel pretty isolated and very alone. Especially in that early school range, five to nine, it can be as high as 10 percent. So if you think about a classroom of 30 kids, there’s probably three or four kids in there that are having similar stooling issues.

There’s a really big misunderstanding of what happens when doctors say that stress and anxiety can be a component in these conditions. Especially with disorders of the gut-brain interaction (DGBI)—things like IBS and chronic nausea—we know that stress and anxiety play a role in making those conditions worse. We know that stress and anxiety can change gut motility. It can change gut permeability and how much things are getting absorbed. It can change how things empty from the stomach to the intestines. When families hear “IBS” or “functional nausea,” some hear that as “we don’t really know how to help you” because there’s not really a medication for this. Actually, GI psychologists are well equipped to treat those conditions. We know exactly what’s wrong and we know exactly how to help them. It’s not a pill and it’s not a surgical procedure, but we do have really good strategies. We can help their quality of life improve, reduce their symptoms and get kids back to being kids again.

We call it gut-directed therapy. What we’re typically doing are different types of relaxation exercises. Sometimes diaphragmatic breathing is one of them. We use guided imagery. We use mindfulness and meditation. Dr. Jerson uses gut-directed hypnosis in certain cases. So we use a wide variety of things. The goal is to reduce the activation of your central nervous system, bring you out of fight or flight mode, helping things calm down. Because when we can calm down the central nervous system, it allows your gut and your enteric nervous system throughout your GI tract to function more optimally.