Ultimately, there is significant risk of stool withholding as a demonstration of control on the child's part, which may lead to acute, then chronic constipation followed by encopresis. As a child withholds stool, the stool may become harder, dryer, and larger. Children then may withhold the stool to avoid the discomfort of passing a larger, harder stool. Parents also may note a transient change in posture or gait as the child tries to prevent passage of an uncomfortable stool. The child also may establish a favorite place to pass the stool that avoids the immediate prompting of the caregiver.
Children demonstrating toileting resistance or refusal tend to have more difficult temperaments.
Additional information suggests that stool toileting refusal is more common if parents have a general difficulty in setting limits with the child. Parents of children who resist or refuse toilet training should be advised to recognize that the child has ultimate control of this situation.