Causes of voluntary stool withholding in infants and children

Painful defecation

Anal fissure
Perianal irritation
Sexual abuse
Hemorrhoids

Change of environment

New school, traveling, or other change in routine
Family stress

Improper toilet training

Emotional disturbance

Severe intellectual disability

Depression

Data from: Tunnessen WJ. Constipation and fecal retention. In: Signs and Symptoms in Pediatrics, 3rd ed, Lippincott, Williams & Wilkins, Philadelphia 1999. p.518.

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Causes of voluntary stool withholding in infants and children