Bokdrolletjies and Chipolatas: Why Talking About Poo Matters More Than Parents Realise

Why getting comfortable speaking about poo is more important now than ever, and why days like National Poop Day in the USA are VERY important.

The Giver – Lois Lowry

“The worst part of holding the memories is not the pain. It’s the loneliness.”

I cannot remember an exact moment or patient encounter that made me realise that managing constipation is really important work. The privilege of sharing a seven-year-old’s story and being able to offer safety without judgement feels like sacred work. Most of the time, parents and caregivers also have the big job of self-reflection and perspective change. Even with great outcomes, these struggles capture mental real estate, and that is even before engaging the village. IT’S A LOT!

There are few opportunities in healthcare to address family wellbeing, like delving into the topics of constipation and gut health. Poop is essentially a scientific marker for health. Poop is also a screening tool for stress. The mental health burden associated with untreated constipation is scary.

A point of entry is daunting if you surrender to the stigma that surrounds many subjects that should just be “biology”. Poop is difficult to rebrand, but it is essential to bravely embrace the challenge. We need to charge our rescue boats against the current of destructive societal taboos to extract children from the islands of discomfort and shame they find themselves on.

Is there a better way to do it than within a bedazzled vessel of joy, complete with a standout soundtrack?

My experience with even the littlest bambino is that we universally underestimate their capacity to understand and process information, but we also underestimate the onslaught of information they’re already exposed to. This underestimation in itself is dangerous, but combined with a lack of a comparable response or effort to assist in the processing of this information, it demands that we prioritise the destigmatisation of conversations about poop (and a myriad of awkward topics).

Why shame is dangerous (especially around poo)

1. Children hide symptoms

When poo is treated as embarrassing or “naughty”, this delays diagnosis and makes treatment more difficult because:

• Children don’t report pain, bleeding, or difficulty
• Accidents are hidden
• Caregivers only notice when constipation is severe

2. Withholding becomes a learned behaviour

Intentional stool withholding is most commonly reported in potty-training–aged children. Before the age of voluntary control, which ranges from eighteen to twenty-four months, what may appear to be behavioural issues with straining and discomfort in younger children usually relate to issues with maturity and coordination.

Hard stool can create a continuum of discomfort, predisposing to intentional stool withholding. Stool withholding:

• Stretches the rectum
• Reduces sensation over time
• Worsens constipation and soiling
• Creates a vicious cycle that can last years

This is a well-recognised mechanism in functional constipation. The cycle is often referred to euphemistically as “the constipation carousel”.

A wonderful resource is the Instagram page Stool Withholding Help, created by Dr Kate McGarry (a psychologist who is creatively passionate about the subject), a bona fide member of the Poop tribe, of which I am a proud card-holding member.

3. Accidents become punishment, not symptoms

Children are reprimanded for something they cannot control. Soiling is often misinterpreted as:

• Laziness
• Bad behaviour
• Defiance

4. Psychological harm accumulates

The effects of unaddressed constipation can persist even after bowel symptoms improve. Children who feel ashamed about bowel problems are more likely to develop:

• Anxiety
• Low self-esteem
• Social withdrawal
• School avoidance

5. Families delay seeking help

Lack of access to trusted information may result in a delay in seeking help. Parents may:

• Normalise severe symptoms
• Feel embarrassed to raise concerns
• Wait until complications occur

6. The management of complicated constipation can be medically traumatic

Disimpaction is the process of “unblocking” the intestines medically once the constipation carousel has gone through a cycle or two. It is very difficult to get around hospital admissions and enemas. By the time children are admitted to the hospital for disimpaction, they have often had multiple attempts at disimpaction (from homemade remedies, traditional healers, and GPs). This is just a function of the workflow and referral framework of our healthcare system — not a condemnation. Children and their caregivers can show symptoms of post-traumatic stress around the administration of enemas.

7. Shame worsens health inequities

Silence amplifies vulnerability. Children are most affected when shame overlaps with:

• poverty or overcrowding
• limited toilet access
• cultural taboos
• school environments where toilet use is restricted

Normalising poop talk improves early detection, reduces fear and withholding, improves treatment adherence, and restores dignity and bodily autonomy. Shame turns a common, treatable problem into a hidden and chronic one. Open conversations are a form of prevention.

National Poop Day carries this objective of destigmatisation at its heart. It’s a day with mysterious origins, with no links to international human rights organisations or major research, but something that sprouted organically from members of this Poop tribe — a motley crew aboard a bedazzled ship.

ALSO READ: Your child’s poo: what’s normal and what’s not

References

1. Yvonne McCague, Katie Hill, Eileen Furlong, Suja Somanadhan, The psychosocial impact of childhood constipation on the children and family: A scoping review, Journal of Pediatric Nursing, Volume 82,2025, Pages e142-e163, ISSN 0882-5963, https://doi.org/10.1016/j.pedn.2025.04.007.
2. https://www.instagram.com/stoolwithholdinghelp?igsh=MTFlMXpmY2QweXV4NA==
3. https://www.instagram.com/pooandtheloo?igsh=MTB3OHVwcnE5b3pkeA==
4. https://www.pelvicfloorphysio.co.za/