My 11-year-old grandson holds in his poop to the point he will pack his butt with toilet paper and when he can't hold it anymore it comes out in the toilet paper. Afterwards, he tries to clean up the mess and then we find it. He's not constipated, but he continues to hold it in. We have asked him why and he says "I don't know". Has anyone else had a problem like this? Any advice is deeply appreciated.
One of the causes of constipation is
Withholding of stool as a result of past discomfort (1)
and what you further describe sounds like the constipation then leads to soiling ("when he can't hold it anymore").
It seems that he may also fulfill one of the two Rome III criteria for children of four years or older:
History of retentive posturing or excessive voluntary stool retention (2)
Even in older children, constipation is not too uncommon:
[...] 1 to 2 of every 100 children at school age. (1)
Constipation is one of the most common chronic disorders of childhood, affecting 1% to 30% of children worldwide. (2)
Possible problems when constipation goes on for too long:
When constipation and impaction have gone on for many months, changes happen in the muscles and nerves in the rectum such that many children cannot feel the need to go and are not able to stop stool that may leak out involuntarily. (1)
Over time, as the rectum stretches to accommodate the retained fecal mass, rectal sensation decreases, and fecal incontinence may develop. (2)
This can ultimately lead to fecal incontinence (2). It is a vicious cycle, since the stool also becomes larger and harder and defecation thereby even more painful.
As a first step, both (1) and (2) suggest medical evaluation. A physician should check, whether it's functional constipation ("there is no evidence of an organic condition" according to (2)) or not. This is not only important to rule out underlying organic conditions, but may also be helpful from a parenting persepctive as the physician is likely to have experience with childhood constipation and may know how to best approach your grandson about it. They will also know best how to treat it, so I will only give a short intorduction to the first steps:
- Education / Behavior
It is suggested to write down all stool outputs, start positive toilet routines and
Maintain a positive outlook. Privileges and incentive programs are often useful and needed for motivating a child to learn new toileting behaviors. (1)
Parents should be encouraged to maintain a positive and supportive attitude throughout treatment and expect gradual improvement with occasional relapses. (2)
Both sources, (1) and (2), suggest to make sure the child drinks enough (clear) fluids (to soften the stool) and to increase the intake of fibers.
An increased intake of fluids and absorbable and nonabsorbable carbohydrates (e.g., sorbitol in prune, pear, and apple juice) can help soften stools, particularly in infants. (2)
(since your grandson is not an infant anymore, I'm not sure how helpful this is.)
The use of laxatives should be discussed with your physician. Here is an algorithm for treatment from (2).
Take your grandson to a physician. Especially considering a possible underlying organic condition, and the possible effect (fecal incontinence). We can help you only by providing some sources (Step 1: Education) and I also suggest you read the sources yourself, as I only quoted some relevant parts. They also contain links to further useful information. Answers also have to remain superficial since not much information is given in your question.
I also suggest you keep a positive attitude towards him and don't assume malice or the like, since you don't even know why he is with-holding. Do not make him feel even more ashamed. Instead, ask him how you can help him with the situation, which may make it easier for all of you, so you also have to maybe clean up less of a mess.
(1) Rao, P S: Constipation, C.S. Mott Children's Hospital, 2018.05
(2) Nurko, M and Zimmerman, L A: Evaluation and Treatment of Constipation in Children and Adolescents, American Family Physician, 2014, pp. 82-90
Disclaimer: I'm sure there's a ton of medical and psychological answers that might apply to your grandson. I don't mean to say the following is the only possible or even the most likely explanation. But it is a possible explanation.
Have you considered the possibility that he gets sexually stimulated by holding it in? He's 11, so he obviously wouldn't know how to talk about it because he might lack the vocabulary to explain, apart from not wanting to admit it because he suspects he'd be ridiculed if he told anyone.
I'd very carefully ask him whether it feels good to hold it in, and make sure you don't make him feel bad about it; if that's why he does it, then there's really nothing wrong with him, he just happens to have discovered that his anus/rectum can give him nice feelings and he hasn't discovered any, uhm, less messy alternatives to produce these feelings yet. Perhaps some hints would be in order, or, to make matters less awkward, a good age-appropriate book about sex education might help.
Since references are requested, here's a few:
These aren't very good references, but they hopefully show that this isn't just a figment of my imagination. A quick google search will turn up more of the same (and also a possible connection to child sexual abuse, but I wouldn't jump to conclusions...). The last reference quotes the co-author of a book called "What's Your Poo Telling You?", namely Anish Sheth, who seems to be a gastroenterologist associated with Princeton and Yale University School of Medicine:
A Princeton doctor has revealed the key is the passing of a large stool.
This, he claims, can stimulate nerves in the body more usually associated with orgasm.
The stool high is relatively safe, but can become an addiction for some, warns Princeton gastroenterologist Dr. Anish Sheth, the co-author of the book ‘What’s Your Poo Telling You?’.