Potty-Training Problems

There’s concentration — and then there’s constipation

The porcelain throne: For adults, the daily routine is a no-brainer. But for toddlers, it’s a strange new world.

Potty training is a big milestone in the kid world, but it can take some time for them to feel comfortable enough to do their business. Peeing in the potty is typically the first win, but pooping can take longer for most kids.

“Potty training is an exciting and frustrating time for parents,” says Dean Focht, MD, a pediatric gastroenterologist at Geisinger. “No two kids are the same, and what works for one may not be effective for another. Getting kids to sit cooperatively on the potty is the first step for success, but forcing them to sit on the toilet before they’re ready can lead to constipation and other health problems.”

Potty training and constipation

You can set your child up for potty training success by accepting there may be setbacks, too.

If kids are nervous or scared to sit on the potty — or simply refuse to because it’s interrupting playtime — they may withhold a bowel movement. And holding it in can lead to stool building up in their colon. The colon absorbs excess water from the stool, making it hard, dry and more difficult to pass.

“Kids are smart, and if it hurts to poop, they’ll hold it in. The result is the stool in the colon gets larger and harder,” says Dr. Focht. “Eventually, they will pass a very large bowel movement or small hard pellets of stool. This can be painful and reinforce the idea that it hurts to poop — continuing the vicious cycle.”

Is your child holding in poop while potty training? Allow them to go in a diaper, then try again once the constipation has cleared.

Risks of sitting too long on the toilet

It might seem logical that the longer your child sits on the toilet, the more likely they are to use it. But potty training is a balancing act. Making your child comfortable with sitting on the toilet to do their business takes time and practice — just be sure it doesn’t take too much time.

Sitting too long on the toilet causes pressure on the child’s rectum and anus. Because the toilet seat has an opening, their rectum is lower than the rest of their backside. Gravity takes over, and blood starts to pool and clot in those veins. Add in any straining or pushing — which increases pressure on the veins — and your child may develop hemorrhoids.

Children should spend no more than 5 to 10 minutes on the toilet during potty training, says Dr. Focht. If your child doesn’t go within the first few minutes, you’re better off trying again later.

“Bowel movements occur because of the movement of the intestines. If your child doesn’t go to the bathroom immediately, the waste can travel back up into the colon,” he explains. “When this happens, it’s best to wait until your child feels the urge again rather than trying to push it out.”

Hemorrhoids are uncomfortable, and might deter children from wanting to use the toilet. That can lead to a cycle of constipation and further health problems — and derail potty training.

Potty-training tips for success

A good way to avoid potty-training problems is by reading to kids. Have about 3 short books that are designated “potty books.” Reading stories can help children relax while they’re on the toilet, making it easier to have a bowel movement. If they don’t go by the time you’re finished with the book, have them come back and try later.

“The best time to bring kids to the bathroom is 10 to 15 minutes after eating,” says Dr. Focht. “The body has a natural reflex after eating that should make having a bowel movement easier. If kids are struggling to have a bowel movement within 10 minutes, look at their diet. Are they getting enough fiber? Are they drinking enough water? If that’s still not enough, talk to your doctor.”

Dr. Focht offers these potty-training tips for success:

Wait until your child shows readiness. Typically, kids 18 months to 3 years are developed enough to recognize the urge to go. But children develop at different rates, so waiting for signs of readiness, like staying dry for longer periods or showing interest in the potty or underwear, is more important than age. Pushing your child too hard can lead to resistance and setbacks.
Establish a potty routine. Consistency is key. Set specific times for bathroom visits, such as in the morning, after naps, before bed and especially after meals, when the urge to go can be strongest.
Support their feet. If using an adult-sized toilet, a footstool can support your child’s bowel movement. A squatting position with the knees at or above the hips is the best position to help with emptying bowels and preventing constipation.
Give kids choices. Involving your child in the process helps them feel more in control of the situation. Let kids decide things like which toilet to use, which book to read first, what color underwear to put on or if they want to flush the toilet.
Focus on the positives. Motivate your child and reinforce positive behavior by being your child’s biggest cheerleader. Give high fives and praise. You also can use rewards, such as a sticker chart or extra story at bedtime, to celebrate small successes. And remember: Accidents can and will happen. Try to stay positive and encourage your child to try harder next time.

When to call your child’s pediatrician

Constipation is a common issue in children who are potty training. Talk to your child’s pediatrician if you think it’s the cause of your potty-training problems.

Signs of constipation in kids can include:

Going more than 2 days without a bowel movement
Leaking, watery stool in diaper or underwear
Passing hard, lumpy or dry stools
Blood in stool

If your child continues to put up strong resistance to sitting on the potty, it’s best to take a break and try again when they’re more receptive to the idea.

“Potty training can be a challenging milestone for parents and children alike,” says Dr. Focht. “But with the right strategies — and a lot of patience and support — it can be a positive experience. Just remember to keep your eye on the prize: We all get potty trained eventually.”