It Hurts When I Poop: A Toilet Training Pitfall
A common toilet training pitfall is stool withholding.
Stool withholding can be a consequence of constipation, or uncomfortable passage of stool. If poop hurts when it comes out, it is a toddler’s natural response to hold the poop in to avoid potential pain. Children can be so good at holding poop that at times they may even appear to be trying to poop, only to be squeezing their buttocks to keep the poop in.
Stool withholding can also happen if a child develops anxiety around the toilet (sounds, size, location.) These fears are very real for some children. Kids will hold poop to avoid an anxiety-provoking situation.
Finally, some stool withholding is a simple power play. If you believe your child is fully capable to be pooping on the toilet, but chooses not to… You could have a simple battle of wills on your hands. It does not take a child long to realize that elimination behaviors (poop and pee) are something only he can control; using elimination behaviors is a great way to get undivided parental attention.
A very small percentage of children have stool holding due to various medical conditions. Talk with your pediatrician if you have this concern.
Why is stool withholding such a big problem?
The longer poop is held within the body, the harder and larger it becomes. Poop can become so large that it can, in fact, stretch the walls of the colon and make the otherwise tight and effective pooping muscles very floppy and ineffective. That makes it more difficult to poop, and a terribly vicious cycle then begins.
A big, stretched out colon does not correctly transmit the signal to the brain that it is time to poop. So, kids really don’t feel the urge, the poop stays in longer, it hurts… You get the idea.
Bottom line: Part of stool withholding may not be your kid’s fault. They really can’t feel when they need to go.
So, what can you do to prevent stool withholding? And, if your child is withholding stool, how can you help?
- Be sure your child is ready. For a list of cues to toilet training readiness, look here.
- Make your child’s pooping position comfortable. Kids need their feet on the ground to poop. Although some will be able to use a step stool near the toilet, most kids need a small potty chair of their own with their feet planted on terra firma. Prepare a comfortable place to poop in every bathroom your child may use.
- Set the stage. Dump the poop from the diaper into the potty. Show the poop in the potty. Help your child flush and watch the poop go down. Talk about how moms and dads to poop in the potty, too. Read about how Everyone Poops.*
- Be prepared outside of the house. Public restrooms are loud, foreign, cold places; and whoever invented them was not thinking about the needs of a potty-training toddler. Some of my families choose to travel with simple “portable potties”** so that their child can always be in a comfortable place, regardless of the facilities.
Super-mom tip: Always travel with Post-It Notes in public restrooms. Stick the Post-It on the flushing sensor as soon as your kiddo sits down. Then, you don’t have to worry about scary, unexpected flushes.
- Remember the basics. Soft, regular bowel movement are dependent on gut health, hydration, and food intake. A healthy diet including fiber-containing foods will help maintain regularity for the young and old alike.
If your child is withholding due to pain:
It only takes one hard, painful poop for start children withholding. Once the association between stooling and pain is established, it can be hard to extinguish. Time can cure things if stooling pain is decreased by softening the stools. Toddler diets can be inconsistent at times, and high-fiber diets are not the most palatable. Ask your pediatrician if fiber supplements or stool softeners are appropriate for your child.
After stools are routinely softer in consistency (“applesauce-y”), help empower your child by reading It Hurts When I Poop,* by Dr. Howard Bennett. This great story helps your child learn to be “the boss of their body,” and “take out the trash.” Reading the book helps kids take responsibility, and “own” their pooping behavior.
If your child is withholding due to anxiety:
Ask your child why she does not like to poop on the potty. For some kids, the location does not feel safe, or she does not like to be alone in the bathroom. Is the sound of the toilet too loud? Maybe she feels like she is going to “fall in.” Does she get too cold while sitting on the toilet without her clothes on? Is the adult stool too big, or too high off the ground?
Knowing the anxiety surrounding your child’s stooling experience can make all the difference. Once defined, corrections to her environment can take place and she will be more relaxed while sitting on the potty.
If your child is withholding as a power play:
After the age of 3 years, most stool withholding is a power play. Kids know that there is nothing that will get an adult’s attention faster than a misplaced poop or a stool “accident.”
If you think you are in the midst of a power struggle, take the upper hand. Don’t talk about pooping, or about the pooping schedule. Offer a stool softener to your child daily, and wait. Don’t keep diapers or Pull-Ups in the house as an option. If an accident occurs, then calmly have your child take care of it. Don’t ask why they had an accident, or discuss what they should have done. Simple, calm, and quiet.
Where you want to focus your attention is on the positive. Give a reward (sticker chart, or reward of time/special activity) for all the days that stooling is NOT an issue. Praise, praise, and praise your child if they stool on the potty. Tell dad, call grandma, Skype the uncles… Your child pooped on the potty! Only recognizing positive stooling behaviors is the goal.
If you are not asking about the poop schedule, not reminding him that he needs to go, and not offering much alarm when he has an accident, then the child’s sense of desired control will be diminished. Stooling will often return to a closer state of normal.
For more information on all these methods, please click here.
If you have tried troubleshooting stool withholding behaviors, and are still unsuccessful, it is time to talk with a professional. Make an appointment with your pediatrician to discuss your next step.