Poop Withholding During Potty Training

Poop withholding typically follows this pattern:

1. The child has a painful or frightening bowel movement (hard stool, unfamiliar toilet, or pressure from an adult)
2. They associate pooping with pain or fear and begin to hold it
3. Holding causes stool to accumulate and harden in the colon
4. When they finally go, it hurts more, confirming their fear
5. The cycle intensifies: more withholding, harder stools, more pain

Breaking this cycle requires making stools soft (so pooping does not hurt) before addressing where the child poops.

Poop withholding is more common than urine withholding because:

• Children can physically control bowel muscles more easily than bladder muscles
• Pooping requires relaxation — the opposite of what an anxious child does
• Many children feel vulnerable or exposed sitting on the toilet for a bowel movement
• Some children prefer the familiar sensation of pooping in a diaper (standing, squatting)
• The sensation of poop leaving the body can be frightening for some toddlers (“a part of me is falling out”)

Step 1: Make stools soft (most important)

• Talk to your pediatrician about a stool softener (such as Miralax/PEG 3350) — this is often the first-line treatment
• Increase fiber: prunes, pears, berries, whole grains, beans, broccoli
• Ensure adequate water intake throughout the day
• Reduce constipating foods: excessive dairy, bananas, white bread, processed foods
• Goal: soft, painless bowel movements every 1-2 days

Step 2: Remove pressure around pooping

• If your child will only poop in a diaper, let them — for now
• Stop all pressure, comments, and negotiations about where they poop
• Do not ask “Do you need to poop?” repeatedly
• Do not make the child sit on the toilet and wait for a bowel movement
• Communicate that it is okay to poop however they need to right now

Step 3: Gradually transition (only after stools are soft and regular)

• If pooping in a diaper in the bathroom, transition to pooping in a diaper while sitting on the toilet (lid down)
• Then diaper on, sitting on toilet (lid up)
• Then diaper loosened/open while sitting on toilet
• Then no diaper, with a foot stool for stability
• Each step may take days to weeks — let the child set the pace

Proper sitting position makes pooping easier:

• Feet supported: Always use a stool so feet are flat (not dangling). This relaxes the pelvic floor.
• Knees above hips: A squatting position opens the anorectal angle, making it easier to pass stool.
• Lean slightly forward: This activates the abdominal muscles that assist in bowel movements.
• Stable and secure: The child should not feel like they might fall in — use a potty seat with handles or a child-sized potty.

• Never force a child to sit on the toilet when they are resisting
• Do not use suppositories or enemas without medical guidance
• Avoid shaming language (“big kids poop on the toilet” said disapprovingly)
• Do not restrict diapers if your child truly will not poop without one — withholding is medically worse
• Never punish accidents or withholding
• Do not ignore the problem hoping it resolves on its own — chronic withholding worsens over time

Contact your child's doctor if:

• Your child has not had a bowel movement in 3+ days
• There is blood in the stool or visible anal fissures
• Your child has abdominal pain or distension
• You notice stool leaking into underwear (possible encopresis)
• Dietary changes alone are not producing soft, regular stools
• Withholding has been going on for more than 2 weeks
• Your child is in visible pain or distress when trying to poop