Here is a scenario that is incredibly common in the world of chronically constipated kids: my child was doing great, pooping every day, but sometime after we potty trained them, they got backed up and have been struggling ever since.
How does this happen? How can it be avoided? Potty training offers several opportunities for constipation to enter the picture.
Scenario one:
Some kids are experts at peeing in the toilet, very early in life. They are mostly potty trained at 18 months and they never look back. Sure, they might still be in pull-ups at night, and sure, they might request a diaper or pull-up to poop, but for the most part, they avoid daytime leaks and do great.
The challenge with these kids is that they are smart enough to hold their pee and poop, but not yet smart enough to know that they shouldn’t hold their pee and poop for long periods of time. But because they are doing so great staying dry all day long, their parents and caregivers don’t pay close attention to their bowel movements. I mean, we all have lives, right? So it isn’t hard to imagine a couple of parents realizing that neither one of them has helped their child with a bowel movement for days.
The prevention: How to avoid this? Well, knowledge is power! I wish every 18-month or 2-year well-child visit would include a little chat about toilet training and constipation. If they’re lucky, constipation isn’t even on most parents’ minds at this point in their child’s life. It would be so easy for every pediatrician to include some instructions to this end: when you are potty training, be sure your child’s bowel movement habits don’t change from pre- to post-training. That is, if they pooped every day before, they should be pooping every day during and after potty training. If they pooped twice a day, that should stay the routine. (Granted, the frequency of bowel movements often decreases in early childhood, but at least daily BMs is a reasonable expectation.) Parents should be checking in with each other, their child, and daycare providers to make sure the child has a BM every day.
Scenario two:
The second way constipation enters a child’s life during potty training is when a very busy toddler learns to control bowel movements and then learns, regretfully, that they can make that urge go away by ignoring it. Almost every adult I have talked to knows the feeling of “missing the window,” as my husband puts it. You feel an urge to have a bowel movement, you’re out and about and too busy, and then by the time you get to a toilet, the urge is gone. That poop didn’t disappear! But young, busy kids don’t know any better, so they just keep ignoring that urge and the poop keeps stacking up. The thing is, the longer poop hangs out in the rectum, the dryer and harder it gets. And once they pass that dry, hard stool, they learn that not only does sitting to have a bowel movement take time, it also hurts! And so they avoid trying to poop even more and a terrible cycle sets in.
The prevention: Schedule time to sit on the toilet shortly after every meal. Explain to your kid that they just ate, so they need to give their bodies a chance to have a bowel movement. Don’t ask “do you need to go to the potty?” Just make a statement: “Time to go see if you have any poop that’s ready to come out!” If they take the time to try to poop after every meal, they won’t have to interrupt their play time later.
Scenario three:
The third way that kids get constipated when potty training is probably the hardest to avoid. Some kids just really don’t like the experience of pooping in the toilet. If you’re lucky, they’ll feel urges and be able to control them long enough to ask for a pull-up. But once you start to take that pull-up away, they teach themselves to hold their poop.
The prevention: These kids need a lot of patience! They too should sit on the toilet to try to poop three times a day, after every meal. This should be a low-stakes situation: get them on the toilet, make sure they are comfortable and supported, set a timer for three minutes, and hang out with them. When the timer goes off, praise them for sitting and giving their body a chance to poop, and go on with your day. If they do end up having a bowel movement, try to stay cool. You can nonchalantly say something like “hey, I see you pooped. Your belly must feel great!”
If they just can’t manage a BM on the toilet, then they should go back to wearing a pull-up, in a completely shame-free way. Tell them something like “The most important thing is that you get that poop out of your body so you don’t get sick. If that means wearing a pull-up, that’s ok!” But keep up the sitting on the potty after meals routine. Eventually, they will get it!
Many toddlers end up constipated because of a mix of all three of these situations: they are busy, holding back a bowel urge is relatively easy, and pooping in the toilet can be yucky. With all kids, it’s important not to underestimate their intelligence! Teach them that it’s important they pay attention to the signals their body sends them. Explain that if they hold poop in their body it doesn’t go away, it just gets harder and drier; that they need to poop every day to make room for the good food they like to eat; and that sitting for a little bit after a meal is an easy way to take care of business before they get back to playing.
If done with careful regard for avoiding constipation, toilet training can be an excellent opportunity to set up healthy toileting habits that will keep your child free from potty issues their whole childhood. But if you do run into constipation issues, I have a book for that!