Six Essentials to Healthy Pooping in Children

One of the biggest constipation challenges for families is figuring out exactly where to put their energy and bandwidth.

Any plan that you put together is going to take up a lot of your time and patience. And it feels frustrating to try to figure out just WHY THIS HAPPENING and to actually get it wrong. So let’s try to take a deeper dive in to how to figure out where to put your energy.

Start with this checklist of required skill sets for your child to have a normal, healthy, non-dramatic pooping experience. If your child is struggling at one of these “essentials” then consider focusing your energy right at that pain point. 

Essential #1:

Does my child sense the urge ‘to go’?

How can you work on healthy pooping if your child cannot even feel the urge to poop?

Well, the answer is: you can’t.

You can try to, but there is simply no way to teach healthy toileting if your child cannot sense the urge “to go”. It all starts with a good strong message that goes something like this:

For the geeks out there, “stretch receptors” line the colon wall. When the colon fills up with stool, the wall is stretched, and the receptors fire. These receptors are responsible for “telling you” when it’s time to poop. When they fire, they “sound the alarm” to the brain.

When stool is retained too long, like in constipation, the stretch receptors just fatigue from over-firing. Once fatigued, the receptors stop doing working. In some children the message is just weak. In others, there is no message at all. Once the message has been muted, your child won’t get those body cues that prompt a child to go to the bathroom.

If your child is not getting the message ‘to go,’ assume that the colon has been stretched out for far too long. That colon is sick and needs to heal.

Here’s the great news. You can fix a stretched out colon. This is going to get covered soon by the Tummy Handbook.

Essential #2:

Does my child translate the message effectively?

Let’s imagine a child with a nice, strong message to the brain when the colon wall gets stretched.  Think about that message—that urge ‘to go’. Concentrate on what that physically feels like. Now answer the following multiple choice question: I would describe the urge to poop as:

a. unpleasant

b. pleasant

Typically, the answer is “a”....unpleasant. It doesn’t actually feel pleasing to have stretch and contractions in your bowels.

But most adults don’t get upset, hold their bellies, or complain when they really ‘gotta go’. This is because we have categorized (or “integrated”) this sensation in our consciousness as “normal”. It is normal to feel this way before pooping. It doesn’t raise any alarm bells.

But in children, a good strong message can be translated as “pain”, “alarming”, or something to “fight off”.

Some children will cry. Many will withhold stool out of fear or just from shutting down emotionally. Others will hide in the corner of a room or under a table out of fear/shame/pain.

See our article on fear of pooping. In there, you will learn how to devise a good “behavior” plan to reduce fear and anxiety around toileting.

Essential #3:

Does my child make an action plan?

Let’s say your child can sense the urge to go and has correctly translated the message as “I have to poop”.

Now, think about the way you yourself might handle receiving the “gotta go” message from your body at the movie theater, five minutes before show time.

So, first you receive a message:

Then, your fully adult brain, in all of its glory, might process this message in the following way:

So, essentially, you made an action plan to take care of business NOW, because waiting will make it worse.

Young children are still learning how to create an action plan. It’s normal to be in the sandbox at age 3 and to ignore the urge “to go” because you are digging a mote around the sand castle with your best friend.

Also, at this young age, the action plan will look different, depending on where in the journey your child is:

1. If fully in diapers, a good plan is to just stop, squat, and concentrate on pooping in a diaper.

2. If using underwear part time, a good plan is to ask a grownup for a diaper to poop in…or maybe try the potty.

3. If they are at the park, in the car, in a classroom, etc, there must be some sort of assertive communication with a grown up. For example, when they have to tell a teacher to help them find the bathroom because “they gotta go now!”

As long as a solid plan is created to poop, your child is on the right track. Unfortunately, without formulating a plan, body cues are usually ignored. When body cues are ignored, stool is retained. That’s when trouble begins.

Essential #4:

Does my child take a leap of faith?

I have to admit: This is the most abstract of the essential elements to healthy toileting. The concept is that for young children, physically relaxing your bottom to let your poop out comes with a lot of baggage….there’s a lot of psychology wrapped up in the decision to “let it go”.

I won’t risk boring you with psychobabble. I will, however, point those who are interested in taking a deeper dive in the right direction. It was Sigmund Freud himself who coined this the “Anal Stage” of psychosexual development. You can read all about it here, but long story short: Young children are control freaks.

The anal stage marks the time in development when a child can control the muscle that allows us to keep poop inside (known as the anal sphincter). Once they obtain this control, they have the ability to pass or withhold stool at will. For some children, this new found control can conflict with parents who may be trying to direct toileting in a specific way. Children eventually need to resolve this conflict between their new found sense of control and their parents’ demands.

So the leap of faith is being able to relax that anal sphincter….to give up control to bodily functions…to accede to parental demands. Heavy stuff….if you are a little kid.

The key here is this: As a parent, you can’t speed up this leap of faith that your child needs to take. You have no leverage over this defining moment. It happens when your child is ready. But–and this is a big one–parents and caregivers can easily disrupt or impede this step if they don’t play their cards right.

The way to mess this up is to push, cajole, trick, pressure, or shame a child in to potty training. When you do this, you run the risk that the control-freak demon inside of your child will come out. It will make your child assert control over the situation because it holds all the leverage. Your child can shut down this potty training with one muscle—the anal sphincter.

In my article on fear of pooping, you can read all about what to focus on as parents to make sure the leap of faith happens sooner rather later. Additionally, I’ll steer you away from the pitfalls that parents fall in to when trying to convince their child to let out poop.

Essential #5:

Does my child coordinate muscles appropriately?

When trying to understand the muscle mechanics of pooping, there are two important events happening simultaneously. One event is a contraction of muscles and the other event is a relaxation of muscles.

First, you need to gently squeeze your belly muscles. This is what people do when they bear down—when they “push”. You are applying a squeeze or pressure to the bowels. The official term for this is called a Valsalva.

Second, you need to relax your bottom—your pelvic muscles—to allow the stool to pass out.

The muscle tone in your child is very important. Children with low muscle tone, for instance, will often not be able to make a strong Valsalva. This will decrease the amount of squeeze or forcefulness behind getting poop out. Children with high tone often have a hard time passing stool because their pelvis is too tight. This almost acts like a minor obstruction—because without pelvis relaxation, stool tends to get stuck.

From a medication standpoint, children with poor muscle coordination should have a specific plan! And if there are any treating therapists (like PT or OT), you’ll want to involve them in the medical planning around constipation.

Essential #6:

Does the colon squeeze hard enough to get the poop out?

In Essential #1, we spoke about one consequence of retained stool: The bowels stretch out–>The urge to poop is lost

So it stands to reason that on a day to day basis, you have to get out 100% of the poop you create. Only then will the colon stay nice and empty.

Your colon must generate a strong enough contraction that the poop is squeezed out—almost like what happens when you squeeze a tube of tooth paste. If you have a strong squeeze, you can get 100% of your poop out.

What it would be like if you always retained 10% of your stool on a day to day basis? Do the math. You would gradually stretch out your bowels to the point that you lose the urge ’to go’.

It turns out that that strength of that squeeze is directly tied to how stretched out the bowels are. When the colon is really stretched out from excess stool, it starts acting like an old sock that barely fits you anymore. It has lost its elasticity and its form. It stops contracting and squeezing well. 

The good news is, unlike a sock, which will never regain its snap and elasticity, the colon can regain its un-stretched, healthy shape with time and the right treatments. That colon will start sending messages to the brain once more. That colon will start squeezing once more. It just takes time and the right strategy.

One of the mainstays to helping to get the colon to squeeze better is to use medications that help the colon contract. These are often referred to as stimulant laxatives. See our guide to stimulant laxatives here.