Your toileting questions answered
We sit down with Dr Lexi Frydenberg, Paediatrician and co-director of Victorian Children's Clinic in Melbourne, to find out the answers to some of our readers' frequently asked bladder and bowel control questions.
Q: Why does my child struggle to do a poo?
A: The most common reason children struggle to poo is constipation. We define constipation as infrequent, hard and/or painful defecation (pooing). For some children, simple strategies, like eating more fibre, drinking plenty of water, being physically active and sitting on the toilet regularly (especially after meals), can resolve the problem. But if constipation has been present for a while, children will often need medication to help manage it and soften the poo and help the bowel empty properly. Speak to your pharmacist or doctor for advice on the correct medication.
It is really important to treat constipation early and consistently. This helps to prevent the negative cycle that can easily develop: withholding of poo, poo building up and becoming harder and more painful to pass, reinforcing fear and reluctance to pass a poo and leading to further stool (poo) withholding and constipation. The good news is that constipation can usually be treated successfully with simple lifestyle changes and medication.
"Constipation is extremely common, affecting up to 1 in 3 children."
What is Stool Withholding?...Stool withholding is when a child avoids doing a poo, even when they feel the urge. This is often due to fear of a hard/painful poo or worries about using the toilet. If children develop a habit of avoiding passing a poo and holding on, this can contribute to the cycle of chronic constipation, tummy pain and soiling in the undies.
Q: Is there a quick fix for constipation?
A: Unfortunately, there isn’t usually a 'quick fix' when it comes to constipation in children, particularly if it has been going on for a while. Kids are not just small adults, their bowels work a little differently, and constipation can easily become a negative cycle that takes time to break.
Depending on how long your child has been constipated and how they respond to medication will determine how long they will need to take it for.
Treating constipation will often take several months, not just days or weeks. This allows the bowel to recover, your child to learn how to pass poos without pain or fear and reduces the chance of the problem coming back.
Reward charts can be very effective when managing constipation, as withholding plays a role in the negative cycle. However, when it comes to toileting, it’s important to reward children for the things they can control, to help reduce shame or fear. The key is to reward the act of sitting on the toilet with something small and immediate, rather than rewarding producing a poo, which isn’t always something the child can control.
Q: Should I let my child watch the iPad on the toilet?
A: It might seem like a helpful distraction, but in most cases it is best to avoid screens on the toilet. When toilet-training, it is important for children to try and tune in to their body signals, the urge to wee or poo, and focus on relaxing the right muscles. If they are distracted with an iPad, they can sit for a long period of time, but not focus on what they actually need to do on the toilet.
If used occasionally and for short periods, it’s not harmful. But for healthy, confident toileting in the long run, screens are best kept out of the bathroom.
I sometimes suggest using screentime as an incentive to get a child to sit on the toilet if they are reluctant. For example, if asking them to do a toilet sit after a meal (to try and pass a poo), you might reward them with 5 mins of screentime after their sit (in a different room, not in the bathroom).
Q: Why do children sometimes start having accidents again when they start school?
A: It is common for children who were previously toilet trained to have accidents when they first start school. This doesn’t mean they have 'gone backwards' or that something is wrong, it’s usually a response to change. This may be because they are busy or distracted, are reluctant to use the school toilets, are getting used to the new routine or it may be due to constipation where the hard poo in the bowels pushes on the bladder and makes it harder to stay dry.
It is important for parents to reassure their child that accidents are common and not the child’s fault. Discuss it discreetly with the teachers and ensure your child is able to use the toilets when needed, while also encouraging good toilet habits at home.
Q: Why do doctors not recommend a tactical wee?
A: A 'tactical wee' is when a child is asked to go to the toilet 'just in case', even if they don’t feel the urge. While it may seem sensible before leaving the house, going on a long car ride or starting an engrossing activity, regularly doing this is not recommended.
Children need to learn how to respond to the urge to wee (the feeling of a full bladder). Bladders need to fill and empty properly, so asking a child to wee when their bladder is not full, can make it harder for them to recognise when they do need to go. Small, frequent wees can create problems as the bladder is emptied before it has stretched properly. Over time, this can train the bladder to hold less urine and cause continence issues. Young children (under about 3–4 years) usually can’t do a 'just in case' wee because their bladder needs to be full to work properly. They may not be able to go on demand, or it can take them a while to relax and coordinate their muscles to release the wee.
Need help with toilet training? call the National Continence Helpline 1800 33 00 66 (8am-8pm Mon-Fri).
More resources
- Royal Melbourne Children's Hospital factsheet
- Podcast episode about constipation with Dr Lexi Frydenberg