Toilet Training Problems: Bowel Movements

Causes

• Some toddlers have control over their bowel movements but are not comfortable going in the toilet. It may because the child is used to standing while having a bowel movement and is uncomfortable sitting down, or it may be that he is unused to the sensation of going in the toilet. This toddler may hold a bowel movement until he is wearing a diaper, even asking for a diaper because he knows he needs to have a bowel movement.

  A toddler who has trouble with completing bowel toilet training may become constipated as a result of trying to hold it. He may also be afraid to have a bowel movement in the toilet after being constipated, especially if his stools became hard and painful.

  A less common problem is chronic toddler diarrhea. Diarrhea is usually the result of a virus, but food allergies or intolerances or a long-term infection like giardia may also cause diarrhea. Chronic diarrhea can cause problems with toilet training, since it is difficult for the toddler to be aware of when he needs to go or to get to the toilet in time.

Time Frame

• In a study by Bruce Taubman of the University of Pennsylvania Department of Pediatrics, 22 percent of children in the process of toilet training refused to have a bowel movement in the toilet for at least one month. In 4 percent of the children, the resistance to bowel training continued for longer than six months. Toddlers who resisted using the toilet for bowel movements completed toilet training at an older age. Most children who finished toilet training at older than 48 months had problems with bowel movement training.

Physical Solutions

• Examine the consistency of the toddler's stools to determine whether diet is a factor in her toilet training problems. A high-fiber diet can relieve both constipation and diarrhea. Make sure she is eating plenty of fiber, preferably from whole-food sources like oatmeal, fresh apples and vegetables. Encourage her to drink water instead of juice.

  Make sure she can sit comfortably on her potty or on the adult toilet with a seat insert. She should be able to sit with her feet flat on the floor or on a stool. Having her feet on a stable surface will help her feel comfortable and make it easier for her to have a bowel movement.

Psychological Solutions

• After you have addressed any physical causes of toilet training problems, the child's fear and discomfort with the toilet may still take time to deal with. Some children will simply use a diaper for bowel movement until they spontaneously choose to use the toilet instead. You should not force a child to sit on the toilet if he is frightened, but you can encourage the transition with small steps. For example, have him sit on the toilet just to practice, without expecting him to use it. He can also practice sitting on the toilet during his bowel movement while still wearing a diaper.

Concerns

• Most toilet training problems are normal and do not require medical advice. However, you should talk to your pediatrician about toilet training concerns, especially if you suspect that there is a physical cause like constipation. According to a 1997 "Pediatrics" article, a child who is trying to hold bowel movements to the point of causing constipation should be evaluated by a pediatrician. In addition, a child older than 42 months who has not completed training should be evaluated by a pediatrician to rule out any additional causes for the toilet training problems. Finally, chronic diarrhea should always be evaluated by a pediatrician, although medical treatment is rarely necessary.