If your child is struggling with toilet training, it's either because she's chock full of poop or too young or both.

By Steve J. Hodges, M.D.
April 22, 2015
girl on potty
Credit: Shutterstock

As a culture we're obsessed with luring kids out of diapers—early, quickly, and in style.

Parents used to bait little ones with sticker charts, M&Ms, and cool undies; now it's medieval-themed potties and door-mounted devices, like the Poop 'N Pull, that deliver encapsulated treats with the tug of a cord. One blogger noted that the Poop 'N Pull, a Kickstarter venture, seemed like something you'd use to house train a puppy. "But, hey, if it gets the job done," she wrote, "who are we to knock it?"

I'm a pediatric urologist, so let me take a shot!

The goal of toilet training should never be "getting the job done." The real triumph is setting your child up to avoid a future of visits to continence clinics like mine. Virtually all the problems I see daily — bedwetting, pee and poop accidents, recurrent urinary tract infections — stem from my patients' potty-training days. In many cases, those days were a decade ago. I regularly treat 7th graders who poop in their pants and 10th graders who wet the bed, in addition to 4-year-olds who can't seem to graduate from diapers.

All of these children are chronically constipated.

Our single-minded focus on getting children out of diapers primes them to become chronic holders of poop (and pee). Eventually, the holding habit catches up with many of them. In short: Poop piles up, forming a large, hard mass that stretches the rectum and presses against and irritates the bladder. Eventually, the child may lose tone and sensation in the rectum — that's when poop falls out without the child even noticing. Holding pee exacerbates toileting problems. When I explain all this to parents, they're blown away. They say, "I wish I'd known this back when we were potty training" or, "I'm going to do things differently with my youngest."

If your child is struggling to use the toilet, it's either because your child is chock full of poop or too young or both. The problems I treat daily are both epidemic and entirely preventable. Follow these 7 Crazy Important Rules for Potty Training Success, and it is highly unlikely your family will ever set foot in a clinic like mine.

potty training infographic

Want to help your child avoid a future of constipation, bedwetting, and accidents? Make sure your child:

#1: Poops plenty of mushy stool daily — before training starts.

A child who poops logs or pellets is constipated, and toilet training a constipated child is a doomed endeavor. Before you even consider training, make sure your child's poop is totally unformed, like a thick milkshake or hummus. Virtually all children who have trouble training — who hide to poop or seem fearful of the toilet — are clogged up and experience pain with pooping.

#2: Faces no deadlines, pressure, or expectations.

Preschool requirements and potty boot camps prime children to hold poop. As parenting expert Janet Lansbury astutely notes, "Children don't need adults to train them to use the toilet. They do need attuned, communicative parents and caregivers to support and facilitate the toilet learning process, a process that is individual to each child."

#3: Is around age 3 — absolutely not younger than 2. My research has found that children trained before age 2 have triple the risk of developing daytime wetting problems than children trained between 2 and 3. This doesn't mean there's a "magic window" between ages 2 and 3. It's just that children trained before age 2 are at the highest risk for developing problems. In reality, most children under 3 haven't developed the capacity to respond to their bodies' urges to pee and poop in a judicious manner, so many become chronic holders.

#4: Poops with feet on a tall stool.

Humans were designed to squat when pooping. Squatting straightens the natural bend in the rectum straightens, allowing poop to fall out easily, no straining required. (The Squatty Potty website illustrates this phenomenon well.) When an adult sits upright on a toilet, pooping is more difficult than it needs to be, but when a child sits upright, legs dangling, it's like trying to poop uphill.

#5: Continues to poop PILES of mush daily.

If, while learning to use the toilet, your child's mushy blobs become pellets or XXL logs, back off training and treat the constipation. Do not resume training until the child's poops are complete mush. Yes, this means you need to peer into the toilet each time your child poops! Also pay attention to how often your child poops. If frequency drops your child is likely constipated.

#6: Pees every few hours — no potty dance!

You might have heard that holding pee is a good thing — that it helps stretch kids' bladders so they can hold more urine and avoid accidents. Untrue! Regular emptying is actually what leads to healthy bladder growth. Holding urine thickens and irritates the bladder and shrinks its capacity. If you see your child doing that elaborate number involving squirming, curtseying, or crotch grabbing, insist the child use the toilet.

#7: Eats "real" food, especially fruits and veggies.

Children learning to use the toilet are highly prone to constipation; eating goldfish crackers, hot dogs, chicken nuggets, and other highly processed "food products" will only make the situation worse. What if your child is waging a vegetable strike? Read "Best Tips Ever for Constipated Picky Eaters" and Lisa Leake's website, 100 Days of Real Food.

Keep these rules handy by downloading the free 7 Crazy Important Rules for Potty Training infographic.

Steve J. Hodges, M.D., pediatric urologist at Wake Forest University and co-author, with Suzanne Schlosberg, of It's No Accident and the kids' book Bedwetting and Accidents Aren't Your Fault.

Comments (2)

July 31, 2019
I don’t think it’s good advice to say NEVER before 2. I think you have to be very careful to make sure they are ready and you aren’t pushing them. However, my daughter was potty trained at 18 months and hasn’t had any issues.
December 3, 2018
It was very difficult to potty train our kids but that all changed when we found Can really recommend it!