Roughly one in five children—22-24%—experience stool toileting refusal, making poop problems one of the most common challenges of potty training.
This isn't a failure of parenting or a behavioral problem with your child. Research has established that constipation precedes stool toileting refusal in 93% of cases, meaning most poop struggles have a physical root cause.
The good news: with patience, proper positioning, and a pressure-free approach, the vast majority of children resolve these difficulties within months.
Your toddler isn't being defiant—their body is genuinely working harder to control bowel movements than urine.
While bladder control requires coordination of essentially two actions, defecation demands orchestration of multiple muscle groups working in precise sequence: two sphincters must coordinate, pelvic floor muscles must relax, abdominal muscles must contract, and specific postures must be adopted.
EMG studies reveal that children who haven't gained voluntary bowel control show fundamentally different neural patterns—patterns that mature gradually and cannot be accelerated.
Children urinate many times daily, providing repeated practice opportunities. Bowel movements occur only 1-2 times per day, giving toddlers far fewer chances to connect the internal signal with the appropriate action.
Toddlers may perceive bowel movements as losing part of themselves. This creates genuine anxiety at a developmental stage characterized by magical thinking and emerging body awareness.
Research shows that 70% of children hide while defecating before toilet training completion—suggesting embarrassment and desire for privacy around a vulnerable act.
When children transition from the enclosed security of a diaper to an exposed position on a potty, they lose both privacy and familiar sensation. The fear of falling into an adult-sized toilet, startling flush sounds, and seeing things "disappear" all compound the challenge.
Research has identified key patterns in stool toileting struggles.
A child who urinates successfully on the toilet but refuses to defecate there for at least one month. Key risk factors include:
Among children who developed STR and hard bowel movements, 93.4% experienced constipation before the onset of refusal.
When a child experiences a hard, painful stool, the natural response is to avoid repeating that experience. Signs include:
Parents often misinterpret these behaviors as pushing, when the child is actually doing the opposite.
Many children struggle with sensory aspects adults take for granted:
Learn more about overcoming potty fear.
When stool remains in the colon, the colon continues absorbing water, making stool progressively harder and larger. The longer a child withholds, the more painful the eventual bowel movement becomes, reinforcing the fear. Over time, chronic retention stretches the rectum and weakens muscles, reducing the child's ability to even sense when they need to go.
Functional constipation peaks at age 2.3 years—precisely during typical toilet training.
The research is unambiguous: coercive approaches to stool training consistently produce worse outcomes. This isn't ideology—it's physiology.
Defecation requires voluntary relaxation of the anal sphincter. A tense, anxious, or resistant child cannot physically achieve this relaxation. This represents one of the few domains where children have complete physiological control that cannot be overridden.
Children held on the toilet against their will, lectured excessively, or punished for accidents typically develop an oppositional response to excessive prompts that transforms toilet training into a power struggle.
The Canadian Paediatric Society advises that toileting battles "damage the parent-child relationship and the child's self-image, and may hinder progress in acquiring toileting skills."
When researchers tested simply interrupting toilet training and returning to diapers for children with STR, 89% spontaneously began using the toilet within three months.
This isn't giving up—it's evidence-based practice.
Evidence-based interventions make bowel movements physically easier and emotionally safer.
When sitting upright on a standard toilet, the puborectalis muscle maintains an angle that creates resistance. In a squatting position with knees elevated above hips, this muscle relaxes and the rectum straightens.
Leverage the gastrocolic reflex—an involuntary increase in colonic motility triggered by stomach filling.
Schedule relaxed, unpressured toilet sitting for 5-10 minutes about 20-30 minutes after meals.
Children absorb messages that feces are disgusting through parental verbal and nonverbal signals. While language alone cannot prevent poop problems, avoiding shaming terms helps resolve them faster.
Neutral, matter-of-fact terms: poop, bowel movement, poo
Stinky, gross, yucky, disgusting, or any language implying defecation is shameful
Children whose parents used positive language had significantly shorter STR duration (5.1 months vs 7.3 months).
Follow the individual child's cues rather than imposing a standard approach.
Rewards can help motivate without pressure—but they must be used correctly.
Learn About RewardsMost stool training struggles resolve with patience, positioning, and addressing any underlying constipation. However, certain signs warrant professional evaluation.
Per AAP and NASPGHAN guidelines:
With proper treatment, 50% of referred children recover within 6-12 months, and 80% recover within 10 years. First-line treatment is polyethylene glycol (PEG), which research confirms is safe and does not cause dependence.
Stopping medication prematurely is the leading cause of treatment failure. Treatment should continue until the child is both trained and symptom-free for at least one additional month.
Address hard stools first with adequate fiber, fluids, and medical treatment if needed—constipation is typically the root cause
Use proper positioning (feet supported, knees above hips) to make defecation physically easier
Time attempts after meals to leverage the gastrocolic reflex
Use neutral, non-shaming language about bowel movements
Avoid pressure, forcing, or punishment—which cannot override physiology and will only prolong the struggle
If problems persist, taking a complete break from training—returning to diapers without shame—allows the child to regain a sense of control and often leads to spontaneous resolution. Your child's body is working through a genuinely complex developmental process. The struggle is normal, treatable, and temporary.