When they hold on: poo withholding and constipation

Holding on to poo is common, distressing and very fixable. It almost always starts with poos that hurt.

Wees are often the easy part. For many families the real struggle is poo. A child who was doing well suddenly refuses to sit, asks for a nappy, or hides behind the curtain and stands very still. If that sounds familiar, you’re far from alone.

What withholding looks like

Withholding is when a child holds on to a poo, using their bottom muscles to stop it coming out when they feel the urge. ERIC stresses that children don’t do this on purpose. It can be surprisingly hard to spot, because it can look like the opposite. Signs ERIC and parents describe include:

appearing to strain, when they’re actually holding on
unusual facial expressions, or holding strange body positions
going quiet or seeming hard to reach
hiding somewhere “safe” when the urge comes
asking for a nappy to poo in, or refusing to sit on the potty or toilet
smears of poo in pants

Why it happens: the cycle

It usually starts with a poo that hurt. That might be from constipation, an illness, a small tear (fissure) from passing a large poo, or a change like starting nursery or not wanting to use unfamiliar toilets. Your child remembers the pain and holds on. Held poo gets bigger and harder, so the next one hurts too, and the cycle tightens.

ERIC is clear that this isn’t naughtiness or stubbornness. It’s about avoiding pain.

Is my child constipated?

The NHS lists these signs of constipation in children:

fewer than three poos in the last week
poos that are large and hard, or look like rabbit droppings or little pellets
straining or pain when pooing
soiled pants, in children over one

The NHS also suggests checking for constipation before you start potty training. Your child should be doing soft poos at least every other day.

What helps

Treat the constipation first. ERIC says this is essential. Reassurance on its own won’t break the cycle, because your child needs to experience soft poos that don’t hurt before they’ll believe it. The NHS notes that laxatives are often recommended for children who are eating solid food, alongside diet and lifestyle changes. Treatment can take several months to work. Speak to a GP or pharmacist before giving laxatives, and don’t stop them early without advice.

Then build a calm routine. NHS advice includes:

plenty to drink, and a variety of food including fruit and vegetables
a regular time to sit on the potty or toilet, after meals or before bed
praise for sitting, whether or not they poo
feet resting flat on the floor or a step

Stay calm. ERIC stresses avoiding anger and keeping the bathroom a relaxed place. Some families keep a basket of books by the toilet so sitting time feels like a nice break.

In the US

The AAP lists constipation and painful bowel movements among the common causes of toilet training setbacks, and recommends talking to your pediatrician to rule out physical causes before treating it as a behavior issue.

When to get help

The NHS’s advice is simple: if you think your child may be constipated, take them to a GP. It also warns that the longer constipation goes on, the harder it can be to get back to normal, so don’t wait it out. We’d also suggest getting medical advice promptly if there’s blood, a lot of pain, or your child seems unwell.