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Sarah Selznick, MS, OTR/L is an occupational therapist, author, and the founder of Sensory Explorers, a private practice supporting children, caregivers, and adults through sensory wellness, pelvic health, and developmental care. She’s the creator of the online Super Poopers course, helping families navigate pediatric bowel and bladder challenges with humor and heart. Sarah is also the author and illustrator of children’s books that support early learning and independence — including I Am Learning: How to Poop in the Toilet and I am Learning how to Listen to my Body.
You can find her on Instagram @sensoryexplorers for tips, tools, and a peek into her playful approach to therapy. ✨ Sign up for her newsletter to stay in the loop:www.sensoryexplorers.com
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Interview with Quiara Smith, OTR/L
An Interview with Dr. Steve Hodges
One of the most common misconceptions among parents is the belief that if a child poops every day, they can't possibly be constipated. But the truth is, many children with chronic constipation do pass stool daily — and still struggle.
If you’re scratching your head, wondering how that’s possible, you're in the right place. Let’s explore the hidden side of constipation, why some kids with sensory challenges or autism may withhold poop, and how interoception and pelvic floor health play a crucial role.
Let’s start by busting the biggest myth:pooping daily does NOT guarantee your child isn’t constipated.
Children can have a bowel movement every day and still be backed up. In fact, Sarah Selznick, a pediatric occupational therapist specializing in pelvic floor therapy, explains that children may pass only small amounts of stool each day or have stools so large that they actually signal long-standing constipation.
Large, bulky stools.
Pebble-like or pellet-shaped poop.
Pain or straining while pooping.
Several small bowel movements a day.
Accidents after potty training.
Complaints of stomach aches or bloating.
“You can poop every single day and still be constipated. It should come out smooth and easy.” - Sarah Selznick, OTR/L
Consistency matters just as much as frequency. Ideally, poop should resemble a smooth banana or soft-serve ice cream. If it’s hard, painful, or inconsistent, it may be time to dig deeper.
Withholding is more common than you might think, especially in children with:
Sensory Processing Disorder (SPD).
Autism.
Anxiety.
A history of painful pooping.
Fear or pain: A single painful poop can trigger fear of going again.
Sensory avoidance: The feeling of pooping, or the bathroom environment, may be overwhelming.
Lack of privacy: Children may feel anxious about pooping at school or away from home.
Body awareness issues: They may not recognize the urge until it’s urgent.
Sometimes, withholding behaviors can look like misbehavior. Tantrums, pacing, toe walking, clenched muscles, or rolling on the floor might not be defiance—they might be attempts to hold it in.
“It can look like huge behavioral problems, but it's really just the body fighting hard not to let the poop out.”
The pelvic floor is a group of muscles that support the bladder, bowels, and internal organs. These muscles must relax to allow poop to pass.
In children who chronically withhold, the pelvic floor muscles can become tight, weak, or uncoordinated. Over time, this leads to dysfunction that makes pooping difficult, even when the child is ready.
Difficulty fully emptying.
Straining during bowel movements.
Feeling like they still need to go after pooping.
Frequent accidents or leakage.
Occupational and physical therapists trained in pediatric pelvic floor therapy can help retrain these muscles using breathwork, movement, and body awareness strategies.
Interoception is the sense that helps us feel internal body signals—like hunger, thirst, temperature, or the need to use the bathroom. Children with poor interoceptive awareness may:
Not realize they need to poop until it’s too late.
Be unaware of how their body feels during constipation.
Have difficulty recognizing fullness or discomfort.
"Interoception is our body's internal dashboard. When it's underdeveloped, it’s like driving with the gas gauge broken."
If your child struggles to recognize their body signals, try these simple, fun ways to build awareness.
Interoception Activities:
Hot vs. cold play: Use warm and cold packs and have your child describe how they feel.
Hunger/fullness scale: Create a visual scale from 1 (starving) to 5 (stuffed) and use it before and after meals.
Breathing exercises: Practice deep belly breathing while lying on the floor with a stuffed animal on their tummy.
Neutral narration: Model your own interoception by saying things like, “My tummy is growling, that means I’m hungry.”
Let’s face it—poop can be an uncomfortable topic. But if we want kids to feel safe and confident, we need to normalize it.
Avoid calling poop "gross" or "yucky".
Use books like"I'm Learning to Poop on the Potty" to visually explain the process.
Validate feelings: "It’s okay to be scared. I’m here to help."
Be patient and keep a calm tone—even when it gets messy.
Remember, your child is doing the best they can with the sensory and body signals they have.
Track bowel habits (use a poop log!).
Encourage hydration and high-fiber foods.
Build a consistent toileting routine.
Create a calm bathroom environment.
Seek help from a pediatric pelvic floor OT or PT.
Shame your child for accidents.
Ignore withholding behaviors.
Assume pooping daily means no constipation.
Push potty training too fast.
If you’ve tried all the strategies and your child is still:
Having accidents
Withholding regularly
Complaining of stomach aches
Afraid of pooping
... it might be time to reach out to a pediatric pelvic floor therapist or occupational therapist.
Some therapists offer virtual sessions. You can also start with your pediatrician for a referral.
If your child is struggling with poop, it doesn’t mean they’re lazy or misbehaving. It means their body may be trying to stay safe in the only way it knows how.
By understanding the hidden signs of constipation, recognizing the role of interoception, and supporting pelvic floor health, you’re laying the foundation for your child to feel confident, comfortable, and in control.
While we make every effort to share correct information, we are still learning. We will double check all of our facts but realize that medicine is a constantly changing science and art. One doctor / therapist may have a different way of doing things from another. We are simply presenting our views and opinions on how to address common sensory challenges, health related difficulties and what we have found to be beneficial that will be as evidenced based as possible. By listening to this podcast, you agree not to use this podcast as medical advice to treat any medical condition in either yourself or your children. Consult your child’s pediatrician/ therapist for any medical issues that he or she may be having. This entire disclaimer also applies to any guests or contributors to the podcast. Under no circumstances shall Rachel Harrington, Harkla, Jessica Hill, or any guests or contributors to the podcast, as well as any employees, associates, or affiliates of Harkla, be responsible for damages arising from use of the podcast.
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This podcast should not be used in any legal capacity whatsoever, including but not limited to establishing “standard of care” in a legal sense or as a basis for expert witness testimony. No guarantee is given regarding the accuracy of any statements or opinions made on the podcast.
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