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If potty training, constipation, accidents, or stool withholding feel way harder than they should, you are not alone. In this episode, we’re talking about pediatric pelvic floor health and why many toileting struggles are actually connected to body awareness, sensory processing, nervous system regulation, and coordination.
Amanda shares her perspective as an OT specializing in pediatric pelvic floor health, while Rachel brings in the sensory and regulation lens. Together, we break down why kids who struggle with toileting are not being lazy, stubborn, or defiant, and why pressure and shame often make things worse.
We also talk about common signs a child may need extra support, how stress and dysregulation impact the body, and practical strategies families can use at home to make toileting feel safer and more manageable.
This episode is all about helping parents better understand what’s happening beneath the surface and reminding families that their child is not broken and they are not failing.
Thanks for listening 🩷
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Potty training can be one of the most exciting milestones in early childhood, but it can also be one of the most stressful. If your child is struggling with constipation, frequent accidents, bedwetting, or difficulty recognizing when they need to use the bathroom, you may feel frustrated, overwhelmed, and unsure of what to do next.
First, take a deep breath. You are not alone, and your child is not doing this on purpose.
Many toileting challenges stem from underlying developmental, sensory, digestive, or pelvic floor concerns that can be addressed with the right support. Understanding how the pelvic floor works and how it connects to sensory processing, body awareness, and nervous system regulation can help you better support your child through the potty-training journey.
The pelvic floor is a group of muscles located at the base of the pelvis. Think of these muscles like a hammock that supports important organs such as the bladder and bowel.
These muscles help children:
Hold urine and stool when appropriate.
Relax to allow bowel movements and urination.
Coordinate with breathing.
Develop body awareness.
Recognize internal signals from their body.
When the pelvic floor is functioning well, toileting becomes much easier. When these muscles are too tight, too weak, or poorly coordinated, children may experience challenges such as constipation, accidents, urinary urgency, or bedwetting.
Many parents hear the words "pelvic floor therapy" and immediately think about adult women's health. Pediatric pelvic floor therapy is very different.
For children, therapy focuses on:
Breathing patterns.
Body awareness.
Sensory processing.
Movement and posture.
Strength and coordination.
Healthy bowel and bladder habits.
Nutrition and hydration.
There is no internal treatment involved in pediatric pelvic floor therapy. Instead, therapists help children learn how their bodies work and develop the skills needed for successful toileting.
Potty training is a developmental milestone, just like crawling, walking, talking, or riding a bike. It requires multiple body systems to work together, including:
Children must be able to notice and interpret signals from their bodies.
Questions they need to answer include:
Do I feel pressure in my bladder?
Do I need to poop?
Is this gas or a bowel movement?
How urgently do I need to go?
This ability to recognize internal body signals is calledinteroception, and it plays a major role in toileting success.
Children need awareness of:
Where their body is in space.
How to sit safely on the toilet.
How to relax their muscles.
How to coordinate breathing with toileting.
When a child feels stressed, anxious, rushed, or unsafe, their body naturally tightens. A tense body has a harder time relaxing enough to successfully urinate or have a bowel movement.
As occupational therapists often remind families:
The body must feel safe before it can relax enough to go to the bathroom.
One of the most overlooked causes of toileting difficulties is constipation. Many children who are labeled as "stubborn," "lazy," or "behavioral" are actually experiencing physical discomfort.
Constipation can contribute to:
Irritability.
Emotional dysregulation.
Sleep difficulties.
Frequent accidents.
Bedwetting.
Reduced appetite.
Difficulty focusing.
When a child feels uncomfortable all day, it affects every area of their life. It's important to remember that there is no such thing as a lazy child. Children communicate through behavior, and toileting struggles often signal that something deeper is going on.
Many parents assume that if their child poops every day, constipation is not a concern. Unfortunately, that's not always true.
Children can have daily bowel movements and still be constipated. Potential signs include:
Hard stools.
Painful bowel movements.
Stool withholding.
Frequent accidents.
Abdominal discomfort.
Bedwetting.
Large bowel movements.
Difficulty sensing the urge to go.
The Bristol Stool Chart can be a helpful tool for understanding stool consistency and identifying signs of constipation.
Some children actively try to prevent bowel movements. Common signs include:
Crossing their legs.
Standing on tiptoes.
Squatting.
Sitting on their heels.
Stiffening their entire body.
While it may look like they're trying to go, they're often doing the opposite, trying to hold it in. Over time, stool withholding can stretch the rectum and make it harder for children to recognize when they need to go, creating a cycle that becomes increasingly difficult to break.
Many children with sensory processing challenges experience additional toileting difficulties.
Some children:
Don't notice body signals.
Get distracted while playing.
Avoid bathrooms due to sensory sensitivities.
Seek pressure by holding stool.
Become anxious about toileting routines.
Because sensory processing affects body awareness and regulation, occupational therapists often evaluate toileting through a sensory lens rather than viewing accidents as purely behavioral.
One of the simplest changes families can make is improving toilet positioning. Many toilets are designed for adults, not children.
When children's feet dangle:
They feel unstable.
Their muscles stay activated.
Their pelvic floor struggles to relax.
For optimal positioning:
Feet should be fully supported on a stool.
Knees should be slightly higher than hips.
Children should lean forward slightly.
A child-sized toilet seat insert may help improve stability.
This positioning encourages the pelvic floor muscles to relax naturally and makes bowel movements easier.
Breathing plays a huge role in pelvic floor function. Many children instinctively hold their breath and push when trying to have a bowel movement.
Unfortunately, this often makes things harder. Instead, encourage:
Practice slow breaths:
In through the nose.
Out through the mouth.
Try:
Blowing bubbles.
Pretending to blow out birthday candles.
Pinwheels.
Humming naturally encourages exhalation and relaxation.
A favorite strategy among pediatric pelvic floor therapists is having children slowly exaggerate the word "moo." The prolonged sound helps build appropriate pressure while encouraging relaxation rather than straining.
Even the best toileting strategies won't work if a child's digestive system isn't supported. Parents are often surprised when they begin tracking:
Daily water intake.
Fiber consumption.
Foods eaten throughout the day.
Keeping a simple food and bowel movement journal for one week can provide valuable insights. Focus on:
Increasing water intake.
Offering fiber-rich foods.
Supporting gut health.
Monitoring foods that may contribute to constipation.
Small changes often lead to significant improvements over time.
Reward systems can work for some children, but they should be used thoughtfully. One challenge is that rewards can unintentionally create shame when a child doesn't earn them.
Instead of focusing solely on outcomes, consider celebrating:
Sitting on the toilet.
Listening to body signals.
Following routines.
Practicing skills.
The goal is to support learning rather than create pressure.
Consider speaking with your pediatrician, occupational therapist, physical therapist, or pediatric pelvic floor specialist if your child experiences:
Chronic constipation.
Frequent stool withholding.
Blood in the stool.
Pain with bowel movements.
Persistent bedwetting after age six.
Difficulty recognizing body signals.
Frequent accidents despite consistent potty-training efforts.
Early intervention often leads to better outcomes and less frustration for the entire family.
Toileting challenges are rarely caused by one factor alone. Depending on your child's needs, support may come from:
Pediatricians.
Occupational therapists.
Pediatric pelvic floor physical therapists.
Dietitians.
Gastroenterologists.
Behavioral health professionals.
A collaborative approach helps uncover the root cause rather than simply managing symptoms.
If you're feeling exhausted by potty training, accidents, or constipation, remember this:
Your child is still learning.
Potty training is not a race, and setbacks do not mean failure. Sometimes children need to pause, regroup, and rebuild confidence before moving forward again.
Creating a calm, supportive environment helps children feel safe enough to listen to their bodies and develop the skills they need. Progress may not happen overnight, but with patience, consistency, and the right support, your child can get there.
BORING, BUT NECESSARY LEGAL DISCLAIMERS
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 & art. One doctor / therapist may have a different way of doing things from another. We are simply presenting our views & opinions on how to address common sensory challenges, health related difficulties & 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.
Keep in mind that we may receive commissions when you click our links & make purchases. However, this does not impact our reviews & comparisons. We try our best to keep things fair & balanced, in order to help you make the best choice for you.
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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