“But my daughter can’t be constipated — she poops every day!”
That’s what I often hear from parents when I explain why their child is wetting the bed or having daytime pee or poop accidents: the child is constipated. Big time.
Most parents of chronically constipated children have no idea their child is backed up, because folks equate “constipation” with “infrequent pooping.” In reality, constipation is about incomplete emptying.
Many severely constipated children poop every day. The problem is, they don’t fully evacuate. So stool piles up in the rectum, forming a large mass. This mass not only can cause stomach aches but also stretches the rectum — often to twice its normal diameter, as my patients’ X-rays demonstrate.
The stretched rectum, in turn, presses against and aggravates the bladder, triggering accidents, day or night. In many kids, the stool-stuffed rectum, like a stretched-out stock, loses its springiness, and can no longer squeeze down to expel the entire load of poop. In addition, a floppy rectum loses sensation, so these kids may not feel the urge to poop or notice when they have a poop accident.
Meantime, fresh poop may ooze around the mass of older poop, so the child appears to be “regular,” and parents are none the wiser.
How can we help kids fully empty?
For more than a decade I’ve advised my patients to poop with a footstool that will position them in a full squat, the way humans were designed to poop — and the way a billion people on the planet, mostly in Asia and Africa, still poop.
But I could never find a commercially available stool tall enough for kids. Eventually I approached the folks at Squatty Potty and suggested a children’s version of their wildly popular stool for adults. As it turned out, they already had one in the works.
Their original design has now been improved, and I’m excited that the Potty Pup and the Potty Cub, two versions of the same design, are now available. I have a small financial stake in these products but would endorse them, anyway!
The Potty Pup and Potty Cub — aka Potty Pets — are cleverly adjustable. Place the top on either stool, and you have a 12.5-inch-high version perfect for kids who are toilet training. Without the top, the stools are 10.5 inches high, suitable for older children.
Little ones should use the contoured potty seat, which keeps them from falling into the toilet or worrying about it.
Why is a tall stool so helpful?
For one thing, planting their feet on a Potty Pet allows kids to relax while pooping, the opposite of what happens when they poop without a platform.
Think about it: Do you fully relax your body when you’re sitting on a bar stool without a footrest?
With their feet dangling, kids instinctively clench their inner thighs and pelvic floor muscles to keep from falling in. We can’t see kids clenching, and they may not know they’re doing it, but I assure you, they are.
A second reason Potty Pets help: in the squat position, kids get the benefit of gravity.
You’d think sitting upright on the toilet would make gravity work in your favor, giving poop a straight shot downward. But human plumbing is not what it seems. In reality, when you stand, your rectum is bent, a position that helps keep poop safely inside; when you squat, the rectum straightens, and poop exits without effort on your part.
Anyone who’s camped in the woods knows how easily you poop when you use nature’s facilities. Sitting upright on the potty, by contrast, is like trying to poop uphill.
Research demonstrates how much easier it is to poop in a squat. An Israeli study that found pooping in a squat is more comfortable and faster than pooping on a toilet. The subjects pooped in a speedy 51 seconds (no iPad needed!) while squatting, compared to a laborious 2 minutes and 10 seconds while sitting on a standard toilet.
A Japanese study recorded the abdominal pressure of volunteers as they pooped and demonstrated they strained less while squatting.
Modern toilets have made life easier in plenty of ways, but they’ve also contributed to a constipation epidemic among children.
To be sure, our kids’ pipes are clogged for many reasons — including our highly processed diet, our rush to potty train, restrictive school bathroom policies, and, on occasion, dairy intolerance. But toilets have surely exacerbated the problem.
To make matters worse, thrones are getting taller!
Standard toilets, 14 or 15 inches from floor to rim, have given way to 17-inch or even 19-inch “comfort height toilets.” Companies boast that taller toilets “make sitting down and standing up easier for most adults, ensuring extra comfort.”
Of course, what these taller toilets actually ensure is more pooping problems for kids!
To reverse chronic constipation, kids must fully evacuate every single day. This means pooping a nice big pile of mush — like a cow patty, a swirl of frozen yogurt, or soft, mushy snakes. If your child’s poops look like a big log, a turkey sausage or rabbit pellets, those
are red flags for constipation.
To help your child identify healthy shapes of poop, download our free infographic, How's Your Poop?, available in both English and Spanish.
Potty Pets: For Potty Training and Beyond
I recommend Potty Pets for kids with enuresis and encopresis, as well as children with milder constipation symptoms, such as stomach aches and the very urgent or very frequent need to pee.
I also strongly recommend the stools for kids who are potty training. The fact is, toilet training is prime time for kids to become constipated, as I explain in my booklet 7 Super Important Rules for Potty Training Success. The habit of withholding poop can become deeply ingrained in children and take years to reverse.
Most cases of enuresis and encopresis I treat date back to the child’s toilet-training period, though the accidents may not begin until years later. Anything parents — and preschools — can do to prevent children from becoming constipated during this critical time will pay off in a big way.
Preschools can help by eliminating potty-training deadlines and placing a Potty Pet in every bathroom.
Learning to heed the body’s urge to poop requires daily reinforcement, and that’s not part of our culture. If healthy toileting were taught in preschool and reinforced in grade school, if all our children pooped with their feet on a stool, and if we monitored our kids for the subtle signs of constipation, we’d have a lot fewer cases of enuresis and encopresis.
If you don’t plan to replace your family’s toilet with a hole in the ground — and I don’t! — my advice is: Get your child a tall stool, like the Potty Pup or Potty Cub.
Steve Hodges, M.D., is an associate professor of pediatric urology at Wake Forest University School of Medicine and coauthor of The M.O.P. Book: A Guide to the Only Proven Way to STOP Bedwetting and Accidents — Anthology Edition, as well as Bedwetting and Accidents Aren't Your Fault, Jane and the Giant Poop, and Dr. Pooper's Activity Book and Poop Calendar for Kids.