Constipation, Potty Training, and the Nervous System: What Every Parent Should Know

Dec 31

Potty training can feel like a rollercoaster, especially when your child consistently resists pooping on the toilet. Many parents assume constipation or “behavior” is the root cause — but from a pediatric occupational therapy perspective, there’s often more going on. Constipation and potty training challenges can stem from the nervous system, sensory processing, and motor function, not just diet or discipline..

Why the Body Matters

Your child’s ability to use the potty isn’t just a behavioral milestone — it’s a complex interaction of muscles, nerves, and brain-body awareness. Two key players are:

1. The Pelvic Floor:
The pelvic floor muscles control the release of urine and stool. If these muscles are tense, weak, or uncoordinated, it can be physically difficult for your child to relax and let go.

2. The Vagus Nerve:
This “superhighway” nerve links your brain to the gut. A well-regulated vagus nerve helps the bowel relax and contract at the right times. Anxiety, overstimulation, or sensory defensiveness can interfere with this pathway, making elimination harder.

Sensory and Motor Roots of Potty Resistance

Children may struggle with pooping on the toilet because they have difficulty sensing internal cues (a sense called interoception) or regulating their bodies. Common underlying contributors include:

Retained reflexes: Primitive reflexes like the spinal Galant or STNR can affect core stability, posture, and the ability to sit upright on a toilet.
Pelvic floor tension: Overactive or underactive muscles can make it physically uncomfortable to go.
Sensory sensitivities: Some children avoid the feel of the toilet seat, the sound of flushing, or even hand-washing afterward.
Emotional factors: Anxiety about the bathroom or fear of accidents can increase muscle tension and delay toileting.

How OT Can Help

Occupational therapists use a body-based, play-focused approach to support potty training. Here’s how:

1. Play-Based Regulation

Activities like jumping, swinging, and crashing into cushions aren’t just fun — they provide proprioceptive input that helps your child feel their body in space and relax the pelvic floor. Regulated children are more likely to recognize and respond to their bowel cues.

2. Sensory Strategies

Warm baths or water play before sitting on the potty can relax muscles and promote elimination.
Breathwork or gentle pelvic rocking while seated helps engage the vagus nerve.
Consistent toilet routines help children anticipate elimination and tune into internal signals.

3. Strengthening and Posture

Core and hip strengthening improve sitting stability.
Exercises to integrate retained reflexes can reduce involuntary tension that interferes with bowel movements.

When to Look Beyond Miralax

While stool softeners and laxatives can be helpful short term, they don’t address the root causes of constipation. If your child:

Waits until the last moment to poop
Resists sitting on the potty despite regular cues
Experiences chronic stool retention or discomfort

…then a therapist-led sensory, motor, and emotional approach may be the missing piece.

Practical Tips for Parents

1. Create predictable potty routines (same time every day).

2. Offer choices to increase control (e.g., pick underwear or toilet seat).

3. Provide proprioceptive input before toilet time: push, pull, or jump activities.

4. Keep visual cues like body charts or a “poop scale” to help them recognize sensations.

5. Celebrate effort, not just results — sitting on the potty is progress!

Bottom Line

Constipation and potty training resistance are rarely “just behavioral.” For many children, nervous system regulation, pelvic floor coordination, and sensory awareness play a major role. Occupational therapy helps children listen to their bodies, relax, and develop confidence, turning potty struggles into success.

If your child is struggling despite dietary changes or laxatives, consider a pediatric OT evaluation — it may be the missing piece to ending those stressful bathroom battles.

Written by: Dr. Marisa McDole

If potty training, tummy troubles, or feeding frustrations are leaving you feeling stuck, you’re not alone. Reach out to us today to learn how our pediatric OT can support your child’s comfort, confidence, and growth!