If you have ever felt the absolute desperation of a potty training “failure,” or wondered why your child is suddenly having “sneaky” accidents after months of success, you are not alone.
In the world of parenting, we often treat potty training like a behavioral hurdle—a test of willpower or a deadline to meet before preschool starts. But as I discussed in our latest episode of Kids These Days with pediatric occupational therapist Annie Close, potty training is actually a complex physical skill.
If your child is struggling, it might not be a behavioral “refusal.” It might be a puzzle piece of their physiology that needs a little extra support. Here is what every parent needs to know about the intersection of the pelvic floor, the nervous system, and the potty.
1. Shift the Mindset: It’s Like Riding a Bike
Annie shared a reframe that I absolutely love: Potty training is a learning process, not a race. Think about it like learning to ride a bike. Some kids hop on and go; others need months of practice, a few falls, and a lot of encouragement. We wouldn’t expect a child to master a bike in a “3-day miracle” method, yet we put that pressure on their bowel and bladder control.
The Key: Both the child’s body and the parent’s nervous system need to be ready for the learning to happen. If either side is in “fight-or-flight” mode, the muscles required to actually go potty simply won’t relax.
2. The "Sneaky" Enemy: Chronic Constipation
One of the most eye-opening parts of our conversation was the “sneaky” nature of constipation. Annie points out that a child can poop every single day and still be chronically constipated.
What to look for: We want “slippery snakes.” If you see “rabbit pellets” or giant, hard logs, your child’s rectum might be holding onto stool.
The Bladder Connection: Anatomically, the rectum and bladder sit right next to each other. When the bowel is full of stool, it puts physical pressure on the bladder, leading to those “sneaky peas” (accidents) that seem to come out of nowhere.
Annie’s Rule: We should not push through potty training if a child is constipated. Address the gut and stool consistency first so the experience isn’t painful or frustrating for them.
3. The Power of Interoception
Have you heard of the “8th sense”? It’s called Interoception, and it’s the ability to feel what is happening inside your body.
Potty training requires a high level of interoceptive awareness. Can the child feel the “urge” before it’s too late? Annie suggests looking for these subtle signs of readiness:
Are they hiding behind the couch to poop?
Are they pausing during play?
Are they starting to name the sensation (“I have a pee”)?
If they don’t have this awareness yet, they aren’t being “difficult”—they literally haven’t connected the dots between their brain and their bladder.
4. Practical Tools: "Poop Whistles" and Positioning
Sometimes, a child wants to go, but their pelvic floor muscles are too tight or they lack the coordination to “push.” Annie shared some brilliant, practical OT tips:
The “Poop Whistle”: Using party blowers or blowing bubbles while on the potty helps generate the correct internal pressure and encourages the diaphragm to drop, which helps the pelvic floor relax.
The Deep Frog Squat: Encourage play that involves squatting or jumping to help strengthen and coordinate the muscles around the pelvis.
Knees Over Hips: Always use a stool (like a Squatty Potty for kids) so their feet are supported and their knees are higher than their hips. This physically opens the “exit route” for poop.
5. The Behavioral Bank Account
As a psychologist, I often talk to parents about the “Bank Account” metaphor. Every command we give our kids (“Go sit down,” “Try to pee”) is a withdrawal. Every moment of connection or curiosity is a deposit.
If we are constantly barking orders at the bathroom door, we run that account into the red, and the result is a power struggle.
The Fix: Start Modeling. Instead of demanding they go, narrate your own body. “Oh, my bladder feels a little full. I’m going to go listen to my body and use the restroom.” This teaches them the “why” without the pressure.
Need More Support?
If your family is navigating these hurdles, remember that you don’t have to figure it out alone.
For OT & Pelvic Health: If you are in Colorado, reach out to Annie Close at OWN Pediatric Therapy. She is our go-to referral for all things pediatric pelvic floor.
For Behavioral & Psychological Support: My practice, Integrated Behavioral Health, specializes in helping families manage the anxiety, power struggles, and developmental “stuck points” that often come with growing up. Visit our website here to learn more about our group practice.
You don’t have to be perfect to be a great parent. We are all learning about how to raise kids these days.