Constipation vs withholding: how to tell the difference

Many kids struggle with pooping. In fact, poop training is the most common issue clients come to me for. 

The first thing that we need to ascertain is whether this lack of poop is due to constipation or withholding. Both have a similar result– a lack of poop, but their treatments will be very different. 

For constipation, the poop itself needs to be addressed. However, for withholding, the underlying reason and behavior needs to be addressed in order to progress towards healthy bathroom habits. 

Here is a short description of each condition, some contributing factors, what it looks like in your toddler, and finally how to tell the difference. 

Constipation: 

I’m sure you are all familiar with this one. Your child could be constipated if they are passing hard or lumpy stools that are hard to pass, or having less than three bowel movements a week. 

Contributing factors to constipation:

There are many factors that could be contributing to constipation in your toddler. These include but are not limited to: 

Dehydration, food sensitivities, picky eating, or perhaps uncoordinated pelvic floor muscles. 

What it can look like in your toddler: 

Your toddler is willing and wanting to poop, but nothing comes out. 

Extra-large adult-sized poops. 

Poop accidents

Bedwetting and excessive daytime pee accidents 

Skidmarks in their underwear

Withholding:

Withholding is when a child makes the conscious decision to hold in their poop. They may try to physically keep it in by squeezing their butt cheeks together and may have meltdowns when the poop does eventually come out. 

Contributing factors for withholding: 

A history of constipation and wants to avoid pooping a poop that will hurt. 

Fear due to a prior traumatic bathroom experience 

Sensory sensitivities– avoidant to the smell, look or feeling of passing a poop. 

What it can look like in your toddler: 

Distended abdomen, increased passing of gas, crossing of legs or holding but to keep the poop in, squeezing butt cheeks together, walking on tiptoes, belly pain. 

How to tell the difference between Constipation and Withholding in your toddler:

Though you may have a constipated toddler who is not a withholder, most withholders are also constipated. 

The biggest telltale sign is that a solely constipated child will want to poop, but a withholding toddler will not. 

Knowing why your toddler isn’t pooping, whether it’s due to constipation or withholding is important so you know how to address the circumstance in the most appropriate way. 

Troubleshooting both conditions can be tricky. 

I work with my clients to solve both constipation and withholding behaviors in their toddlers by addressing the root of the problem through poop protocols, routines and proven methods.