One of my first questions I ask when I'm speaking with a child about what they do on the toilet to help their body evacuate stool, is what they do to get the poop out. I ask them to show me the position they use, how long they sit – but I always ask about what they do on the toilet to help their body get the poop out. And do you know what kiddos often tell me?
Nothing? So... you wait for magic to get it out?
Pooping is not a passive task. Yes, sometimes if your urge is strong (or your poop happens to be diarrhea), your poop may just fall out as soon as you sit on the toilet. However, a majority of the time, your stool should not simply fall out if you wait long enough.
I've had kids tell me they sit for as little as 5 seconds, and as long as ninety minutes (neither of which is appropriate, by the way!). But what most kids with a dysfunctional pelvic floor tell me, is that one way or another, they are disengaged during toileting. They sit, and fight to get off, or they sit and are glued to their tablet. Either way, that leaves them disengaged with their bodies, and leaves their body confused as to what it is supposed to be doing.
On the toilet, kids should be engaged with the task of toileting. However, they should also be tolerable to toileting enough, that they can sit there for at least ten minutes to give their bodies enough time to realize they are sitting on the toilet, and that now is an appropriate time to evacuate stool. Toileting requires a few things, two major components being: complete relaxation, combined with purposeful bulge attempts of the pelvic floor.
My recommendation? Alternating.
Sitting on the toilet for 10 minutes may be like pulling teeth with some kiddos. However, sprinkle some tablet time throughout that 10 minutes, and suddenly their tolerance improves (just like any time you change a habit, don't expect a complete change the first attempt!). Alternating a few minutes of active, engaged toileting mechanics, with relaxed, appropriate toilet posturing while using a distraction of some kind, is a great way to increase toilet time without the fight to keep them there. And the fighting is something you want to avoid. Not only does it make everyone feel terrible, upset and angry, but it also elevates Your child's muscle tone throughout their entire body – including their pelvic floor. And a high tone pelvic floor, means the gates are closed, and no stool is getting out.
Why so long on the toilet?
Not everyone needs 10 minutes to evacuate all of their stool. Some people may need more. However, in a dysfunctional body that is dealing with constipation, the GI tract is delayed, and ssssllllloooowwwwww to engage in the process. This means, if your child sits and is relaxed on the toilet, it may take 2, 4 or more minutes for their brain to realize that now is an appropriate time to turn the GI tract on, stimulate peristalsis, and to get stool out. So if your child is only tolerating 3 minutes, but their body needs 5 minutes to realize they're on the toilet, they will never evacuate stool on the toilet successfully.
"You AND your body need to learn to become better poopers!"
A child with constipation and a dysfunctional pelvic floor needs a few things. They need to learn HOW to push the poop out. The mechanics of evacuating stool are an essential piece to pelvic floor health and staying continent. However, their body also needs to learn what it is supposed to do on the toilet – which is to move the poop down to the anus, so that your child can then complete the mechanics to push the stool out. Without one, the whole system fails.
So no, you shouldn't wait for "the magic to happen." Your child needs to be engaged and needs to know that the goal is to get poop out. And not just a tiny plop of poop. ALL of the poop. If they understand that their body needs to participate too, it will likely give them the understanding of WHY they need to sit for longer and will then be more agreeable to sit longer.
How long as your child tolerated sitting on the toilet? Are they relaxed the whole time you sit them there? Is there something you could do with them while they are sitting to help them tolerate a longer toilet attempt? How does their position look? Make sure they are in a completely relaxed position so they can optimize the amount of stool they get out in one toileting attempt!