Potty Training: How Long is Too Long for Children to ‘Hold It’?

Working in the world of pediatrics, I often hear comments about how long a child can hold their pee. For example, parents and caregivers will share things like, “Their bladder is so large; they can go hours without going to the bathroom” or “My child will avoid the bathroom at all costs.” While this may not seem like an issue if the child isn’t experiencing accidents, holding urine and stool can actually lead to a handful of negative outcomes. The following are disadvantages to holding behaviors and strategies to avoid or address holding pee and poop in children.

What Can Happen From Holding Pee and Poop

Holding habits can lead to accidents

When your bladder or bowel becomes full, there are inherent processes to send an urge and prompt your child to get ready for the bladder or bowel to empty. The bladder and bowel will actually start to contract or mobilize in order to empty, and if that urge is ignored, your child’s pelvic floor has to kick on in order to prevent the emptying from occurring in inopportune places. However, the pelvic floor is not meant to hold for long periods of time, and this prolonged holding eventually leads to a “breaking point” where the urine or stool will inevitably leak out during the daytime or nighttime. The leaking can occur as a full emptying or as a small leak over time, both of which can become emotionally troubling for a previously continent child. 

Holding poop can lead to constipation

Muscle makes up our bowels and intestines. Just like other muscles in the body, this muscle is able to stretch and change shape as needed. When we hold poop or stool, the bowel can expand to hold more stool, and when stool is in there for longer than needed, the body continues to take water from it, making it into a harder consistency and, thus, more difficult to pass. By holding in the poop, we can become significantly constipated and backed up. And then, once that bowel becomes distended, it is inherently able to store more, thus leading to a vicious cycle that is difficult to break. Those hard poops become painful poops, which leads to children holding more because they don’t want to experience that pain again.

Holding habits can lead to infections

At the end of the day, pee and poop are waste products, and they need to be expelled from our bodies in a timely fashion. When they are not expelled, the bacteria can lead to infections. Some urinary tract infections can be minor; however, some may lead to more serious kidney infections, which can damage the kidneys. Kidney damage can be difficult to reverse and may require more serious medical interventions.

Holding habits can lead to pain

As mentioned previously, the pelvic floor muscles can only hold for so long, and when we overuse a muscle, that muscle may spasm or become strained, leading to pain. I often see patients with pelvic floor muscle spasms as a result of prolonged holding habits, and these spasms can be so severe that it keeps children from school and sport participation.

How to Address and Avoid Holding Habits in Children

All of these disadvantages are examples of when the pelvic floor or voiding habits have reached a “dysfunctional” level. This dysfunction then presents differently in each child: with accidents, constipation, infections, pain, or a combination of all symptoms. Intermittent holding pee and poop habits won’t immediately lead to these symptoms, however, the cumulative effect of prolonged holding can present at any age. It’s important to try and discourage a toddler from holding pee and poop in order to avoid these symptoms after the potty-training years.

Potty breaks every 2-3 hours

You can help your child practice healthy voiding practice by prompting voids—AKA potty breaks—every two to three hours. Instead of asking your child, “Do you need to use the bathroom,” prompt your child with “It’s time to try to use the bathroom.” Even if they do not void, the pelvic floor has adequately relaxed to reset and prevent negative impacts.

Proper hydration

In order to void on a regular schedule, it’s important to stay hydrated. Children should drink their weight in ounces; for example, if your child weighs 50 pounds, they should drink 50 ounces of water per day.

Adequate fiber intake

Water plays a huge part in making sure your child doesn’t get constipated, and eating a diet high in fiber will also help keep the bowel moving along nicely. It only takes one painful poop for a child to begin holding, but by eating a diet high in fiber and water, you can set your child up for softer and more regular bowel movements.

Normalize the bathroom

I’ll admit, talking about pee and poop is funny—I do it all day long. But trying to normalize it with kids will help them feel more comfortable with going and with talking about it when something isn’t going quite right. Try to get your child comfortable with the bathroom as soon as possible, and this includes public bathrooms. Very often, kids avoid going to the bathroom at school, and when a child is avoiding the bathroom for seven to eight hours a day, that pelvic floor is working overtime.

Address any fears associated with the bathroom

If your child is avoiding the bathroom secondary to fears, try to address those barriers. It may be the smells, sounds, textures, or just the novel experience as a whole. Work with your child to break down those barriers so that they feel comfortable with the toilet and the bathroom.

When to Talk to Your Pediatrician

Hopefully, these tips can be helpful in making sure your child maintains healthy voiding habits—however, if your child is already presenting with some of these negative symptoms, your child may benefit from a visit to the doctor. The medical team can then work with your family to determine if physical or occupational therapy could be an adjunct to the plan of care. Physical therapy can help address any muscular contributors to the symptoms, and occupational therapy can help address any sensory contributors.