My 4 1/2 year old daughter knows how to use the potty, and she usually does pretty well unless she's in her room for afternoon quiet time (right next to the bathroom). At first, we thought it was an issue with her not realizing she could open the door to go to the bathroom. She'd poop in her pants or on the floor if she was in a dress no matter how many times we told her she had permission to open the door and go to the toilet (sometimes she would pee, too). Finally, after keeping her in afternoon quiet time and only letting her out for dinner, she started to understand that she could open the door and go into the bathroom(with much prompting and repetition), but no matter how many times we tell her she doesn't need to ask permission, she seems to feel like she has to get permission, and so she often has accidents. Sometimes, she will still poop in her room rather than come out and ask us if she can go. We're at our wits end. I have a chronic illness, so forgoing quiet time and keeping her in a different room just isn't an option (I desperately need rest by that point). My daughter has IBS due to multiple antibiotics, medications, and blood plasma required to keep her alive when she was born with septic shock. I'm wondering if this could be contributing to the problem (When she's not in her room, she sometimes has trouble getting to the toilet in time. It just seems to come out sometimes before she's aware, and her bowel movements do shift back and forth between constipation and looser, grainy stools, which could also be a factor). She's the size of a 3-year-old. She can't even reach back far enough to wipe her own behind yet, and when I ask her why she is pooping in her pants or in her room, her answers don't even relate to the question (this is not the only area in which we have problems with comprehension, but she's usually quite a smart little girl). This is a girl who, unlike other children (according to pediatricians) has no problem with poop being in her pants. We've only been keeping her in her room at night for about a week. My husband has also removed most of her toys (She doesn't have a lot) in case she was being distracted Are we going about this all wrong, or do we just need a little more patience? I'm sorry to make this so long, but I didn't want to leave out anything that could be affecting her. Thank you for your time.