The episode starts at City Hall where the City Council are having a meeting about funding. Mayor McDaniels tells everyone she plans to cut the budget of the Christmas pageant and has called the director in to tell him the news. The mayor tells the director, who is revealed to be Mr. Hankey his budget is being halved, explaining that people find him offensive, upsetting him.
Hankey gets the South Park Elementary children to practice for the pageant and is annoyed when they all seem to play terribly. In the school corridor, PC Principal is walking to Strong Woman's office to ask if there is anything she wants to tell him. She angrily tells him she is fine and berates him for trying to say it was his fault, saying that they can just move on. PC asks her if they can move on, or is there was any fallout, and she tells him to leave. After he leaves, she walks up to the mirror, to reveal she is pregnant.
Stan, Cartman, and Kenny go to Kyle's house to confront Kyle. They show him a tweet Mr. Hankey made insulting the school band. Kyle goes off to berate Mr. Hankey, who is making costumes. Mr. Hankey blames his actions on Ambien, and tells Kyle he didn't mean it.
PC Principal and Strong Woman set up an assembly to discuss in vitro fertilization as a cover-up for the real cause of Strong Woman's pregnancy. While speaking, Strong Woman starts to get pains, before her waters break in front of the whole school. She acts strong, like it's no big deal. The two then go to the hospital for Strong Woman to give birth. Strong Woman drives and is angry at PC Principal for trying to help, worried people will get the wrong idea.
The city council confronts Mr. Hankey while he is setting up the stage, angry about his offensive tweet about them. Hankey tries to blame it on Ambien, but the council fires him from the pageant. He tries to find a lawyer to take his case, blaming his actions on Ambien, but they all reject him. After Gerald rejects him, he sits outside, ready to give up. Kyle comes up to comfort him, and Hankey realizes that, because Kyle has "lawyer blood" from his father, he can be his lawyer and Kyle accepts.
At Hells Pass Hospital, the doctor shows PC Principal Strong Woman's 5 babies. He tells them that the babies are all very PC. PC Principal asks if he can hold the babies, but the doctor forbids him, saying only the mother and father can hold the baby, and, according to Strong Woman, the father doesn't exist.
Kyle speaks to the boys at the Basketball Court to tell them about the hearing. He asks them to be witnesses, but the boys reject him, with Cartman warning him that protecting Mr. Hankey is a dangerous thing in 2018.
Back at the hospital, PC Principal goes to speak to Strong Woman. She snaps at him again for suggesting he took advantage of her, and PC Principal tells her he will pretend to be the male nanny. The babies are then brought in and are upset by the doctor's "Speedy Gonzales" shirt.
At the Mr. Hankey hearing, Mr. Hankey tries to convince everyone that these tweets shouldn't matter because Christmas is coming. The judge reads out a tweet Hankey made about the mayor, causing Mr. Hankey to flip out with anger.
Kyle and Hankey discuss the trial at Denny’s after. Craig's Gang stare at Kyle, angry for trying to help Mr. Hankey. Hankey blames the tweet on Ambien, and then comes up with an idea to bring back the holiday spirit. Kyle reluctantly agrees, only if Hankey doesn't take any more Ambien.
PC Principal and Strong Woman are struggling to hide their PC babies from the public, with townspeople fascinated by the babies. In the park, the town is distracted from the babies by a Christmas live show by Kyle and Mr. Hankey. The town are initially impressed and happy because of the show, until Mr. Hankey accidentally upsets the PC babies. He eventually snaps because of their crying. Kyle comes to try and calm him down, and the two start fighting, with the town walking away.
Kyle walks down the street alone, covered in shit. Everyone hates him for helping Mr. Hankey. Mr. Hankey then tries to apologize, blaming his actions on Ambien, but Kyle walks away. He tries to persuade him to stay by telling him they're going to throw him out of town, but Kyle, not wanting to be thrown out too, leaves him.
PC Principal and Strong Woman tuck the babies into bed in Strong Woman's office. They walk out and tell each other that the babies must remain hidden, and must never know PC Principal is their father.
On Main Street, the town watch Mr. Hankey leave, sad to see him go. Mr. Hankey says goodbye and is then driven away in a Lyft (or a "pooper"). Stan asks where he will go, so Randy explains that he's going to a place that doesn't care about bigotry and hate.
AV Club gave "The Problem with a Poo" a "C" rating saying: "“The Problem With A Poo” was a convoluted attempt to insert too many of-the-moment references into one half-hour without definitively saying anything about the possibility of redemption for once-beloved entertainers who engage in abusive behavior. Granted, this is a function of the serial storyline, which is going to come to a head at the end of the season, and by that point, we’ll hopefully have a more clear view of what this season is trying to say."
IGN gave "The Problem with a Poo" a "4.3" rating saying: "Too many South Park episodes are guilty of trying to cover too much ground and failing to establish a clear, consistent parody. "The Problem With a Poo" is just one of the more glaring examples of that trend. This episode tries to have its cake and eat it too by attacking badly behaving celebrities and outrage culture at the same time, and it fails to accomplish either. The funny moments this week can't outweigh the jumbled, frustrating narrative."