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Let’s Talk About Poop!! Sensory-based toileting issues you may see and some ideas to try.

There are many reasons why children have challenges with toileting.

It is important in the first instance to ensure that everything is ‘working optimally’ from a physical and nutritional perspective as there can be many factors that impact toileting and a GP or dietician can look into these areas in more detail.

As an Occupational Therapist physical access to the toilet, toilet hygiene and managing successful toileting are areas that are often raised by families seeking advice. 

What’s getting ‘in the way’

If your child suffers from constipation, it is essential that this problem is solved first. This can be the result of issues such as poor or restricted diet, poor fluid intake (not drinking enough) or a sedentary lifestyle (not moving much in the day). This can look like soft stools or even diarrhoea if there is a blockage with poo seeping around it. If your child does not go to the toilet daily or every couple of days they may be constipated. Successful toileting will be very difficult to achieve unless these issues are solved as constipation can change the stretch and change the shape of the bowel which then impacts the signs and signals that tell us we need to go. The consistency should be like a ripe banana and not painful. If you are concerned visit your GP as your child may need a change in diet or medication to get things working.

What has gone on before

A child’s early experiences of toileting, constipation, medical interventions etc can significantly impact levels of anxiety and successful toileting. Making the experience positive when your child is open, interested and developmentally ready is important. 

Signs on the inside 

Some children struggle with registering or interpreting the ‘signs’ related to knowing when they need to go to the toilet, having enough warning of when they need to go then getting to the toilet in time etc. This is related to a sense called ‘Interoception’. This sense tells us when we are hungry, thirsty, hot, cold, when we want to use the loo etc i.e. all the internal messages registering them and then knowing what to do about them. It is helpful to talk to your child about listening to their body and modelling this to them ‘my body is telling me …..’. Do little activities that help them to ‘tune in’ e.g. comparing the feel of hands in warm water then cold water, how does your tummy feel before a meal then afterwards, Does it feel hot or cold outside ?, does you feel awake or sleepy ? How do your insides feel just before you do a poo compared with afterwards? This will help them to tune into their Interoceptive sense.

The ‘feel’ 

Some children struggle with the ‘feel’ of going to the toilet, managing the resulting toilet hygiene (wiping etc) and the possibility of getting messy. This can be the case especially if they struggle with tolerating different textures in other areas of daily living skills e.g. the feel of clothes on their body, mixed textures of food in their mouths, messy play on their hands etc. These issues with the ‘feel’ can lead to challenges with being comfortable with passing a bowel movement and can result in withholding and constipation. For other children, their ability to feel is dampened down and they may not feel things in a more typical way for example being unaware when they are wet/dirty etc. 

Providing opportunities for messy play for their hands/bodies (at their pace and NEVER forcing), helping them to tune into how it feels and making it fun can be helpful. If direct touching is too much strategies such as using tools as a ‘bridge’ to touching such as a spoon to stir, car to drive through, a paint brush to draw in etc can be helpful.

Don’t know how

Some children have challenges related to thinking things through and knowing how to physically tackle things, especially new things. This can be called ‘praxis’ and involves putting the right steps together to be successful in a task. This can impact any element of daily living skills including toileting from the actual pushing and expulsion elements to the managing the clothing and wiping elements. They may need you to help them by breaking down the steps for them with pictures or show them how. 

Sitting on 

If your child is nervous about sitting on the toilet use a potty, ring reducer with a step under their feet (their feet must be always supported while they are sitting on the toilet) so that ideally their knees are a little higher than their bottom. Introduce these elements alongside the usual way they poo e.g. having the potty around and perhaps emptying the poo into the potty/toilet from the nappy or pull-up  ‘This is where the poo goes’. If climbing onto the toilet is challenging practice skills involving taking their feet off of the floor in other settings such as climbing at the park, taking their feet off of the ground by jumping on a trampoline, sitting up on higher surfaces e.g. dining chair with distractions of fun activities. Play rough and tumble so that they feel comfortable with being lifted up and moving forward / backwards in ways that are fun but unpredictable.

The environment

It is important to make the bathroom as welcoming as possible. Having distractions such as pictures to look at, books, toys etc to use while they are sitting on the toilet can be helpful.

Some extra helpful tips :-

  • Encourage both boys and girls to sit so that they can just perform and not have to work out if they need a poo or a wee.

  • Using a schedule can be useful if this is something that you do together and create a routine (collaboratively) e.g. sitting on the toilet every 2 hours whether needed or not and praise for sitting on not performing.

  • Avoid use of music or technology as a reinforcer it is important to build their intrinsic motivation.

  • Accidents can typically happen for up to a year after potty training starts.

  • Your child may struggle with the transitions involved with toileting i.e. going from the lounge to the bathroom use of visuals can support this e.g. a consistent picture or object to show them to prepare them for what is happening. Or reduce the number of transitions by taking the potty to them.

  • Refusal and withholding can occur if we focus on toileting too much – take the pressure off, pick the right time and always be positive.

Compiled by TCT's Highly Specialist Occupational Therapist, Jo Scott. You can find more details about the services Jo and the OT team offer using the link below.

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