Toileting Troubles & Sensory Processing Disorder

When we see kids in our office for constipation or toileting challenges, we often discover there is more going on than just their diet, hydration, or pelvic floor. They may not get the concept of pooping in the potty, or it may be something else happening that is related to their sensory.  Our sensory system plays a major role in how we experience going to the bathroom and can directly impact toileting behavior. There are a plethora of sensory issues that could be disrupting child’s acceptance of using the potty. A child with sensory processing disorder likely experiences stress and anxiety through out the body. This cause the tightening of the pelvic floor muscles. Additionally it can slow down digestion which may cause stool to sit in the rectum longer, becoming more dehydrated. Check out our latest video where we talk more about these issues.

Sensory issues can be anything from interoception, (how your body feels internally in response to internal or external stimuli) to the child doesn’t like how the toilet paper or toilet seat feels on their bottom.  In conjunction with our typical strategies for constipation and withholding behavior we have a lot of ideas to help your kiddo if they are struggling with a sensory issue that is contributing to their overall toileting challenges.  Check out some of these common sensory challenges kids have that make potty time stressful for parents and kids.

Common Sensory Issues that affect Toileting Behavior with Solutions:

Discomfort: Child dislikes feel of scratchy, dry, rough, toilet paper on their bottom or they fear touching the poop by accident while wiping.

Solutions: flushable wet wipes, wipe warmer, or a bidet!  Yes, bidets are back in style and one can easily be installed on your existing toilet for very little money or effort!  In case you’re unfamiliar, a bidet uses a stream of water to get you clean!

 Interoception: Interoception is the 6th sense that has recently become more well known. It’s the body’s ability to make the connection between what we feel and what action we should take when we have that feeling. We know the signals the body sends us when we’re hungry (empty stomach, growling, low energy, headache) and that’s how we know we should eat. It’s the same for toileting. We may feel pressure in the pelvic area, have gas and cramping, feel antsy and we know to go use the bathroom. Some kids don’t know how to connect these sensations with the action needed.

Solution:  Seek out an Occupational Therapist and/or Physical Therapist that has been trained specifically to help resolve this issue. For more help with Interoception, check out Kelly Mahler’s work.

The Strip Down: Some kids want to take off every piece of clothing each time they use the bathroom!

Solution:  You will just have to wait it out for this one, it won’t last forever!  Just allow it because it may be helping them in some way.  They will grow out of this eventually.  Don’t worry, they won’t still be stripping down when they get to elementary school!

Child will only poop in a pull up: Some kids will only poop if they’re wearing a diaper or pull up. Some will even ask for one to poop in while they are willing to pee on the toilet. Think about it, they have been wearing a diaper since birth and know no other way!  They’re used to feeling the of dampness of pee or poop against their skin, so it doesn’t bother them. 

Solution: Some kids need the feeling of something around their waist to give feedback and just the slightest bit of pressure. In this situation we recommend making a small hole in the pull up, and cutting it bigger and bigger over a period of time. Eventually the only thing left will be the band around the child’s waist. A belt can be a good option here too.

Environment: If you have a child with Sensory Processing Disorder, you know how big of an impact the environment around the child can make. Same goes for the bathroom. Some kids dislike the smell in the bathroom and have a gag reflex that kicks in. Even clean bathrooms smell weird sometimes!

Solutions: Use some candles or pleasant-smelling spray. If the room is too bright or too dark use lower watt light bulbs or add some twinkle lights. If they don’t like how the bathroom looks let them decorate it! Have them help you pick out some décor that they like to make it feel comfy or fun!  Let them bring a favorite stuffed animal or toy in with them.  If they have a toy potty the doll or stuffed animal can go to the potty at the same time!

Pain: Many kids report it hurts when they are sitting on the potty and it’s the toilet seat that’s bothering them.  Toilet seats are sized for adult bottoms, so it makes sense their little tushies aren’t comfortable!

Solution: Get a smaller toilet seat insert made for potty training or a padded cushy seat to make them more comfortable. 

Fear: Adults and children alike can be startled by the loud flush of a public toilet that can sometimes sound like a freight train is coming through the wall! 

Solution: Use a sticky note to cover the sensor so it won’t flush, or another idea is to use some headphones with music. 

 It’s Disgusting! Sometimes kids just can’t stand the sight of their own poop! 

Solution:  Just cover up the poop with toilet paper before standing up. 

Oral Sensory Issues

Sensory processing disorders don’t just impact toileting behaviors, they also impact what and how much a child may eat. Kids who are picky eaters may have an oral sensory issue going on that is contributing to their discerning tastes. This may be seen in children who object to certain temperatures and/or textures of foods. Another sign may be if a child is pocketing food while eating. 

Solution:  Feeding specialists such as a Registered Dietitian or Occupational Therapist that are trained in this area have many strategies to help work through these issues.  

We always recommend that kids work through these sensory issues before tackling the constipation and withholding behavior.  Once a strategy is in place for the sensory issues then other toileting challenges such as constipation and withholding can be addressed more easily.  Another common question is how to continue with potty training if a child is dealing with constipation, withholding behavior, or sensory issues.  It is always wise to wait until the constipation is treated, the withholding behavior is resolved, and the sensory issues are addressed BEFORE beginning potty training.  It will go so much more smoothly and be a much less stressful experience for all! 

What interesting or frustrating behavior does your child display when using the toilet??  Share with us your struggles in our private Constipation Gurus Facebook group!  Join by clicking here!  If you’d like your child to be evaluated by Annette, our Pediatric Physical Therapist or Jess, our Registered Dietitian connect with us here!