One of the most common questions that comes up in our lively Interoception Facebook Group is around toileting :). So, in this blog I wanted to focus on a big thing that is missing from most toileting programs, and that is something called interoception.
If you’re not familiar with interoception, it is a sense within all of our bodies that allows many of us to notice internal sensations or internal body signals such as a racing heart or a growling stomach or tight shaky muscles or hot skin, or a full bladder. And being able to notice these body signals serves as really important clues to what is going on in our bodies and what our bodies need to be regulated. And so that’s why one of the most common questions that we hear in our Interoception Facebook Group is about toileting. It’s great to see that professionals and caregivers are starting to become aware of the fact that interoception plays a vital role in successful toileting—both for successful urination or successful defecation….in simpler terms, successful peeing and successful pooping.
How Interoception Impacts Toileting
Let’s start with breaking down how interoception works for many of us that experience independent toileting and regulation. We notice certain feelings within our bodies. Since we have experienced these feelings over time, we have learned how to give them meaning. For example, we may have learned that a certain feeling in our body means that we need to pee and that is what serves as our motivation to get ourselves to a bathroom on time. Or if we are talking about poop, we might notice a certain feeling within our body, and over time we have learned that this feeling means that we need to poop. And that feeling is what serves as our motivation, our clue that we need to get to a toilet in order to eliminate it in a safe and effective way. So what interoception provides is the ability to notice the way our bodies are feeling. And noticing these important body signals is what serves as our motivation to regulate these toileting needs.
Unfortunately, the bulk of toileting programs out there do not incorporate interoception. Instead, many are very compliance based. They focus on surface behaviors (e.g., the number or frequency of accidents), failing to acknowledge underlying factors that could be contributing to the toileting issues. By giving sticker after sticker, a child will not magically develop interoception (and other underlying skills) needed for successful toileting. In other words, the underlying factors limiting toileting success do not magically improve as a result of a sticker or other reinforcer.
When a toileting approach is shifted to building the underlying skills such as interoception, we can help them to develop the ability to notice and understand the signals coming from their body. And those signals again, become an important foundation of independent toileting regulation.
Tuning Into Inner Signals Rather Than Relying External Rewards
In collaboration with my colleague, Kerri Hample, a fellow OT and Associate Professor of Occupational Therapy at Elizabethtown College, we’ve dedicated the last 5 years to completing the very first pediatric studies to investigate the outcomes of interoception-based interventions on areas such as toileting and emotional regulation.
From these studies, we have learned that for some learners, as they’re developing their interoceptive awareness, they might be dry during the day, but they still experience nighttime bedwetting—that is very common. But, as the child practices tuning into their internal signals, they gain more interoceptive awareness skills, so that many times those nighttime accidents eventually disappear. I don’t mean to oversimplify toileting, because we know that there’s so many underlying factors that go into successful toileting. However, our studies have highlighted the importance of incorporating interoception practices into the toilet training process.
If you’re interested in exploring this topic in more detail, be sure to join us for our On-Demand course. In this class we share practical, evidence-based strategies that are easy to implement and are applicable in supporting learners of a variety of ages, backgrounds, diagnoses & learning styles.
This course is a game-changer and empowered me with many practical strategies that I can begin using to support my client’s toileting needs immediately. Kerri and Kelly are extremely knowledgeable and relatable presenters. They tell a lot of client stories which helped me link the information presented to practical application. For so long, I knew that there were underlying factors that affected my clients’ toileting success, but I wasn’t sure how to assess and address these needs. This course made me feel more confident and I can’t wait to start using what I learned in this course! Thank you, Kerri and Kelly!