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Interoception and Toileting: Improving Body Awareness for Successful Bathroom Routines

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How Can Interoception Improve Toileting?

A toilet roll with a smiley face drawn on it, held in place by a toilet seat and lid.

Let’s start by breaking down how interoception works for many of us who experience independent toileting and regulation. We notice specific sensations within our bodies. Over time, as we repeatedly experience these sensations, we learn to assign meaning to them.

For example, we might learn that a certain feeling means we need to pee, and that becomes our motivation to get to the bathroom in time. Similarly, when it comes to pooping, we may notice a particular sensation and come to understand that it means we need to poop. This feeling then serves as a signal, motivating us to find a toilet so we can eliminate it safely and effectively.

Essentially, interoception allows us to recognize what our bodies are feeling, and noticing these internal signals is key to regulating our toileting needs.

Unfortunately, most toileting programs don’t incorporate interoception. Instead, they tend to be very compliance-based, focusing on surface behaviors—like counting the number or frequency of accidents—without acknowledging the underlying factors contributing to toileting challenges. Simply giving a child sticker after sticker won’t magically develop the interoception and other foundational skills they need for successful toileting.

In other words, the deeper issues hindering toileting success don’t improve just because of a reward. By shifting the focus of a toileting approach to building these underlying skills, including interoception, we can help individuals learn to notice and interpret the signals from their bodies, forming a crucial foundation for independent toileting regulation.

Why Doesn’t External Reinforcement Work?

Rewards, sticker charts, and alarms often don’t work for successful toileting because they fail to acknowledge the “deep whys” of many toileting challenges. For example, does the external reinforcement consider:

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The child may be fearful of the toilet flushing or not like the feeling of toilet paper on their hands.

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Sitting on the toilet might feel unsafe.

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The person could struggle to relax the pelvic floor muscles in order to pee or poop.

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The child might need nurturing and/or comfort strategies to feel safe in the bathroom.

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The person could have an underlying medical need.

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They may have a food sensitivity or limited nutrient intake.

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The person might not yet notice and understand internal pee and poop signals.

So, how can interoception better help with toileting? For effective toileting regulation, people need to develop a keen sense of their internal signals. This way, they can:

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Interoception is the inner sense of self that connects all of these steps. This sense tells us when we have a fever, when we’re feeling happy, and yes, when we need to pee or poop. This sense can be difficult for some of us to really connect with, which can make toileting difficult or lead to accidents.

The core of self-regulation and toileting is recognizing these inner feelings that are connected with the need to use the restroom – often fullness or pressure. Still, these sensations will vary from person to person. This is why connecting to our senses and developing a feeling of what our body is telling us is so important – what I feel that tells me it’s time to head to the bathroom might be different from what you think.

Interoception Activities for Toileting

In collaboration with my colleague, Kerri Hample—a fellow occupational therapist and Associate Professor of Occupational Therapy at Elizabethtown College—we’ve spent the past five years conducting the first pediatric studies to investigate the outcomes of interoception-based interventions on areas like toileting and emotional regulation.

From these studies, we’ve learned that, for some learners, as they develop their interoceptive awareness, they may be dry during the day but still experience nighttime bedwetting—which is very common. However, as the child continues to practice tuning into their internal signals, they often gain enough interoceptive awareness for those nighttime accidents to disappear eventually.

I don’t mean to oversimplify toileting, as we know many underlying factors contribute to success. Still, our studies have highlighted the importance of incorporating interoception practices into the toilet training process.

If you’re interested in exploring interoception and toileting further, we invite you to join us for our On-Demand course. In this class, we share practical, evidence-based strategies that are easy to implement and suitable for learners of all ages, backgrounds, diagnoses, and learning styles.

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