Interoception and Toilet Training – How Kids Know they Need to Use the Toilet
Toilet training is tricky, kids need to string together a whole bunch of new skills: recognizing that they need to pee or poop, communicating this to an adult, making their way to the bathroom, pulling down their pants, climbing the stool to the toilet and then voiding. Sometimes that first step, recognizing that they need to pee or poop can be the trickiest, because it involves listening to their body signals, something that is hard for adults to fully model. Listening to body signals involves listening to our body’s interoceptive signals.
Most kindergarteners can rattle off our 5 external senses: smell, hearing, touch, taste and vision. However, we also have 3 internal senses, which help us understand our body and its relation to the outside world: vestibular (information gained from the crystals in our ear canals that help orient us in space), proprioception (information gained from sensors in your muscles that sense movement, action and location) and interoception (information gained from sensors all over the body which help us recognize everything from emotions to pain to urge to void and have a bowel movement).
As with everything related to humans, how each individual experiences and is able to interpret events and sensory information is on a spectrum. For instance, my husband can never smell our neighbour’s delicious curry, but it’s the first thing I can smell when I open the front door to our apartment. Similarly, interoceptive information can be too quiet or too loud. This can lead to issues like feeling that we need to pee every 10 minutes to only feeling like we need to pee when our bladders are full and we can barely make it to the washroom in time.
Too loud or too quiet bladder and bowel symptoms can happen for a variety of reasons. It can be how a person was born, it can be related to sensory processing disorders or due to acquired bowel and bladder issues. Due to infection or a stressful event, our bladder signals can be kicked into overdrive, sending the signal to void more frequently than usual. At the bowel end of things, persistent constipation can stretch out the intestinal tissues, changing the way that they send signals that we need to have a bowel movement.
The good news is that in every one of these cases, interoception can be tested and there are ways that we can help regulate our interoceptive signals so that they aren’t too quiet or too loud. The approach usually begins slowly with the caregiver narrating their interoceptive sensations to external stimuli. This can include statements like “my hand feels wet when you splash me” and “my arms feel tired after carrying big bags of groceries”. Slowly, over time the caregiver starts narrating what the child is likely feeling and then asking closed and then open questions to the child about their body signals.
Interoceptive training is often a piece of the treatment puzzle with children’s bowel and bladder disorders, along with constipation management, bowel and bladder routines, relaxation techniques and core strengthening. If your child is having bowel or bladder issues, a pediatric pelvic health physiotherapist can help put the puzzle pieces together, including interoceptive training.
Resources:
Toileting, Interoception & Nutrition: An Evidence-Based Approach for Promoting Toileting Success and Independence, K. Hample and K. Mahler. 2021