Understanding Interoception and Toileting
What is Interoception and how does it related to toileting?
Interoception is a sense within our bodies that allows us to notice internal sensations or internal body signals. (our heart pounding when we are upset, our grumbling stomach when we’re hungry, shaky muscles when working out or a full bladder when we need to relieve ourselves). Being able to notice these body signals gives us important clues about what is going on in our bodies and whether we need to attend to it.
I get a lot of great questions specifically about toileting. Sometimes, it can be a child who is having difficulty with bedwetting at night or a kiddo who isn’t making it to the toilet in time (waiting til the very last second and then dashing to the toilet- not always making it in time), or even young adults who don’t notice the sense of having to use the toilet in time and having accidents. Yes, this happens to adults too!
The Connection Between Interception and Toileting
In general, interoception helps us to be independent with toileting and regulating toileting needs. Here’s an example; you notice that you body feels a certain way. You’ve have experienced that feeling before. Your body has learned to associate that feeling with the fact that you have a full bladder; so now it is time to relieve yourself.
If we need to urinate, our interoceptors give us a cue that it is time to get to the bathroom. Whereas when we need to have a bowel movement, we might feel a certain sensation in our bottom or belly; that makes us learn that we need to go to the restroom and have a bowel movement. The feeling gives us motivation and a clue as to the fact that we need stop what we’re doing; get up and move in order to make it to the toilet in time. Interoception provides access to our body cues to notice certain sensations and feelings and do something about it. This helps us to regulate our needs for toileting.
The behavioral approach to toileting.
I fell into the behavioral trap of toileting training. When my kids were learning to toilet, I gave my kids stickers when they successfully used the toilet. It worked for one or two times and then my child sort of lost interest. That’s because, instead of focusing on what was going on in her body, she was focusing on getting stickers. Giving a sticker does not magically develop interoception and underlying skills needed for successful toileting. Giving a sticker or other reward, does not help kids develop the sense of what is going on in their body in order to be successful on the toilet.
How can I help my kid be successful with toileting using the concept of interoception?
Shift the toileting approach to begin building underlying skills needed for success. The person develops interoception skills and then the person begins to develop and notice and understand the signals coming from their body. This becomes an important foundation for independent toileting regulation. (This is assuming there are not any underlying medical or nutritional concerns).
Tell me about the evidence for interoception and toileting!
Dr. Kelly Mehler and Dr. Kerri Hample, collaborated to investigate the outcomes of interoception based toileting interventions in the areas of toileting and emotional regulation. These studies indicated that for some learners, as they’re developing their interoceptive awareness, they might be dry during the day, but they still experience nighttime bedwetting. This is very common. As a child practices tuning into their internal signals, they gain more interoceptive awareness, and eventually those night time accidents disappear. This doesn’t necessarily mean that there’s other underlying factors that could be impacting successful toileting. However, the study did highlight the importance of incorporating interoceptive practices into the toilet training process.
The interoceptive curriculum, by Dr. Kelly Mehler, is an important part of clearly learning how to identify body signals which impact not only toileting but also hunger, sleep, emotional regulation, handwriting, and many other internal signals our body gives us about what is going on with our body. This in turn, affects outcomes in our environment.
If you’d like to learn more about how occupational therapy can help you or your child “tune into” interception for all sorts of internal body cues reach out!!
