Pooping Problems - Is this why your kiddo hides to poop?

Functional Defecation Disorders are highly prevalent worldwide and are increasing every day... 

What are “Functional Defecation Disorders (FDD)” anyway? 

They are pooping problems such as constipation, pooping in places and times that are inappropriate, refusing to the toilet, and fear of pooping. 

Many children who will willingly pee in the toilet independently yet refuse to poop in the toilet and request for a diaper to hide to poop in are at high risk of developing functional defection problems but will avoid FDD as long as the adult continues to provide the diaper to poop in. 

These pooping problems are more common in children with diagnoses such as Autism and ADHD. 

Here are the two main factors that are needed to avoid pooping problems:

1. Adequate sensory perception - the ability to recognize the urge to pee or poop (interoception). This also includes the tolerance of the sensation of passing poop. 
2. Reactivity - how to react to those sensations and what to do. 

That begs the question, is there a link between sensory hyperactivity and pooping problems? 

What if many children with pooping problems are experiencing sensory hyper-reactivity?

It’s a great question because let us say you have a child on your caseload who can:

• pee in the toilet no problem so you know the child is not fearful of the toilet itself such as fear of the flushing sound
• comply with peeing in the toilet so you know it's not an oppositional behavior problem
• request for a diaper one way or another to poop in and can even communicate when they are soiled and want to be changed so you know communication and interoception is there

Yet, refuses and is completely resistant to pooping in the toilet and demands a diaper to poop in. 

Your first thought may be “perhaps the child is refusing due to fear of pain associated with constipation?”

But what if their diet is healthy and they have healthy stools according to the Bristol stool chart? 

OTR/L, and researcher Isabelle Beaudry-Bellefeuille and her research team had the same questions so they decided to get to the bottom of this. 

Isabelle and her research team developed and validated a tool that measures sensory hyper-reactivity in relation to defecation-related sensations: the Toileting Habit Profile Questionnaire-Revised (THPQ-R). 

The Toileting Habit Profile Questionnaire-Revised (THPQ-R)

This assessment tool is revolutionary because it addresses a huge gap when address toileting goals within the OT field. 

I remember when I worked in pediatrics as a certified occupational therapy assistant in home health and outpatient clinics, basically ALL my clients on my caseload were still in diapers over the age of 2 and desperately needed help with toileting independence however toileting goals seemed to never be a part of the intervention plan. 

I always wondered why especially because this vital "toileting" ADL is under our scope of practice and our families needed so much help with it. 

Then shortly after, I realized, at the time there were no validated measures or screening tools to implement for reimbursement purposes. So it had made sense. 

But now, we have the THPQ-R so I’m thrilled! Thank you Isabelle!

Anyway, you may be wondering what the THPQ-R is exactly…

It is a parent-report questionnaire designed to distinguish typical pooping behaviors and reactions from those that are potential manifestations of sensory reactivity issues associated with FDD (functional defecation disorders) and STR (stool toileting refusal). 

Question items on this questionnaire are questions such as:

“My child hides to poop” or, “My child asks for a diaper when he feels the need to poop” and so on. 

After many research studies, researchers concluded that the THPQ-R has been shown to adequately discriminate between children with and without pooping problems.

Pooping problems continue to rise and the solutions for functional defecation problems are becoming increasingly important

It’s important that pediatric therapists be sensitive to the possibility of sensory hyper-reactivity when working with children with functional defecation problems. 

If you would like to access this screening tool and have any more questions on this research article, simply go to this research article and email Isabelle and she’ll respond. See reference below. 

 The 3 Best Toilet Training Books 📚 (p.s. Tasha is my pen name)

1. The Holy Grail of Potty Training - Nonfiction book for parents by Tasha Powers
2. Now I Know, How to Go Potty - Children's book by Tasha Powers
3. How To Wipe Your Butt For Kids - Children's book by Tasha Powers

Are you a therapy professional? Check out Toilet Training Success Academy that awards CEUs! 🥳

• Toilet Training Success Academy  by Arianna Medina, AOTA Approved Provider

References

Beaudry-Bellefeuille, I., Lane, S., Lane, A., & Ramos-Polo, E.; (2020). Examining Hyper-Reactivity to Defecation-Related Sensations in Children With Functional Defecation Disorders (FDD). American Journal of Occupational Therapy, 74(4_Supplement_1):7411505146. https://doi.org/10.5014/ajot.2020.74S1-RP201A