Bottoms and Toilets
Many children have difficulty with bottom wiping and the whole process of going to the toilet from start to finish. It can cause anxiety for the child and the parent and can go on for much longer than the parents expect. The child may find strategies for avoiding the whole situation and may not take responsibility for his own actions. This can prevent a child from becoming independent with toileting and can hold them back from the activities they want and need to be part of.
The child with co-ordination problems may have low muscle tone and this can affect their bowel tone, making it harder to recognise when they need to go, as well as having less control when pushing the stools out. Some children may have difficulty with remembering the various steps in the tasks and so need a lot of prompting and support to achieve independence with toileting.
More Information
Which ‘bit’ is the problem for your child and what can you do to help?
1. When does your child go?
Does your child have a regular bowel habit that means they go at the same time each day? Do they vary from day to day, or is it a mad rush when they gets home from school to reach the toilet? A regular routine can take a lot of the stress and rush out of this.
2. How often do they go?
Do they open their bowels once a week, or three times a day? Are their stools soft or hard? This will determine how they are treated and what you can do to help them. If they are constipated then their stools need softening, and if they have loose stools, then they need them to be bulkier.
3. How much do they drink and what do they eat?
If they are avoiding going to the toilet they may also be avoiding drinking. This can cause constipation. Are they eating fruit and vegetables or is their diet more the burger and chips variety? By increasing the fibre with fruit, salads and vegetables, this will make their stools bulkier. The child with low tone may not be getting the message telling them to go until it is too late, so this dietary adjustment may help.
4. Try to get a rhythm
After a meal there is a gastro-colic reflex that stimulates the bowel, so encourage them to go after breakfast for example. If they have gone then they won’t be worrying about it all day in school or have a tummy ache.
5. Can they perch?
Do they feel safe on the toilet or do they feel like they may fall into the hole or off the toilet seat?
Consider using a child toilet seat even with an older child. Are their feet dangling? If so, put a step or telephone directory under their feet for them to rest their feet on. This will support balance and help them feel more stable.
6. Getting undressed
The second stage in going to the toilet is getting undressed and doing buttons and zips. The child may have trousers that are difficult to undo because of zips and buttons which may be the cause of difficulties and accidents.
7. The wiping bit
If they need to open their bowels and wipe their bottom, this may be an additional problem. They may forget to wipe altogether or not wipe successfully. This may be due to sequencing problems i.e. they went because they needed to, but have now forgotten the next stage in the sequence.
They may have poor balance and may not be stable to let go of the seat or wall to wipe effectively.
Guide your child’s hand to wipe, so they get a “feel” for the correct movements. To improve your child’s ability to move their hand behind the body in a controlled manner, play games at other times to toileting such as passing beanbags in between the legs.
8. Have you got wet wipes or toilet paper?
Do they need to move to reach them or are they close at hand? If they can see them, they are more likely to remember to use them. Using flushable wet wipes may help the child to clean more thoroughly and with less effort.
Encourage checking the tissue before dropping it into the bowl to establish if they are clean or not.
9. Getting there – what happens in school?
Negotiating the school toilets may cause great concern. There are several stages in the process that may result in problems: the first being getting to and from the classroom. Direction is often a problem, and the child may get lost and therefore take more time than is expected. Try to let their teacher know that they have a problem that may mean that they have to go to the toilet at short notice and may need to go more often than other children. This will avoid questions/ challenges when they return to class after having taken longer than expected.
10. The stress
This can be one reason why some children avoid going to the toilet at all during the school day and end up having accidents. Some children become constipated, holding it in until they get home.
Instead of concentrating on their lessons they are spending time thinking about going to or avoiding the toilet. They may also complain of tummy ache. At a stage when they are trying to attain new skills alongside their peers, the added problems they have can cause huge anxiety for the child.
Tips to help
- Let their teacher know that this is a problem – discreetly. If they are using wet wipes, give them a small packet to take to school in their pocket
- Make sure they know where the toilets are before they start a new school or classroom.
- Make sure that they can pull clothes up and down easily
- Ensure that they are well balanced when sitting on the toilet and can use at least one hand freely, rather than holding on to a surface to maintain their balance
- Ignore mistakes
- Praise them for trying – they may not be having the sensations that tell them when they need to go and you may need to work out a timetable to remind them
- Use a watch with a buzzer to remind them when to go. If they have 1:1 support, they could remind them to use the toilet at various intervals throughout the day. At home they could be reminded at intervals too
- Change may be slow so be patient – the problems may have been there for some time and won’t improve suddenly. Try to achieve the various steps one at a time giving the child plenty of time to fully make one step before moving on to the next one.