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What is Interoception?

Interoception is our eighth sense which responds to signals and sensations from inside our bodies. It describes how we feel and interpret the signals from our internal body organs, such as hunger, tummy sensation from digestion, heart rate, breathing, feeling that the bladder is full, and when we need to poo.

Our other senses are: sight, hearing, touch, taste, smell, balance and proprioception (understanding where our body is and how it moves).

This video explains more about interoception:

How does Interoception work?

We all have sensory receptors in all our internal organs and muscles. These respond to sensations experienced and create a stimulus that is transmitted along the nerve fibres to the brain. There it connects with other sensations, memory and knowledge and the brain make sense of these messages. In this way we learn how our body feels and it helps us to know when we are tired, excited, hungry, and need the toilet. This can connect to parts of the brain that make decisions and stimulate our body to respond.

Learning our body's signals

In the same way children learn to understand sounds and speech, young children gradually learn to notice and understand the messages they receive from their bodies.  Like with everything else, all children are different and some children find it easier to learn and understand these sensations and what they mean than others.  They often have a different awareness of their body signals. Some children don’t notice them so much at first, and only gradually become aware of these and start to understand what the messages mean and what their body is doing.

Understanding signals from our bowel and bladder

Some children have increased sensation and find their body signals uncomfortable and upsetting. There is evidence that some children learn to recognise their body signals of a full bladder and bowel after they learn to use the potty and toilet and have developed a toileting routine.  Current thinking suggests that it is not necessary to wait until children show signs that they recognise they are weeing or pooing, but that a regular toileting routine can help them learn to use a toilet or potty and the awareness of their body sensation can sometimes be understood and responded to afterwards.

We can’t know exactly what a child is feeling, but we can understand a great deal by watching their behaviour and responses. If children understand and notice how their body feels they can then begin to respond to their physical needs, including learning toileting skills. 

Interoception and toilet training

It is helpful to include an understanding of body sensations into toilet training. It can be helpful for children to understand where the wee and poo comes from and  how it tells them when it needs to come out. Instead of asking if the child wants to go to the toilet, asking if they can feel any wee or poo that wants to go in the toilet helps them make sense of the messages they are receiving. Pictures and videos on how the body works and the bowel and bladder may be fun and make sense of why we use the toilet. Understanding messages from their body helps children with toilet training and it is helpful to include this as part of their learning process to get clean and dry.

Emotional understanding and interoception

We also know that emotions such as anxiety, excitement may stimulate the functioning of internal organs, and this is linked to hormonal effects caused by adrenaline.

Our body sensations are very closely linked to our feelings and emotions. Anxiety causes a rapid heart rate, and increased shallow breathing, as well as sometimes affecting digestion.

Many of our body’s reactions help people to notice and understand emotions including feelings of tension and relaxation. These feelings can sometimes be confusing and worrying and can sometimes be linked to difficulties with control of the bowel and bladder.

There is increasing understanding about the complex interaction of body signals, emotions and learning in children. It is important to understand the impact of internal sensations on children’s toilet training and take these into consideration to tailor programmes to meet their specific needs. We are also learning more about this and this will be helpful for children and families in future.

Autism and interoception 

Autistic children who have sensory difficulties may have more difficulty in understanding and noticing their body signals and take more time to appreciate these and make sense of what they mean. This is becoming increasingly appreciated and these children may need more help and prompts to achieve a reliable awareness of toileting needs and become clean and dry. They do usually achieve this but it may be more difficult and they often need more support. If this is not appreciated it can be mistaken for laziness or lack of co-operation.

Tips to help children understand their sensations:

  • Identify and understand how a child is feeling and responding
  • Talk to children and help them understand how their body is feeling
  • Help them understand how their body works, videos, pictures and stories can help
  • Help them to understand the difference between the feelings of normal bowel activity, discomfort and pain
  • Explore the size of pain and discomfort, with showing with their hands the size; score out of 10 or a bit, a lot, loads, huge.

If children are having difficulty noticing and understanding their body sensations:

  • Link body feelings to routines and other activities, e.g. we sit on the toilet before football, or play time
  • Use other cues reminders and prompts e.g. picture cues, alarms, vibrating watches (we stock these in our online shop)
  • Reward effort as much as success

Older children and teenagers

Body awareness often can cause problem for older children. It is never too late to help children tune into their body sensations. It may be helpful to talk about this and help them practice noticing how their body is feeling.

Some children can enjoy the ‘be a scientist’ approach to keep a record of their wee and poo and their sensations, which may help their understanding. Help may be needed for some such as with timers or visual cues, and reminders linked to day time routines.

Body awareness signals may be more difficult to notice as social and educational demands increase as young people grow older.  Increased internal body signals can also occur with anxiety, especially about toilets and be linked to holding in the wee and poo, or sometimes going to the toilet more often. Understanding this can be helpful to work out solutions.

There is some interesting research that demonstrates children do not receive as many sensations from neurological receptor stimuli in the brain when they are absorbed in activities, such as when playing on computer games. This may be linked to the body awareness sensations being more subtle. Sensations from inside our bodies may not be as intense as other sensations and may be more difficult to notice.

Interoception and toilet training tips:

  • Include body awareness to help children understand the messages from their bowel and bladder
  • Help children link the messages from their bodies with bowel and bladder actions
  • Ask if their tummy has any messages from the wee and poo
  • Say is there any wee and poo there, instead of do you want to go to the toilet.
  • Identify if children are having difficulty learning interoception messages and take this into account. If needed a sensory assessment may be helpful.

More information:

Watch Kelly Mahler, Occupational Therapist and author of Interoception: The Eighth Sensory System explain why it plays such a vital role in successful toileting: