{"id":3400,"date":"2022-09-01T11:49:23","date_gmt":"2022-09-01T10:49:23","guid":{"rendered":"https:\/\/eric.org.uk\/?page_id=3400"},"modified":"2023-07-18T19:16:15","modified_gmt":"2023-07-18T18:16:15","slug":"toilet-anxiety","status":"publish","type":"page","link":"https:\/\/eric.org.uk\/information\/toilet-anxiety\/","title":{"rendered":"Toilet anxiety and toilet phobia in children"},"content":{"rendered":"<nav aria-label=\"breadcrumbs\"><p><a href=\"https:\/\/eric.org.uk\">Home<\/a> &gt; <a href=\"https:\/\/eric.org.uk\/information\/\">Information and advice<\/a><\/p><\/nav><h1>\n\t\tH1 heading\n\t<\/h1>\n\t<p>Many people, of all ages, find toilets unpleasant and sometimes worrying. It is particularly common in children and can impact on their bowel and bladder control and function.<\/p>\n<p>It is important to recognise toilet anxiety or toilet phobia in children and the effect it can have on them, so that they can be supported to overcome their fear. This can avoid further problems developing and focuses on the underlying cause.<\/p>\n<hr>\n<h2>What is anxiety?<\/h2>\n<p>Anxiety is the emotional response to an unfamiliar or alarming situation, and is linked with physical changes in the body. It is a normal response which can help us learn and adapt &#x2013; you may have heard it described as &#x2018;flight or fight&#x2019;.<\/p>\n<p>It can sometimes be fun and exciting, such as in stories like &#x2018;Going on a Bear Hunt&#x2019; or whilst watching films, like Star Wars. New situations can often make children anxious, but this feeling usually reduces quickly and they start to feel better.<\/p>\n<hr>\n<h2>What is toilet anxiety?<\/h2>\n<p>Toilet anxiety, toilet phobia or paruresis may be triggered by an unpleasant experience, such as a noisy or smelly toilet. Children might remember this each time they go &#x2013; leading to an association of anxiety with going to the toilet. They may also start to hold in wee or poo to avoid using the toilet.<\/p>\n<p>This can lead to <a class=\"glossaryLink\" aria-describedby=\"tt\" data-cmtooltip=\"&lt;div class=glossaryItemTitle&gt;Constipation&lt;\/div&gt;&lt;div class=glossaryItemBody&gt;Children with constipation may open their bowels less than once every three days; pass occasional very large motions, or have more frequent small motions; stools may be different textures and may be offensive smelling; they may withhold or strain to prevent themselves from passing large painful stools and may have problems with abdominal pain and distension, or soiling. Children with constipation often have reduced appetite, are unhappy, irritable or moody and may have reduced energy levels. All of the latter symptoms may improve for a time after a large bowel motion.&lt;\/div&gt;\" href=\"https:\/\/eric.org.uk\/glossary\/constipation\/\" data-mobile-support=\"0\" data-gt-translate-attributes='[{\"attribute\":\"data-cmtooltip\", \"format\":\"html\"}]' tabindex=\"0\" role=\"link\">constipation<\/a> as the poo is not let go and this can result in a large uncomfortable poo, causing even more increased anxiety. Memories of an unpleasant or painful poo, following constipation can last for a long time, even if the poo has returned to normal so the anxiety may continue.<\/p>\n<p>Anxiety following an unpleasant experience can be hard to forget and overcome. It can also continue to affect children&#x2019;s confidence and behaviour.<\/p>\n<p>Fear of toilets is often about the unknown, and may be linked to imagined monsters and scary things, snakes in the toilet, and dangerous germs (Toilet cleaners &#x2018;kill all known germs&#x2019; after all!).<\/p>\n<hr>\n<h2>Physical effects of anxiety<\/h2>\n<p>These may include:<\/p>\n<ul>\n<li>Nausea and stomach ache<\/li>\n<li>Rapid shallow pulse<\/li>\n<li>Rapid shallow breathing (even triggering an asthma attack if children have this).<\/li>\n<li>Headaches<\/li>\n<li>Wee and poo accidents<\/li>\n<li>Faints<\/li>\n<\/ul>\n<hr>\n<h2>Emotional effects of anxiety<\/h2>\n<p>These might include:<\/p>\n<ul>\n<li>Panic attacks<\/li>\n<li>Tantrums and meltdowns<\/li>\n<li>Withdrawal<\/li>\n<li>Freezing<\/li>\n<li>Sleep problems and nightmares<\/li>\n<li>Irritability<\/li>\n<li>Clinging<\/li>\n<li>Distress and exhaustion<\/li>\n<li>Denial and resistance to engage with the problem<\/li>\n<\/ul>\n<hr>\n<h2>Possible causes of toilet anxiety<\/h2>\n<ul>\n<li>New, unfamiliar toilets<\/li>\n<li>Constipation and\/or a painful poo<\/li>\n<li>Soreness and skin inflammation round the anus or round the urine outlet<\/li>\n<li>Different clothes e.g. pants which may be different and feel strange<\/li>\n<li>The sensation of wee and poo coming out and losing part of yourself<\/li>\n<li>Splash back from the toilet<\/li>\n<li>Will it stop?<\/li>\n<li>Feeling that they could fall into the loo<\/li>\n<\/ul>\n<h3>Background factors<\/h3>\n<ul>\n<li>Individual personality<\/li>\n<li>Family changes and stress e.g. new baby, moving house<\/li>\n<li>Potty training (this is the first time a child needs to actually engage with their wee or poo)<\/li>\n<li>Starting school and\/or nursery<br>\nBeing denied access to the toilet at school<\/li>\n<li>Being called names or bullied<\/li>\n<li>Inability to cope with new situations<\/li>\n<li>Trauma<\/li>\n<li>Health issues<\/li>\n<li>Developmental conditions e.g. autism (ASD)<\/li>\n<li>Children with concentration difficulties (ADHD,ADD)<\/li>\n<\/ul>\n<h3>Sensory factors<\/h3>\n<p>Many children may be upset by too much sensory stimulation including:<\/p>\n<ul>\n<li>Visual &#x2013; bright lights, reflections, glare<\/li>\n<li>Hearing &#x2013; echoes, sounds of toilet filling and\/or flushing, hand driers<\/li>\n<li>Touch &#x2013; the feeling of the toilet seat, toilet paper, clothes being down round the legs<\/li>\n<li>Smell &#x2013; highly perfumed bathroom products and cleaners, the smell of poo<\/li>\n<li>Balance &#x2013; feeling of unsteadiness especially on a strange or different toilet<\/li>\n<li>Proprioception &#x2013; understanding where your body is in space and in relation to the toilet<\/li>\n<li>Interoception &#x2013; understanding and feeling the sensations from inside the body, including sensations from bowel and bladder activity<\/li>\n<\/ul>\n<h3><strong>Responding to sensory factors<\/strong><\/h3>\n<ul>\n<li>Analyse the toilet environment<\/li>\n<li>Reduce the amount and impact of unpleasant sensations<\/li>\n<li>Make the bathroom familiar and friendly, with games music and pictures<\/li>\n<li>Provide distractions and more stimulation for those who need it<\/li>\n<\/ul>\n<p>Our <a href=\"https:\/\/eric.org.uk\/sensory-needs-and-toileting\/\">sensory factsheet<\/a> has lot more information on supporting children with sensory needs.<\/p>\n<hr>\n<h2>How to stop toilet anxiety in children<\/h2>\n<ul>\n<li>Accept and recognise the child&#x2019;s anxiety and analyse the factors contributing to this.<\/li>\n<li>Check bowel and bladder function. Many children are constipated too and that will need treatment before progress can be made. See our advice for children with constipation for more information.<\/li>\n<li>Build confidence with other activities and skills e.g. washing hands, putting on socks, being helpful<\/li>\n<li>Break up the task into small, easy steps that can be gradually built on<\/li>\n<li>Use predictable routines<\/li>\n<li>Distraction<\/li>\n<li>Try to make toileting fun<\/li>\n<li>Talk to the child about anxiety<\/li>\n<\/ul>\n<h3><strong>Some things to try<\/strong><\/h3>\n<ul>\n<li>Music and songs<\/li>\n<li>Videos which explain how toilets work<\/li>\n<li>Tactile activities e.g. fiddle toys, putty, play dough<\/li>\n<li>Joke book &#x2013; laughter is a great way to relax children<\/li>\n<li>Visuals e.g. kaleidoscopes, spinning danglers<\/li>\n<li>Gentle massage, tummy, feet or hands<\/li>\n<li>Sounds e.g. waves, music, bird song<\/li>\n<li>Slow, deep breathing<\/li>\n<li>Thinking about a favourite place or activity<\/li>\n<\/ul>\n<h3><strong>Using rewards<\/strong><\/h3>\n<ul>\n<li>Reward effort as much as success<\/li>\n<li>Keep rewards small and fun<\/li>\n<li>A lucky dip box<\/li>\n<li>Activities and targets for older children<\/li>\n<li>Peace and quiet may be preferred by some children.<\/li>\n<\/ul>\n<h3><strong>Things to avoid<\/strong><\/h3>\n<ul>\n<li>Giving unrealistic targets<\/li>\n<li>Asking too many questions- use &#x201C;I wonder what&#x2026;&#x201D;?<\/li>\n<li>Getting cross &#x2013; but you can be cross with the wee and poo coming out in the wrong place! Talk about how annoying it is that the wee\/poo is misbehaving again, and how you and the child will have to teach it how to behave.<\/li>\n<\/ul>\n<hr>\n<h2><strong>Other things to consider and try<\/strong><\/h2>\n<ul>\n<li>It&#x2019;s always important to consider and assess anxiety<\/li>\n<li>Try to see the situation from the child&#x2019;s perspective<\/li>\n<li>Toilet anxiety may be linked only to toileting activities<\/li>\n<li>Anxiety improves with experience and familiarity<\/li>\n<li>Parents and carers need support too, it is stressful dealing with an upset child<\/li>\n<li>Consider and discuss school toilets<\/li>\n<li>Make sure children get used to other toilets (these can be scored out of 10).<\/li>\n<\/ul>\n<p><strong>Remember:<\/strong> Anxiety usually improves with experience, support and growing up.<\/p>\n\t\t\t\t<a href=\"https:\/\/eric.org.uk\/supporting-children-to-feel-more-comfortable-around-poo\/\" target=\"_self\" itemprop=\"url\" rel=\"noopener\">\n\t\t\t\t<img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/eric.org.uk\/wp-content\/uploads\/2022\/10\/Poo-with-arms-in-air--680x500.png\" alt=\"Poo character\" itemprop=\"image\" height=\"500\" width=\"680\" title=\"Helpline children who are scared of poo\" onerror=\"this.style.display='none'\"\/>\n\t\t\t\t<\/a>\n<h3>\n\t\t<a href=\"https:\/\/eric.org.uk\/supporting-children-to-feel-more-comfortable-around-poo\/\" title=\"Making poo less scary \" target=\"_self\" rel=\"noopener\">\n\t\tMaking poo less scary \n\t\t<\/a>\n\t<\/h3>\n\t<p>Tips to help children overcome any worries or fears they have of poop.<\/p>\n\t\t\t<a href=\"https:\/\/eric.org.uk\/supporting-children-to-feel-more-comfortable-around-poo\/\" target=\"_self\" rel=\"noopener\">\n\t\t\t\t\t\t\tFind out more about withholding\n\t\t\t\t\t<\/a>\n\t\t\t\t<a href=\"https:\/\/eric.org.uk\/childrens-bowels\/stool-withholding\/\" target=\"_self\" itemprop=\"url\" rel=\"noopener\">\n\t\t\t\t<img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/eric.org.uk\/wp-content\/uploads\/2022\/09\/Boy-crying--680x500.png\" alt=\"Young boy crying\" itemprop=\"image\" height=\"500\" width=\"680\" title=\"Boy crying\" onerror=\"this.style.display='none'\"\/>\n\t\t\t\t<\/a>\n<h3>\n\t\t<a href=\"https:\/\/eric.org.uk\/childrens-bowels\/stool-withholding\/\" title=\"Stool withholding \" target=\"_self\" rel=\"noopener\">\n\t\tStool withholding \n\t\t<\/a>\n\t<\/h3>\n\t<p>Find out why poo <a class=\"glossaryLink\" aria-describedby=\"tt\" data-cmtooltip=\"&lt;div class=glossaryItemTitle&gt;withholding&lt;\/div&gt;&lt;div class=glossaryItemBody&gt;&amp;lt;!-- wp:paragraph --&amp;gt;Using the anal muscles to deliberately stop a poo from leaving the body. In young children this behaviour normally starts because of previously passing a painful poo. Withholding can quickly lead to constipation because the longer the poo stays in the bowel, the harder, drier and bigger it gets, making it more and more painful to pass. It can be a difficult behaviour to break. Laxative treatment can help to keep the poo soft and easier to pass.&amp;lt;br\/&amp;gt;&amp;lt;!-- \/wp:paragraph --&amp;gt;&lt;\/div&gt;\" href=\"withholding\" data-mobile-support=\"0\" data-gt-translate-attributes='[{\"attribute\":\"data-cmtooltip\", \"format\":\"html\"}]' tabindex=\"0\" role=\"link\">withholding<\/a> happens and how to help your child overcome this stressful cycle of behaviour.<\/p>\n\t\t\t<a href=\"https:\/\/eric.org.uk\/childrens-bowels\/stool-withholding\/\" target=\"_self\" rel=\"noopener\">\n\t\t\t\t\t\t\tFind out more about withholding\n\t\t\t\t\t<\/a>\n\t\t\t\t<a href=\"https:\/\/eric.org.uk\/children-who-will-only-poo-in-a-nappy-and-other-toilet-avoiders\/\" target=\"_self\" itemprop=\"url\" rel=\"noopener\">\n\t\t\t\t<img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/eric.org.uk\/wp-content\/uploads\/2022\/09\/Nappy--680x500.png\" alt=\"Nappy\" itemprop=\"image\" height=\"500\" width=\"680\" title=\"Nappy\" onerror=\"this.style.display='none'\"\/>\n\t\t\t\t<\/a>\n<h3>\n\t\t<a href=\"https:\/\/eric.org.uk\/children-who-will-only-poo-in-a-nappy-and-other-toilet-avoiders\/\" title=\"Children who will only poo in a nappy \" target=\"_self\" rel=\"noopener\">\n\t\tChildren who will only poo in a nappy \n\t\t<\/a>\n\t<\/h3>\n\t<p>Children only wanting to poo in a nappy is very common especially around the potty training stage. Get help with supporting your child to break this habit.<\/p>\n\t\t\t<a href=\"https:\/\/eric.org.uk\/children-who-will-only-poo-in-a-nappy-and-other-toilet-avoiders\/\" target=\"_self\" rel=\"noopener\">\n\t\t\t\t\t\t\tFind out more about withholding\n\t\t\t\t\t<\/a>\n\t<h2>Still need help?<\/h2>\n<strong>Free helpline:<\/strong><br>\n<strong>0808 169 9949<\/strong><br>\n<strong>Monday to Thursday, 10am &#x2013; 2pm<\/strong>\n<p>&#xA0;<\/p>\n\t<h2>Support us<\/h2>\n<p>We rely on donations to continue our work.<\/p>\n\t\t\t<a href=\"https:\/\/eric.org.uk\/donate\/\" target=\"_self\" rel=\"noopener\">\n\t\t\t\t\t\t\tDonate now\n\t\t\t\t\t<\/a>\n\n","protected":false},"excerpt":{"rendered":"<p>Why the bathroom is frightening place for some children and how we can help them overcome their fears.<\/p>\n","protected":false},"author":7,"featured_media":3450,"parent":333,"menu_order":5,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_acf_changed":false,"footnotes":""},"blocksy_meta":{"styles_descriptor":{"styles":{"desktop":"","tablet":"","mobile":""},"google_fonts":[],"version":6}},"acf":[],"_links":{"self":[{"href":"https:\/\/eric.org.uk\/wp-json\/wp\/v2\/pages\/3400"}],"collection":[{"href":"https:\/\/eric.org.uk\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/eric.org.uk\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/eric.org.uk\/wp-json\/wp\/v2\/users\/7"}],"replies":[{"embeddable":true,"href":"https:\/\/eric.org.uk\/wp-json\/wp\/v2\/comments?post=3400"}],"version-history":[{"count":5,"href":"https:\/\/eric.org.uk\/wp-json\/wp\/v2\/pages\/3400\/revisions"}],"predecessor-version":[{"id":8224,"href":"https:\/\/eric.org.uk\/wp-json\/wp\/v2\/pages\/3400\/revisions\/8224"}],"up":[{"embeddable":true,"href":"https:\/\/eric.org.uk\/wp-json\/wp\/v2\/pages\/333"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/eric.org.uk\/wp-json\/wp\/v2\/media\/3450"}],"wp:attachment":[{"href":"https:\/\/eric.org.uk\/wp-json\/wp\/v2\/media?parent=3400"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}