How well do you know your own internal bowel and bladder functioning? Do you have detailed words to talk about it? Do you have specific environmental set ups that you prefer? Which stall in the public toilets do you use? Do you prefer privacy? How many carers are you required to work with over the course of the day? Do they help with your toileting? Are you allowed to stay on the toilet for as long as you need? If not, why not? Is that due to the time of the day when you are using the toilet? Is that due to the location of the toilet? Is it due to the size of the toilet stall? Can another person fit into that stall easily? What about your privacy with the disabled toilets where the door is frosted and you can see shapes or outlines of people moving in it? Do some people need more privacy that others when using the toileting?
How long you need to sit on the toilet has a significant impact on the schedule of your day. If you don’t have your timing managed well you’ll be late. How late? Continually late or just occasionally late? So does that change the way you protect yourself with your activities throughout the day. Do you refuse to go out to certain places because of the location of the toilets and how unclean they are or because you know that you’ll be yelled at by others wanting their turn when it takes you so long – but you don’t know how to make your internal body go any faster, which makes you more distressed and blame yourself because everyone else seems to be able to go to the toilet – so really you shouldn’t go out to those places. This can be an extreme or dependent on your body it can be an everyday experience.
What happens with supervision and toileting as you age? When you’re in preschool or are little its ok to have your parents or an adult helping you. What happens when it isn’t? What happens when its something that you don’t want despite the fact that you know that you need help. Do you have the vocabulary or knowledge or ability to link it all together in a conversation with someone to talk about it? What happens if you can but you get punished for it? repeatedly. Do you want to stay at school? Expelling gas can be common place for some but considered to be highly rude in other situations. Yet what happens in a classroom situation where your bowel doesn’t work properly. You are on medication to make it work better, but that changes on you every so often because you’re working on it with your doctor. Is it ok to fart in the classroom? What happens with the reactions of others? If you are already being teased is it ok for others to make comments about your toileting? How is your resilience already because of school work, health etc? Focusing on these challenges requires a detailed understanding of toileting across every part of the day and every part of those environments that the individual goes into and for how long etc. Documenting as many details as possible and helping individuals and their carers / families be able to have detailed conversations with the medical staff involved with their care is extremely important. Sensory details about clothing tolerance in terms of waist bands, movement flexibility of materials to cope with bloated stomaches etc is important to identify through home visits with detailed wardrobe and drawer access.