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Abstract

Background: Childhood functional defecation disorders (FDD), including functional constipation and non-retentive fecal incontinence, are classified as disorders of gut–brain interaction and are increasingly recognized as a public health concern. FDD are commonly associated with challenging toileting behaviors and reduced participation in age-appropriate toileting routines, which may contribute to both the onset and maintenance of symptoms. Identifying factors underlying toileting participation difficulties is essential for effective intervention planning. Occupational therapy practitioners have developed expertise in addressing participation challenges in daily activities, including toileting, and in identifying sensory integration issues that may interfere with engagement. Aim: This paper introduces the Toileting Habit Profile Questionnaire–Revised 2 (THPQ-R2), an expanded version of the THPQ-R, designed to more comprehensively assess sensory hypo-reactivity and poor perception related to defecation sensations in children with FDD. Methods: Development of the THPQ-R2 hypo-reactivity/poor perception subscale occurred in two phases. In Phase 1, supplementary items were generated from systematic parental reports of toileting behaviors observed in children referred by pediatric gastroenterologists to a private occupational therapy clinic for fecal incontinence and/or reduced toileting autonomy between September 2021 and September 2023. In Phase 2, all parent-reported behaviors were compared with existing literature to identify theoretical links to sensory hypo-reactivity and perceptual difficulties. Only behaviors supported by peer-reviewed literature were retained, and evidence-based hypotheses were formulated to explain observed patterns. Results: All retained behaviors were corroborated by existing literature and aligned with theoretical constructs of sensory hypo-reactivity and poor perception, including reduced awareness, localization, or interpretation of defecation-related sensations. Conclusion: The THPQ-R2 extends the original measure by addressing sensory issues not adequately captured by existing tools. The hypo-reactivity/poor perception subscale is now ready for formal psychometric evaluation to establish its validity and reliability. This measure may enhance identification of sensory-based toileting participation challenges and support more individualized, participation-focused interventions for pediatric FDD.

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