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Toileting difficulties

We aim to provide assessments and interventions for psychological needs related to toileting difficulties. This can include psychological causes and associated feelings such as shame, fatigue or anxiety.

What are toileting difficulties?

Toileting difficulties refers to a range of needs children and young people may have with going to the bathroom. Toileting difficulties includes:

Whilst it is normal for young children to have accidents every now and again, when this behaviour persists past five years of age or happens consistently, for a period of longer than three months, there may be an underlying emotional cause. Also, having a recognised need can lead to associated feelings. 

What are the psychological needs associated with toileting difficulties?

Psychological needs associated with toileting difficulties can include underlying causes or associated feelings such as; anxiety, trauma, sensory needs, low mood, feeling pressured, conduct disorder or oppositional defiant disorder. Toileting difficulties can affect children and young people in all areas of their life, including at school, at home and in general social situations. Most significantly, feelings of shame and embarrassment associated with having accidents can cause avoidance of social situations, resulting in school refusal and potentially isolation or withdrawal. Parents, carers and adults around the children can also feel a combination of feelings.

Our process

At HSR Psychology we ensure that we meet the needs of children and young people. To achieve this we ensure that any specific assessments, intervention, or direct work, is only carried out following an initial discussion.

An initial discussion allows us to understand the background and your expectations of our involvement. Having an initial discussion ensures any services we provide appropriately identify or address needs.

Our process for any specific assessments, intervention, or direct work is as follows:

Step 1: Contact us

We will usually be contacted by the child or young person, parent or carer, or another professional (eg education or health).

You can contact us or complete a referral

Step 2: Arrange an initial discussion

An initial discussion allows us to understand the background and your expectations of our involvement. Arrange an initial discussion

Step 3: Review our recommendations

Following an initial discussion we will send you an email that includes:

  • Next steps recommendations - to provide a bespoke package of support. For example:
    • Assessments
    • Reports
    • Information gathering
    • Meeting
    • Interventions
    • Consultancy
    • Reviews
  • Costing - we will provide costings for any services recommended.

Step 4: Let's get started

On receipt of the next steps recommendations and costing you can decide how to proceed. Once you have decided contact us to arrange the chosen services.

How are psychological needs associated with toileting difficulties assessed?

Psychological needs relating to toileting difficulties are assessed using tests such as behavioural checklists, scales, and also journals. Assessments and scales are helpful in determining if there are any underlying difficulties (e.g. anxiety, depression, anger, ADHD) that contribute to or worsen the difficulties.

We recommend that any physical causes or conditions are investigated by a medical professional before our assessments take place. An assessment for psychological needs with HSR Psychology relating to toileting difficulties would aim to identify and focus on the underlying cause of the behaviours, for example mental health and sensory needs, not the physical symptoms. 

What happens after an assessment for toileting difficulties?

After an assessment, psychological needs related to toileting difficulties are used to recommend future intervention and support. If we do not identify an underlying cause, then we may recommend that the child or young person sees a medical professional. Any needs identified can be outlined in a brief or a comprehensive report according to the circumstances. This will be discussed during the initial discussion.

What interventions do we support?

Our team support numerous interventions. Psychological interventions we can provide include:

There may be a medical underlying need causing the toileting difficulties, in these cases a psychological intervention may or may not be appropriate. Our specialist interventions tend to focus on psychological or sensory needs and reduce the risk of difficulties escalating, or the impact of associated feelings. If we are not the most appropriate service, we would signpost parents and carers to the most appropriate support. Some behaviours may be the result of repeated behaviour, so we may be able to reduce these behaviours through an individualised intervention plan working closely with home and/or school.

Arrange an Initial Discussion

Arrange an Initial Discussion to find out how we can help. The initial discussion lasts 1-1.5 hours, comes with a written recommendation summary and is a starting point to identify needs. The cost is £180.

  • No waiting lists
  • Experienced psychologists
  • Includes recommendation summary

Find out more



Toileting difficulties can impact several areas of a child or young person’s life. Early needs identification can ensure effective interventions are put in place to provide strategies and techniques to help support needs. For more information, or to book an initial discussion, please contact us to speak to a member of our team.

What makes us different

Access to a named psychologist

Focus on mental health and wellbeing

Joined-up approach

Bespoke services to meet needs

Multidisciplinary team

Holistic approach

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Flexible, consistent, and competitively priced

We provide bespoke solutions to suit all budgets and requirements for children and young people aged 0-25 in homes, education settings and the community. Our clinical, educational and child psychology services are cost effective.

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Make a referral

To make a referral and arrange an initial discussion please complete our referral form.

Make a referral

Contact us

Ready to get started? The next step is to speak to our team to find out more about the services we provide and how we can help. Call us on 0161 820 9229 or email

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