SIGNIFICANCE: Retentive fecal incontinence (RFI) is a common disorder in children that can affect participation. Behavior seems to be partly responsible for RFI. Current research examines behavior mainly from a psychological perspective. An alternative perspective, on the basis of sensory integration theory, could offer additional insight. Until now, there have not been tools to identify the sensory aspects of toileting. Further, there is little empirical evidence in support of a relationship between sensory overresponsivity (SOR) and RFI. Having the tools and understanding this relationship will affect treatment for this disorder.

INNOVATION: This investigation is driven by a nontraditional perspective on RFI, one that considers the sensory features of toileting. Correctly diagnosing and treating underlying sensory difficulties could improve treatment success rates.

APPROACH: In this study, we attempted to answer the following research questions: (1) How well does the Toilet Habit Profile Questionnaire (THPQ) differentiate between typical children and children (aged 3 to 5 yr) with RFI who have not responded to first-line treatment? (2) What are the relationships among SOR, THPQ scores, and RFI that has not responded to first-line treatment in children aged 3 to 5 yr?

Hypotheses for Question 2 include the following: (1) a low SOR score will be associated with low THPQ scores, (2) children with RFI will show lower THPQ scores than children without RFI, and (3) children with RFI will show lower SOR scores than children without RFI.

Recent clinical work suggests that some behaviors associated with RFI could be related to SOR. In this study, we examined the ability of the THPQ to identify toileting difficulties, and we investigated the relationship among RFI, SOR, and THPQ scores.

METHOD: We used a survey questionnaire design, and the setting was Spain. Participants included parents of children aged 3 to 5 yr (n = 16), with physician-diagnosed RFI, recruited through local gastroenterologists and occupational therapists, as well as parents of typically developing children (n = 27) recruited through local schools. All participants completed two questionnaires.

The THPQ describes behaviors common to children with RFI. The Short Sensory Profile (SSP) was used to assess sensory processing abilities. In this investigation, we focused on SOR as it relates to RFI. As such, data analysis was done on relevant items of the THPQ and the SSP. Group differences were examined with a Mann–Whitney U test. The relationship between SOR and THPQ scores was examined with a Spearman correlation.

RESULTS: Children with RFI presented with significantly more behaviors related to SOR than typically developing children (RFI group: Mdn = 76.50, Q1 = 71.25, Q3 = 85.25; typical group: Mdn = 84.00, Q1 = 76.00, Q3 = 90.00; p = .0346). The THPQ effectively discriminated between children with RFI and those without toileting difficulties (RFI group: Mdn = 23.50, Q1 = 17.50, Q3 = 28.00; typical group: Mdn = 36.00, Q1 = 34.00, Q3 = 38.00; p = .000). There exists a linear dependency between SOR and THPQ scores (rs = .423, p = .005).

CONCLUSION: Children with treatment-resistant RFI show a greater degree of SOR than typically developing children. The THPQ effectively discriminates between children with RFI and typically developing children. The small sample size in this study is the most prominent limitation.