Wee withholding, when someone avoids or delays urinating, can feel puzzling and frustrating. This is especially true if it starts after what has been toileting progress. But it’s actually quite common, and there are many understandable reasons behind it. Let’s explore what might be going on and how to support your young person.
Image from Canva, by atlasstudio
You may also be interested in my related blogs ‘Rethinking Praise: Practical Strategies for Toileting Support‘, ‘Supporting PDAers with Hygiene: A Compassionate Approach‘, ‘Hypermobility and Ehlers Danlos and How They Affect Toileting’
Transiting to the Toilet May Have Been Too Soon
Sometimes, transitioning to toilet use might have happened before a young person is truly ready. If a young person has had several accidents, they may begin to withhold wee to avoid the embarrassment or discomfort of wetting again.
What to try:
If this sounds familiar, it may be time to pause and reset. Return to using nappies without pressure. You can begin to watch for signs that your young person is feeling safe and starting to wee again. Then, gently reintroduce toilet learning at a pace that suits them.
Withholding Due to Pain
Pain is a very common cause of wee withholding. Even one painful wee can lead to fear of it happening again.
Possible causes of pain include:
- Urinary tract infections (UTIs) – these need medical treatment
- Thrush – often overlooked and can cause discomfort or burning and need medical treatment
- General soreness or irritation
While accessing treatment for the underlying cause, you may have success in supporting your young person to wee in the bath or during a shower. The sensation of warm water helps relieve pain and relaxes the pelvic floor muscles which makes it easier to wee.
What to try:
- Always rule out infections or physical causes with your medical provider
- Incorporate the use of warm water via a sitz bath, bath or shower
- If the underlying cause of discomfort is now resolved, try encouraging your young person to sit on the toilet clothed or after a warm bath or shower to show that the pain is no longer there.
A Way to Find Control
Toileting is one of the few areas a young person can control in their day. Withholding might be a response to other demands or changes they can’t control.
What to try:
Offer choices in other areas like what to wear, what book to read and which snack to have. Build small choices into toileting too. This could include having a few distraction options to pick from to bring into the bathroom space or giving hand washing options to choose from. Respect their pace and avoid battles for control. Also ensure that your young person has plenty of self-led time in order to balance the hours in structured settings like school or activities.
Too Much Pressure or Praise
Toileting can become a high-pressure experience when there’s too much attention on getting it ‘right.’ Overpraising every wee, comparing progress to siblings or peers, or using rewards and charts might seem encouraging at first but for some young people, this can backfire. It may create performance anxiety or make the toilet feel like a pressured task rather than a place of safety.
This is especially true if your young person is sensitive to expectations or is already feeling unsure. They may begin to associate the toilet with pressure, worry about letting you down, or feel overwhelmed by the focus.
What to try:
Shift the tone to one of quiet support. Keep toileting as neutral and as just another part of the rhythm of the day, not a big deal. You might say things like:
- “We use the toilet when our body needs it.”
- “It’s okay to try again next time.”
- “Let’s go together and see how it feels today.”
“They Just Can’t Be Bothered”: When Fun or Focus Takes Over
Sometimes, adults say a young person is “lazy” or “they just can’t be bothered” about toileting, but it’s rarely that simple. Toileting interrupts fun. It’s boring. It requires stopping an activity they care about like building, gaming or imagining and that’s a big deal for a lot of people. That break can feel frustrating.
What to try:
Acknowledge that frustration: “I know stopping your game is hard.” Offer reassurance: “You can go right back after.” Or “I’ll make sure no one touches your block tower while you are gone.”
For some children, especially those who are neurodivergent, not initiating toileting may be linked to monotropism. Monotropism is a way of thinking where they focus deeply on one thing at a time. When they’re fully absorbed in an activity, they might not notice body signals or may find it difficult to shift their attention away.
| What is Monotropism? Monotropism is a theory of attention that describes how some people (often Autistic) focus intensely on one interest or activity at a time. This deep focus can make switching tasks, like pausing to use the toilet, feel challenging or even distressing. Rather than resisting on purpose, the young person may simply be fully immersed and not aware of their body’s signals in that moment. The theory was first developed by Dr. Dinah Murray, Wendy Lawson and Mike Lesser (Murray et al., 2005), and is increasingly used to better understand the strengths and needs of Autistic individuals. |
What to try:
- Acknowledge and validate the challenge: “It’s hard to stop when you’re really into something.”
- Offer reassurance: “You can come right back, we’ve paused the movie and we’ll wait for you.”
- Use respectful, routine-based prompts around natural breaks like snack time or after finishing a task.
Even adults lose track of time and forget to eat, drink, or wee when they’re fully focused. This is just a part of being human. Supporting young people with understanding and through transitions can help reduce stress and bladder voiding.
Body Awareness (Interoception)
Interoception is the ability to notice and interpret body signals like hunger, thirst or the need to wee. Some young people (especially if they’re constipated or neurodivergent) struggle with this.
What to try:
Address constipation first
Constipation can dull or block the body’s signals, making it hard for a young person to recognise when they need a wee. If the bowel is full, it can press against the bladder and confuse the signals for both. Before working on interoception strategies, make sure any constipation is identified and treated as this helps restore clearer body messages.
Offer gentle, regular prompts
Don’t assume a young person can ‘just tell’ when they need to wee. Many children with interoception differences need external support to notice and act on these cues. Instead of asking “Do you need a wee?” (which they may genuinely not know), try calm, neutral prompts like:
“Let’s try the toilet before we get our shoes on,” or “It’s been a while, shall we have a toilet break?”
It can also help to pay attention to physical signs like squirming, squeezing their legs together, crossing legs or holding their genitals. These often show a need to go, even if your young person hasn’t recognised it yet.
Work with an occupational therapist
An occupational therapist (OT) who understands interoception can offer personalised support and strategies. This might include body awareness activities, visual cues, movement routines or sensory supports that help your young person learn what different internal signals feel like.
Role model and use declarative language
Talk aloud about your own body signals in a way that teaches. For example:
“Hmm, my tummy feels full, I think I need the toilet,” or “I’ve been sitting a while, it’s probably time for a wee.”
This kind of declarative language helps build awareness without putting pressure on your child to perform. It models curiosity and problem-solving, which they can gradually internalise.
Important: If your young person is constipated or has an untreated infection, they are tuning into pain, not the “need to wee” feeling. Always treat those issues first.
This handout can be used as a communication tool to share with all caregivers and educators involved in your young person’s care. It’s designed to help explain common reasons for wee withholding in order to help problem solve the underlying cause and therefore how to support the young person best.
Thank you for learning about the community,
Laura Hellfeld
RN, MSN, PHN, CNL
Sign up to my Newsletter Here
Connect with me on social media
BlueSky, LinkedIn, Instagram and Facebook
Disclaimer: The information shared in this blog is for informational purposes only and is not intended to replace medical advice, diagnosis, or treatment. Please consult a licensed healthcare provider for personalised support and care tailored to your specific needs.
Signposting and Resources:
- Rethinking Praise: Practical Strategies for Toileting Support, Blog
- Hypermobility and Ehlers Danlos and How They Affect Toileting, Blog
- Supporting PDAers with Hygiene: A Compassionate Approach’, Blog
- Creating Safe Spaces for Autistic People
- Murray, D., Lesser, M., & Lawson, W. (2005). Attention, monotropism and the diagnostic criteria for autism. Autism, 9(2), 139–156. https://doi.org/10.1177/1362361305051398
Last modified: 22 July 2025