More Information

Neurodiversity Hub Wirral

More About Bladder and Bowel Health

Bladder and bowel problems are common in neurodivergent children and young people, and they are not always noticed early.

Some children develop difficulties because they do not drink enough or eat a wide range of foods. Increasing fluids, encouraging helpful foods, and having a regular toilet routine can reduce the risk of bladder and bowel issues. Health Visitors and School Nurses can support with this advice.

Some children experience rigid behaviour, anxiety, or strong sensory needs. These can lead to holding in poo or wee (called stool withholding). When this happens for a long time, the brain stops sending clear signals that it is time to use the toilet, which increases the chance of bladder and bowel problems.

Most children improve with behavioural support and treatment for constipation.

For more information:
ERIC (Education and Resources for Improving Childhood Continence)

inside human body

  • Toilet training may feel challenging, but patience and a clear, consistent routine usually lead to success.

    Encourage the child to sit on the toilet for 5–10 minutes, about 20–30 minutes after meals. This is when they are most likely to poo. Keep this time calm and give them something to hold, look at, or play with.

    Using a footstool helps by lifting the knees to hip level — the best position for pooing.

    For more information:
    National Autistic Society

    Bladder and Bowel UK

    ERIC

  • Neurodivergent children often experience constipation.

    Signs of constipation include:

    • fewer than 4 poos a week

    • small, hard, or pellet‑like poos

    • poo in their pants

    • poo accidents

    • tummy aches

    • a swollen or bloated tummy

    • needing many small wees

    For more information:
    ERIC -consipation

    Children with constipation should see a GP. The GP will choose the most suitable laxative, usually a macrogol (such as Movicol, Laxido, or Cosmocol), which helps soften the poo.

    How to make macrogol:

    • Paediatric sachets – mix with at least 63ml cold water. Add juice or squash if needed.

    • Adult sachets (for ages 12+) – mix with at least 125ml cold water. Add juice or squash to taste.

    More information:
    How to use Laxatives

    Some children may be given Lactulose to soften poo. Because it is sugary, they should brush their teeth afterwards.

    Children who are very constipated may need bowel disimpaction, which involves taking higher doses of macrogol for several days to clear the bowel. This may take a week or longer, and the child may need to stay off school. A doctor or health professional can provide a letter if needed.

    Disimpaction is complete when the child passes poo that looks like brown water with bits in it. Afterwards, they will start a lower maintenance dose for 3–6 months so the bowel can heal. Some children may need laxatives for longer, depending on professional advice.

    More information:
    NHS England (March 2023)

    If constipation does not improve with treatment, a referral may be made to the Bladder and Bowel Specialist Service.

  • Some children need a safe and calm space to poo if they are holding it in. This behaviour is called stool withholding.

    Stool withholding often happens because children are afraid pooing will hurt. It can start during potty training.

    Providing reassurance, support, and gentle strategies can help reduce fear around pooing.

    For more information:
    ERIC Stool withholding

  • Some neurodivergent children may put their hands in their nappy and smear poo on their body, walls, or furniture.

    For help and advice:
    ERIC smearing poo

  • Signs of bladder problems include:

    • going to the toilet more than usual (4–7 times a day is normal)

    • always rushing to the toilet

    • wetting accidents (a full wee or damp pants)

    These can be caused by an overactive bladder, which may happen when:

    • constipation puts pressure on the bladder

    • the child drinks too little (strong, dark wee irritates the bladder)

    • the child drinks too many bladder‑irritating drinks

    Drinks that may irritate the bladder include:

    • blackcurrant drinks

    • citrus drinks

    • fizzy drinks

    • drinks with caffeine

    • pure fruit juices

    • hot chocolate

    Water is the best option.

    Other signs:

    • painful wees

    • smelly wees

    Smelly or painful wees may be a sign of a urinary tract infection (UTI), often with fever and feeling unwell. A GP should be contacted, and a urine sample will be needed.

  • Bedwetting after age 5 is common and can happen for many reasons:

    • it may run in families

    • the body may produce less of the hormone vasopressin, which reduces night‑time wee

    • constipation may worsen bedwetting

    • the child may have an overactive bladder

    Bedwetting is never done on purpose. Children need understanding and gentle support.

    Do not lift the child for a “dream wee” — this does not help the brain learn to wake when the bladder is full.

    Make sure the child drinks enough during the day (6–8 cups). Stop drinks about an hour before bed.

    If the washing is manageable, not using pull‑ups may help — as long as it is not stressful for the child.

    Children over age 7 who are upset by bedwetting should see a GP. They may be offered:

    • Desmopressin tablets, or

    • Desmo Melt (dissolvable), or

    • an enuresis alarm, if suitable for the child

    For more information:
    Bladder and Bowel UK

    ERIC