bladder and bowel dysfunction is often unrecognised in neurodivergent children and young people.

Problems may occur because food and fluid intake is often a challenge due to a restrictive diet. Long-term risk of bladder and bowel dysfunction may be decreased through guidance and advice on fluid consumption, food, and toileting routines given by health Visitors and School Nurses.

Also children with rigidities, anxiety, or sensory preferences may develop a pattern of retaining their poos (known as stool withholding) and their wees. This eventually lessens the neural signals to the brain which indicate the sensation for needing the toilet, and this puts children at a greater risk of having bladder and bowel dysfunction.

Behaviour therapies, with treatment of associated constipation, may improve bladder and bowel concerns in most cases.
https://eric.org.uk/children-with-additional-needs/help-with-toileting/

TOILET TRAINING THE CHILD WITH ADDITIONAL NEEDS:

Although there may be challenges in toilet training, patience and sticking to a toileting regime will often bring success in the end; never say never! Encouraging 5-10 minutes (maximum) on the toilet 20-30 minutes after meals, is when the child is most likely to pass a poo. This should be a relaxing time with something for the child to do. A footstool enabling the child’s knees to be at hip height, will provide the best toileting position.

For further information, please visit:

• National Autistic Society: https://www.autism.org.uk/advice-and-guidance/professional-practice/toileting
• Bladder and Bowel UK: https://www.bbuk.org.uk/children-young-people/resources-for-children/
• ERIC: https://eric.org.uk/children-with-additional-needs/toileting-support-for-autistic-children/

CONSTIPATION:

Neurodivergent children often tend to suffer with constipation.

Signs and symptoms of constipation include:

• fewer than 4 poos/week
• rabbit dropping type poos or hard poos
• soiled pants
• poo accidents
• tummy aches
• a bloated tummy
• needing lots of small wees.

For further information, please visit:

https://eric.org.uk/childrens-bowels/constipation-in-children/

Children who are constipated will need to see the GP, who would prescribe the best laxative. This is likely to be a macrogol (Movicol, Laxido or Cosmocol), which will help to soften the poo. The paediatric sachets should be made up with at least 63mls cold water, then you can add juice such as pure juice or squash, plus more water if necessary, so that it is palatable for the child to drink. Adult sachets, which can be given to children over 12 years, should be made up with at least 125mls of cold water, then add juice, squash etc. to taste. For further information, please visit:

https://eric.org.uk/how-to-use-macrogol-laxatives/

Some children are given Lactulose, which also softens the poo. Children who are given Lactulose should clean their teeth afterwards, as it is very sugary.

Children who are very constipated may need to have a bowel disimpaction. This involves giving increasing amounts of a macrogol according to a disimpaction regime. This may take up to a week or longer and the child will need to be off school for this. Children are allowed to be off school for medical reasons and the doctor or health professional would be happy to write a letter to the school to let them know. A disimpaction regime continues until the child passes a poo like brown water with bits in. They only need to have one episode like this, then the disimpaction stops and a prescribed maintenance dose is given. The maintenance dose will need to be given for at least 3-6 months to keep the poos soft and give the bowel time to recover. Children who have been constipated for a long time, may need to stay on laxatives for longer, as advised by the GP or other health professional (NHS England, March 2023 https://www.england.nhs.uk/long-read/national-clinical-constipation-pathway-for-primary-care-for-children/).

When constipation continues and does not respond to treatment, the GP, Health Visitor, School Nurse or other health care professional may decide to do a referral to the Bladder and Bowel Specialist Service.

STOOL WITHHOLDING:

Children may need a safe space to release their poo if they are stool withholding, whilst strategies are considered to help the child disassociate fear with pooing.  Stool withholding can be common and is usually a result of fear that the poo will hurt when it releases.  It can often start at potty training.

For more information and support of how to tackle stool withholding, please visit:

https://eric.org.uk/childrens-bowels/stool-withholding/

SMEARING POO:

Neurodivergent children sometimes put their hands in their nappy and smear poo over themselves, walls or furniture. For help with this, please visit https://eric.org.uk/smearing/

BLADDER PROBLEMS:

Signs and symptoms of bladder problems include:

• going to the toilet more often than others (4-7 times a day is considered normal)
• always being desperate for the toilet
• wetting accidents (full wees or damp pants)

These may be due to an overactive bladder, which could be caused by constipation pressing on the bladder, drinking too little (strong urine can be the bladder’s own worst enemy), or drinking too much of the wrong things. Drinks which may irritate the bladder include blackcurrant and citrus drinks, fizzy and caffeinated drinks, pure fruit juices and hot chocolate. Water is best.

• painful wees
• smelly wees

Smelly and painful wees may indicate a urinary tract infection, particularly if accompanied by a fever and feeling unwell. The GP should be contacted, and a urine sample taken.

BEDWETTING:

Bedwetting which persists past the age of 5 years may occur for various reasons:

• it may run in families
• it may be due to a lack of the hormone vasopressin which is responsible for the kidney producing less urine at night
• it may be exacerbated by constipation
• it may be due to an overactive bladder

Bedwetting needs to be handled with sensitivity, as it is not something that the child will be doing on purpose. Don’t lift the child for a ‘dream wee’, as this has been proved to not help train the brain to wake to a feeling of a full bladder. Do make sure the child is drinking adequately (6- 8 cups/day) but stop drinks about an hour before bed. If you can manage the washing, not having the child in pullups is better (NICE 2010).

Children over 7 years who are upset by being wet at night, should see a GP as they may be able to have a tablet called Desmopressin (or the melt version which is called Desmo Melt), which might help, or for those neurodivergent children who would tolerate it, an enuresis alarm may help. For information, please visit:

https://www.bbuk.org.uk/children-young-people/resources-for-children/
or
https://eric.org.uk/?s=bedwetting&ct_post_type=post%3Apage%3Afamily_experiences