Inside: We’re talking causes and solutions to your autistic family member and their incontinence. We want our kids to have dignity and reduce bullying whenever possible.
Uncomfortable and embarrassing problems are not exclusive to autism. Heck, I’m finding out a ton of stuff about perimenopause that no one talks about. But a while back, by request, I published an article about autism and poop smearing. Afterward, I received several emails that said “That’s great advice, but what about autism incontinence?” Or, kids who are still bedwetting.
So, let’s dig in. Let’s talk about it. Because we have an obligation to provide our kids with dignity whenever we can. And, no one wants to wet themselves. It also leaves our kids ripe for bullying and social ostracization.
It can also affect other members of the family, like siblings. They may be embarrassed in public or to have friends over.
Studies have shown that children with ASD are more likely to experience incontinence than typically developing children. Incontinence can present in different ways, such as bedwetting, daytime wetting, and fecal incontinence.
It can be a challenging issue for parents and caregivers to manage, and it can have a significant impact on the quality of life of both the child and the family.
In this article, we will explore the topic of incontinence in children with autism spectrum disorder. We will discuss the different types of incontinence, the causes, and the available treatment options.
We will also provide practical tips and strategies for parents and caregivers to help manage incontinence in children with ASD. A reminder that I am not a doctor nor do I play one on the internet.
Always keep your child’s medical team engaged in these conversations and rule out all medical causes first.
Understanding Autism and Incontinence
Incontinence is a condition that affects many people, including those with autism spectrum disorder (ASD). ASD is a neurodevelopmental condition that affects communication, social interaction, and behavior.
Children with ASD may have difficulty with toilet training, which can lead to incontinence.
There are three types of incontinence commonly found in autistic children:
- Urinary Incontinence (UI): This is the loss of bladder control that can result in accidents or bedwetting. UI is more common in boys with ASD than girls.
- Fecal Incontinence (FI): This is the loss of bowel control that can result in soiling or accidents. FI is more common in girls with ASD than boys.
- Encopresis: This is a type of FI that occurs when a child holds in their bowel movements, leading to impacted stool and involuntary soiling.
As I stated above, I discussed fecal incontinence and poop smearing in another article.
The causes of incontinence in children with ASD are not fully understood, but some possible factors include:
- Sensory processing issues: Children with ASD may have difficulty sensing when they need to use the bathroom or may not recognize the sensation of a full bladder or bowel. Read up on interoception to understand the internal senses that our kids experience.
- Communication difficulties: Children with ASD may have trouble communicating their needs or may not understand social cues related to bathroom use.
- Anxiety: Children with ASD may become anxious about using unfamiliar bathrooms or may have anxiety related to social situations.
Treatment for incontinence in children with ASD may include behavioral interventions, such as timed voiding or positive reinforcement for successful bathroom use.
Medications, such as laxatives or anticholinergics, may also be prescribed to treat underlying bowel or bladder issues. It is important to work with a healthcare provider to develop a treatment plan that is tailored to the individual needs of the child.
Causes of Incontinence in Autism
Incontinence is a common issue in children with autism spectrum disorder (ASD). Understanding the causes of incontinence in children with ASD is crucial for effective management of this condition.
There are several factors that can contribute to incontinence in children with ASD, including sensory processing issues and communication difficulties.
You also want to have these conversations with your child’s doctors. There may be kidney, bladder or other issues your doctor may want to test for first.
And, I can’t stress this enough. Autism incontinence is one of those things that I so frequently see treated as behavioral. With adults around the child thinking “won’t” instead of “can’t.” Please find me the person of any age who deliberately has bathroom accidents because they just “won’t” go to the bathroom.
It’s not likely. There is something underneath that has to be discovered and taught.
Sensory Processing Issues
Children with ASD may have sensory processing issues, which can affect their ability to recognize and respond to the need to urinate or defecate. For example, some children may have difficulty sensing the urge to go to the bathroom or may have an overactive bladder that causes them to urinate frequently.
On the other hand, some children may have an underactive bladder that causes them to hold urine for too long, leading to accidents.
Communication difficulties are another factor that can contribute to incontinence in children with ASD. Many children with ASD have difficulty communicating their needs and may not be able to express when they need to go to the bathroom.
Additionally, some children may not understand the social norms surrounding bathroom use, such as asking for permission or waiting for a turn.
It is important to note that incontinence in children with ASD is not always caused by sensory processing issues or communication difficulties. Other factors, such as medical conditions or medication side effects, may also contribute to incontinence.
Therefore, it is important to consult with a healthcare provider to determine the underlying cause of incontinence in each individual case.
Symptoms of Incontinence in Autism
Children with autism spectrum disorder (ASD) may experience nocturnal enuresis, commonly known as bedwetting. Bedwetting is when a child involuntarily urinates during sleep. It is a common issue for children with ASD and can continue into adolescence.
It is important to note that bedwetting can also be a symptom of other medical conditions, so it is important to seek medical advice if it persists.
Daytime urinary incontinence, also known as daytime wetting, is when a child involuntarily urinates during the day. This can be due to a variety of factors, including bladder control issues, sensory processing difficulties, and communication challenges.
Children with ASD may also experience urinary tract infections, which can contribute to urinary incontinence.
It is important to note that incontinence can have a significant impact on a child’s quality of life and may lead to social isolation and self-esteem issues.
Parents and caregivers should seek medical advice if their child is experiencing incontinence to determine the underlying cause and develop a management plan.
Treatment Options for Incontinence in Autism
Incontinence is a common issue faced by individuals with autism spectrum disorder (ASD). Fortunately, there are several treatment options available that can help manage and improve incontinence symptoms.
Behavioral therapies are the first line of treatment for incontinence in individuals with ASD. These therapies aim to improve bladder and bowel control by modifying behavior and habits. Some common behavioral therapies include:
- Bladder training: This involves gradually increasing the time between bathroom breaks to help the individual with ASD learn to hold urine for longer periods.
- Timed voiding: This involves scheduling regular bathroom breaks to ensure the individual with ASD does not hold urine for too long.
In some cases, medication may be prescribed to help manage incontinence symptoms in individuals with ASD. Some common medications used to treat incontinence include:
- Anticholinergics: These medications help reduce bladder contractions and increase bladder capacity, which can help with urinary incontinence.
- Mirabegron: This medication helps relax the bladder muscle, which can help with urinary incontinence.
It is important to note that medication should only be used under the guidance of a healthcare professional.
Managing Incontinence in Autism at Home and School
Children with Autism Spectrum Disorder (ASD) are more likely to experience incontinence than typically developing children. Managing incontinence in these children can be challenging, but it is possible with the right strategies.
Here are some tips for managing incontinence in autism at home and school.
Creating a Routine
Creating a routine is essential for managing incontinence in children with autism. A consistent routine can help children understand when it is time to use the bathroom and reduce the likelihood of accidents.
Parents and caregivers can create a schedule for bathroom breaks and stick to it as much as possible. It is also important to encourage children to use the bathroom at regular intervals, such as before and after meals and before bedtime.
Assistive devices can be helpful for children with autism who experience incontinence. These devices can include bedwetting alarms, toilet training pants, and waterproof bedding.
Parents and caregivers can also consider using underpads or chux to protect furniture and mattresses from accidents. It is important to choose the right assistive device for the child’s needs and preferences.
Communication strategies can help children with autism understand the importance of using the bathroom and reduce anxiety around toileting. Parents and caregivers can use visual aids, such as picture schedules or social stories, to help children understand the steps involved in using the bathroom.
It is also important to use clear, simple language when talking about toileting and to avoid using negative language or punishment for accidents.
Managing incontinence in children with autism requires patience, consistency, and the right strategies.
Creating a routine, using assistive devices, and using communication strategies can all be helpful in managing incontinence at home and school. With the right support, children with autism can learn to manage their incontinence and feel more confident and independent.
Think Outside the Box
Be creative and think about what may work for your child.
Typically, boys are taught to stand up and pee. Well, maybe try sitting.
It’s also important to be aware of the language you are using. Kindergarteners use the word potty. Teenagers do not. But, some of our kids take that long to learn.
Use the correct word from the beginning–something like “bathroom” or “toilet” so that you don’t have to switch because your child turned 10 and still hasn’t mastered the skill.
Plan ahead. I know the location of almost every family friendly restroom in metro Philadelphia. (ok maybe I’m exaggerating) But, it’s important to plan ahead for outings so your day isn’t cut short due to an accident.
Adding to your IEP
Yes! Toileting can be on an IEP. There is nothing in IDEA preventing this. I have a whole separate article on toileting IEP goals and protocols.
If you are told that a child “must” be toilet trained to access a specific support, service or placement, ask your team where it says that in IDEA or your state regulations.
To deny a child access based upon their disability is discrimination. We all want our kids toilet trained and not having accidents as soon as they can master that skill. For some of our disabled kiddos, it just doesn’t happen at age 3 or 4.
I have a friend whose son was toilet trained at age 20. It just took him a lot longer. And that’s ok.
Shaming and exclusion should never be a part of toileting. If that is happening to your child at any point during their day, stop it immediately.
We know that shame inhibits progress.