11 Feb Autism and Toileting Challenges: What Parents Need to Know

It may sound like an odd topic, but the reality is that when you are raising an autistic child, poop can become a very real part of everyday family life.

All parents deal with nappies, toilet training and the occasional accident. When children are babies, conversations about colour, consistency, constipation and strange-looking nappies are completely normal.

For some families of autistic children, however, those conversations continue long after the baby years.

There may be constipation, diarrhoea, toilet-training difficulties, accidents, withholding, difficulty wiping independently or even faecal smearing. And because nobody really talks about these things, parents can feel as though they are the only family dealing with them.

You aren’t.

As an autism mom, I have had more conversations about poop, cleaned up more accidents and developed more toileting strategies than I ever imagined I would need to. For some families, these challenges disappear with time. For others, they simply become another part of everyday life that needs to be understood and supported.

Common toileting and poop-related challenges in autistic children

Every autistic child is different, but some of the challenges families may encounter include:

• Faecal smearing
• Difficulty toilet training for bowel movements
• Refusing to poop anywhere except in a nappy
• Constipation
• Diarrhoea
• Withholding stool
• Accidents after toilet training
• Difficulty wiping or cleaning independently
• Fear or anxiety around the bathroom
• Difficulty recognising the body’s signals
• Playing with stool or toilet water

These behaviours can have different causes, so it is important to look beyond the behaviour itself and ask what the child may be experiencing or communicating.

Faecal smearing and autism

Faecal smearing is one of the toileting behaviours parents may find particularly difficult to talk about.

It can feel embarrassing, distressing and incredibly difficult to manage, but families dealing with it should know that they are not alone.

There can be many possible reasons for faecal smearing. Depending on the child, these might include:

• Sensory seeking
• Exploration
• Difficulty understanding toileting expectations
• Constipation or discomfort
• Difficulty communicating discomfort
• Anxiety
• Seeking a particular reaction
• Difficulty with self-care routines

Rather than treating smearing simply as “naughty” behaviour, it is worth trying to understand what is happening before, during and after the behaviour.

Practical clothing adaptations may sometimes help prevent access while parents and professionals work on understanding the underlying reason. In our own family, clothing that limited access was one of the practical strategies we used for a period of time.

However, recurring faecal smearing should also prompt a discussion with the child’s healthcare provider to rule out constipation, pain or other medical causes.

Constipation and diarrhoea shouldn’t simply be ignored

Gastrointestinal problems can occur in autistic children, but persistent constipation or diarrhoea should not automatically be assumed to be “part of autism”.

A child may be dealing with pain, diet-related difficulties, restricted eating, medication side effects or another medical issue that needs attention.

If your child experiences ongoing constipation, diarrhoea, pain, bleeding, withholding or a significant change in their normal bowel habits, speak to their doctor or another suitably qualified healthcare professional.

You may also find our article on constipation and autistic children useful.

Keep a poop diary

It may not sound glamorous, but keeping a simple toileting diary can be extremely useful.

Record:

• When your child has a bowel movement
• When accidents happen
• Whether the stool appears hard, loose or unusual
• What your child ate and drank
• Whether they appeared uncomfortable
• Changes in routine
• Medication changes
• Where accidents tend to occur
• What your child was doing immediately beforehand

This can help you identify patterns and gives your child’s doctor or therapist more useful information if professional support is needed.

Remember that your child may not be able to tell you what is wrong

One of the most important things to remember is that behaviour can sometimes be communication.

A child who cannot easily say:

• “My tummy hurts.”
• “I need the toilet.”
• “I’m constipated.”
• “I’m frightened.”
• “That toilet is too noisy.”
• “I don’t know what I’m supposed to do.”

may communicate their discomfort in another way.

Use toileting routines – but allow flexibility

Predictable toileting routines can be very helpful for some autistic children.

A visual schedule in the bathroom may help a child remember the different steps involved, such as:

1. Pull down clothing
2. Use the toilet
3. Wipe
4. Flush
5. Pull clothing up
6. Wash hands

But routines also need some flexibility.

A child should gradually learn that they can use the toilet when their body tells them they need to go, rather than believing that toileting may only happen at one scheduled time.

Think about the sensory environment

What seems like an ordinary bathroom to an adult may be overwhelming to an autistic child.

Consider:

• The noise of flushing
• Hand dryers
• Extractor fans
• Bright lights
• The temperature of the toilet seat
• Strong smells
• The feeling of toilet paper
• The sensation of sitting still

Sometimes small environmental changes can make using the bathroom considerably easier.

Don’t turn toileting into a battle

Repeated accidents can be exhausting for parents, particularly when you have cleaned the same mess more times than you care to remember.

But punishment, shame or anger may increase anxiety around toileting and make the problem more difficult.

Try to remember that the child may not be deliberately defiant.

They may be struggling with sensory differences, communication, body awareness, anxiety, constipation, routine or simply understanding what is expected of them.

Once you start asking “Why is this difficult for my child?” rather than “Why won’t my child do this?”, the way you approach the problem can change completely.

Building independence takes time

Toileting is ultimately an independence skill.

And for some autistic children, skills that other children seem to pick up naturally need to be broken into smaller steps, taught explicitly and practised many times.

The same can be true for:

• Dressing
• Eating
• Communicating needs
• Following routines
• Personal hygiene
• Participating in a group
• Managing transitions
• School readiness

Progress may be gradual, but every step towards greater independence matters.

Please note: This article shares general information and personal experience and should not replace medical advice. Persistent constipation, diarrhoea, pain, bleeding, faecal smearing or significant changes in bowel habits should be discussed with your child’s healthcare professional.