When the Body Speaks Differently: Neurodivergence and Pelvic Floor Challenges in Children

If your child is neurodivergent—meaning they might have autism, ADHD, intellectual disability, or other neurodevelopmental differences—you may have noticed that bladder, bowel, or pelvic floor issues come up more often than in “neurotypical” kids. You’re not imagining it: research supports that these challenges are common, serious, but also treatable. This post will walk you through what we know: how these issues arise, what they look like, and how pelvic health/physiotherapy can help.

How common are bladder, bowel, and pelvic floor challenges for neurodivergent children?

• A systematic review found that children with autism have significantly higher prevalence of bedwetting, daytime incontinence, and fecal incontinence compared to their neurotypical peers. PubMed

• Another study comparing children with ASD to controls showed increased rates of nocturnal enuresis (~30% vs ~0%) and daytime urinary incontinence (25% vs ~5%). PubMed

• Studies also suggest that severity of the neurodevelopmental condition is often associated with more severe or more frequent bladder and bowel problems. Frontiers+2PubMed+2

Why do these challenges happen (or why are they more frequent)?

There isn't just one reason. Multiple overlapping factors seem to contribute. Some of them are:

1. Sensory processing differences
   Neurodivergent children often process bodily sensations differently. That means signals that most of us “automatically” feel (full bladder, urge to poo) may be less noticeable, delayed, or overridden by other stimuli. This can lead to not feeling or not acting on urges. PMC+2PubMed+2

2. Holding / postponement behaviours
   Children with autism or ADHD might resist going to the toilet due to rigid routines, dislike of bathrooms, fear of flushing noises, sensory discomfort, or simply being deeply focused in another activity. Over time this can contribute to constipation, incomplete emptying, or bladder issues. PMC+2PubMed+2

3. Constipation and bowel issues
   Constipation is more common in ASD and other neurodivergent populations. The presence of hard stool or a full rectum can press against the bladder, reduce capacity, or impair bladder emptying. This increases risk of daytime wetting, urgency, accidents, or even urinary tract infections. Journal of Pediatric Surgery+3ScienceDirect+3PubMed+3

4. Motor control, posture, and pelvic floor function
   Some studies suggest that children with enuresis and/or neurodivergence have differences in neuromuscular development: delayed maturation in motor pathways, altered posture or balance, or difficulty coordinating pelvic floor muscles. These can make it harder to fully empty the bladder or bowel, or to contract / relax pelvic floor muscles appropriately. Jpurol+1

5. Sleep disturbances
   Neurodivergent children often have sleep differences (e.g. insomnia, fragmented sleep). Poor sleep can impair alertness to bladder signals at night, making it harder to wake to urinate. PubMed+1

6. Behavioral, anxiety, communication factors
   Communication challenges may make it harder for a child to tell an adult they need to go. Anxiety, fear, or distress around toileting can make them avoid it. Also, stress may exacerbate bowel and bladder issues. PMC+1

How these issues affect quality of life (for child & family)

Bladder, bowel, and pelvic floor challenges can have many consequences beyond the physical:

• Emotional / social impact: shame, embarrassment, low self-esteem, avoiding social events like sleepovers.

• Practical impact: extra washing, bed or clothing changes, school disruptions.

• Family stress: worry, frustration, feeling stuck or judged.

• Health risks: UTIs, skin irritation, constipation worsening, sometimes kidney issues if bladder retention is severe.

Because neurodivergent children might already face challenges in other areas, adding a bladder/bowel issue can amplify stress for everyone.

What helps: How pelvic health / physiotherapy & multidisciplinary approaches can make a difference

The good news is there are strategies that work—and many can be adapted to the needs of neurodivergent children. Here are what the literature and clinical practice suggest, along with how physiotherapy specifically can help.

Key approaches & strategies

1. Early detection and screening

   • Because delays in bladder or bowel control are more common, it helps if pediatricians, therapists, schools ask about them early, not waiting until things “should be better.”

   • Use of bladder/bowel diaries, asking specifically about daytime accidents, night-wetting, constipation, toileting refusal.

2. Individualised and adapted treatment

   • Interventions need to be tailored to the child’s sensory preferences, communication style, behavioral motivators, and routines. What works for one child may not work for another. PubMed+1

   • Use visual supports, schedules, rewards, social stories for toileting routines.

3. Constipation management

   • Diet changes (fiber, fluids), behavioural strategies, possibly medications under doctor supervision. Clearing constipation can improve bladder function substantially. ScienceDirect+2PubMed+2

4. Toileting behaviour and pelvic floor training

   • Teaching toilet posture (foot support, relaxed pelvic floor), breathing and relaxation techniques.

   • Helping the child become more aware of bladder / bowel signals (interoceptive awareness).

5. Bladder retraining & scheduled voiding

   • Encouraging regular bathroom breaks even when the child doesn’t feel an urge, to avoid holding.

   • Gradually increasing bladder hold times.

6. Family support and education

   • Helping parents understand the “why” behind the behaviour, reduce blame, reduce shame.

   • Empowering caregivers with strategies, tools, and patience.

7. Multidisciplinary teamwork

   • Pediatricians / paediatric urologists, gastroenterologists, occupational therapists (for sensory / motor), speech therapists if communication is a challenge, mental health professionals if anxiety or behaviour are big factors, and pelvic health physiotherapists.

What to watch out for (red flags / when to get extra help)

You should seek medical or specialist help when:

• There’s pain during urination or stool passage, blood in urine or stool.

• There’s very infrequent urination or poos, or very large hard stool (risk of impaction).

• Sudden worsening of symptoms (e.g. child was dry, then suddenly very wet).

• Signs of neurological problem (weakness, sensory loss, etc.).

• Very high level of distress or impact on everyday life.

What the research still needs

While there’s increasing recognition of these challenges, there are still gaps:

• More large, high-quality studies that use consistent definitions (of incontinence, constipation, neurodivergence).

• Better data on what interventions work best for specific neurodivergent profiles (e.g. ASD level, ADHD, ID) and what modifications are needed.

• Long-term follow up to see which treatments lead to lasting improvements.

Practical tips for parents: What you can try now

Here are some ideas you might start using today, alongside professional support:

• Use a simple diary to note wet nights / accidents / poos / holding behaviour.

• Establish consistent toileting times (after meals, maybe before screen time or at transition points).

• Make the toilet environment more comfortable: soft lighting, minimal noise, sensory considerations (seat comfort, smells, etc.).

• Use reminders / visual schedules.

• Reward charts for effort (not just success).

• Gentle encouragement to drink enough fluids (but avoid too much right before bed).

• Be patient, reduce shame, celebrate small wins.

The bottom line

Neurodivergent children are more likely to experience bladder, bowel, and pelvic floor challenges—but they are not destined to “always struggle.” With awareness, adapted strategies, and the right professional support, many children improve significantly. Pelvic health physiotherapists have a vital role in helping tailor treatment: teaching toileting techniques, helping with posture and muscle control, support for constipation, adapting interventions to sensory and communication needs, and working in partnership with families.

If something feels off, if your child is wetting nights, having accidents, or avoiding going to the toilet—or just seems uncomfortable with bowel habits—it’s worth bringing it up. You deserve support, and your child deserves to feel safe, clean, confident, and able to participate fully in their life.