The Difficulties with Toilet Training a Person with Autism - Autism Awareness
We’re here for you during COVID-19, providing information and resources like we always have for the past 17 years. Let us know how we can help.
Potty training with autism

The Difficulties with Toilet Training a Person with Autism

The topic of toilet training or toileting issues continues to be my most frequently asked question. I’m asked what to do about withholding a bowel movement, toileting readiness, fecal smearing, constipation, continued use of diapers, elimination on the floor or other inappropriate place, and how to teach the toileting process. These are all very important questions that can be hard to find answers to…but why? Because each person is an individual and has their own reasons or issues for having any one or several of these problems.

Both of my children were late toilet trainers, but their issues were quite different. My son took 3 years to train for a bowel movement. He could withhold a bowel movement for up to one week at a time, was frequently constipated, and smeared feces. I always gave up with the training the third week into it because I couldn’t handle the daily clean up. It was just easier to give in and go back to using Pull-Ups. We finally got him trained at age 9.5 years after trying just about everything. The turning point for us on the third try was persisting with the process for 6 weeks. Our son showed signs of getting closer to pooping during the 5th week of training. By the sixth week, he had it mastered. He has never had an accident in 13 years.

Understanding fecal smearing and other toilet training issues

What helped me the most mentally was understanding why the fecal smearing was happening. This is a misunderstood behavior and one that tends to be the most upsetting. When a child withholds their stool, it becomes harder in consistency as the days go on leading to constipation. Constipation can cause an itchy anus which then leads to picking to relieve the itchiness and pressure. I believe this why our son was picking – because of the itch and by removing some fecal matter, he could relieve some pressure which allowed him to continue to hold in his stool.

My daughter was quite different. She used to eliminate on the carpet without warning. When she was 6, I told her if she went to the bathroom in the toilet, she could have some Smarties. She replied, “OK” and the process was done in one day. I will never know why she was so easy and my son was not; however, my daughter’s cognitive functioning is higher than my son’s. Both were very late talkers – just before their 5th birthday – and missed most developmental milestones.

Why Are There Toileting Difficulties?

I believe there are two main problems in toileting difficulties.

  1. The first one is eating a limited diet and low fluid intake. A diet that is low in fiber can cause constipation, but the biggest concern is fluid intake. If a person is dehydrated, colonic motility slows down so that more water can be absorbed. This results in not only a decreased number of bowel movements, but also stools that are harder, more dense, and drier (Barnhill and Winter 2016).
  2. The other problem is interoceptive awareness. Receptors located throughout the inside or our body, in our organs, muscles, skin, bones gather information from the inside of our body and send it to brain. People with autism tend to have impairment in this area. This means the signal of a full bladder or needing to eliminate does not reach the brain so there is no impetus to get to the toilet or the sensation of needing to go is felt too late (a full bladder to the point of bursting).

I have also heard of individuals who do not understand that different types of toilets are all toilets and you do the same thing in them. This may need to be taught if the toilet at school is very different from the toilet at home (often the case).

Toileting Readiness

Many people make the mistake of thinking toileting readiness is related to chronological age – it is not. In fact, the greater the developmental delay, the greater the toileting delay tends to be. I have never come across any studies that make the connection between language development and toileting, but in my experience the two seem to be related.

Some signs of toileting readiness are:

  • gets a diaper when needs to eliminate
  • goes off to a quiet spot for toileting
  • asks to be changed when a diaper is soiled
  • there is a pattern with elimination
  • the child remains dry at night

Make sure life is stable (no stress from a move, new baby, major illness or divorce) before you start toilet training. Parents should also be emotionally ready as there will be some set backs and clean ups in the early stages.

potty training in bathroom

Buy the Toilet Training E-Book

Ideal for quickly grasping concepts and strategies for Toilet Training.

The Toileting Team

When you decide to start toilet training, have a meeting with everyone involved in the child’s life. This would be grandparents, teachers, babysitters – anyone who may be spending extended periods of time with the child. Decide what language you will use around toileting. Because my children were older with this process, we did not use a potty chair so our words were toilet and all body parts were called by their anatomically correct name (penis, vagina, but we did use the word bum). Everyone should use the same statement when it’s time to go such as, “It’s time to use the bathroom.”

Use the same toileting visuals both at home and at school and present them in the same way (i.e., separate cards on a ring, a horizontal strip or vertical strip).

If the child is small but still using a toilet, use a toilet insert to make the opening smaller. If the child is unbalanced in any way, they may feel too unstable to relax for elimination. Also use a foot stool if their feet can’t firmly touch the floor. Feeling secure and balanced is a big part of relaxing for elimination.

Allow boys to sit for both peeing and pooping. This will help with release and avoid confusion that you have different positions for peeing and pooping. Standing can happen later.

How Do We Start?

I have written a more lengthy blog post on toiletting readiness and how to start here.Many children don’t even know they are supposed to go into a bathroom to eliminate so start by just leading them by the hand into the bathroom every time they eliminate.

  • Make sure all changing of diapers happen in the bathroom and not in another room.
  • Do not allow other activities to go on during changing time and if you can, have your child help with the clean up.
  • Have them shake the solid waste into the toilet from the diaper so that they learn where the poop is supposed to go.
  • Have them help with wiping.

Some children do not understand how to release their bowels. Telling them to push can cause muscles to tighten. Try blowing bubbles while on the toilet or using a blow-type toy. The blowing action will help the diaphragm to relax and support release.

I also think you have to stop using all diapers in this process and go to underwear. Flipping back and forth leads to confusion. My son was very clever and would hold his bowel movement all day until he knew he was going to get the Pull-Up at night. As soon as the Pull-Up went on, the poop came out. We had accidents moving to underwear, but we had our son help shake all excess waste into the toilet and by the 5th week, he was ready to just sit on the toilet and go.

We did reward our son for using the toilet with one ripple potato chip. He was willing to work for that one chip. We were unable to phase out that reward for several years after the toilet training was completed, but for us it was better to continue with the reward rather than going back to Pull-Ups.

Learning to use the toilet will not look the same for each child. Try to troubleshoot along the way and please feel free to write and ask questions. I am a firm believer that everyone can be toilet trained unless there is a medical issue.

For further reading:

The Potty Journey

What to Do About Smearing

For children:

It Hurts When I Poop!

Liam Goes Poo in the Toilet: A Story about Trouble with Toilet Training

Tags: , , , .

Editorial Policy: Autism Awareness Centre believes that education is the key to success in assisting individuals who have autism and related disorders. Autism Awareness Centre’s mission is to ensure our extensive autism resource selection features the newest titles available in North America. Note that the information contained on this web site should not be used as a substitute for medical care and advice.

Read Our Full Editorial Policy

43 Comments Moderation Policy

  1. Lori M Jones says:

    Sorry forgot to say. My oldest 16 was diagnosed with PDD ( sleeping disorder and add adhd ) at the age of 2. aspergers later and now just autism spectrum. My 8 year old was diagnosed with autism spectrum disorder, but has low cognition as well as developmental delays and my daughter developmental delays, autism level 1 with language impairment.

  2. Lori M Jones says:

    My two son’s and daughter, do not know what it feels like to have to go to the bathroom.. But know when they have. their ages are 16 8 and 4. The 16 and 8 year old, well, the 16 year old still has accidents but wears underwear, and the 8 year old has medical pull ups and knows how to clean himself in bathroom when he has used his diaper. My 4 year old is working on it she tells me after she goes.. But thank you for this article. My daughters neurologist explained the disconnection from cns to the brain for learning the signs of having to go. and this article was great for me to use to help people understand it isn’t an intelligent thing, infact they are very intelligent to be able to take care of themselves when it happens. Will they ever get that “brain” notification back?

  3. Jo says:

    Maureen, I am so glad to found this website as i can relate so many things that other moms are saying here. My Son is going to be 6 years old in two more months, he’s been diagnosed with Asperger syndrome at age of 4. He expresses his needs very well but very stubborn to accept a change. He got potty trained for pee at 2 years old like a breeze but poop training is a nightmare. At 2 years age, he started standing and pooping in diapers wherever he was. We got ride of diapers at 2 years and moved to underpants, he does not like getting wet or soiled. so the pee training he could do it with no issues but poop he rejected sitting on toilet. I made biggest mistake of putting him in the bath tub as he was pooping in the living room floor or so. However, he got so used to pooping in bath tub standing, as i was the one who does the poop cleaning by using the wipes and i do dump it in the toilet right infront of him and he gets cleaned by me.

    I tried making him lift the poop using the wipes and dump in the toilet. but that didnt help him change his mind to poop in toilet.

    Its been 4 months, now he comfortably sits on the toilet with a timer running for 5 minutes and says “i tried and it didnt come out”. jumps into tub and pushes it out.

    i tried not letting him use the tub,i gave a stool with a small ring, he tried a lot to poop on the toilet, poor kid, i just dont know if he can push it by sitting on toilet, he usually stands in tub and squats his legs a bit and pushes. so he did hold the poop for 3 days and his tummy got so big, he sits but when its time to go, he just gets up and holds it in. i could not see him go through that trouble anymore on 3rd day, so i gave in. next minute he poops in the tub.

    So another attempt, he tried holding it in as usual, this time i gave him pedialax suppository and he sat there, but it was all watery, so he really didnt master the art of pushing. So next day, without suppository, he kept saying the same dialogue “its not coming without suppository”.

    i know that he is not constipated, as he poops very well the minute he jumps into the bath tub. Its just the sitting position in which he is little afraid to release the poop. I tried sturdy stool potty ring, coconut oil suppositories to not make him constipated while potty traning, pedialax suppositories to release the poop but he has to learn to push naturally.

    Tomorrow i will try to make him blow whistle or blow toys kind of stuff as u suggested to someone to relax them while on potty, but i really appreciate if you can suggest me some more tips that can help him transition to toilet.

    Thanks a ton.

    • Jo, on September 15th, I have a new blog post being published which tackles some of the things you are struggling with. When you talk about the poop being watery with the suppository, this makes me thing there may be some constipation because you are describing what is called overflow. This is poop that comes from higher up the bowel and moves around the blockage and leaks out.

      Your son may be pooping in the tub because he needs a different elimination position. Is there water in the tub when you put him in? If so, I am wondering if the water touching his stomach gives him interoceptive feedback, giving him the message that he has to poop.

      You are describing the need to squat in order to release the bowel movement. Have you seen the Squatty Potty? https://www.squattypotty.com/ It may help your son to have his legs more raised up.

      Your son may need to work on body awareness in order to feel the need to push – https://autismawarenesscentre.com/interoception-and-autism-body-awareness-challenges-for-those-with-asd/

      Please look for my upcoming post on September 15th on constipation and other bowel difficulties. I have a lot to say in it.

  4. Lori says:

    My daughter is almost 6 and still has no clue when to use the bathroom. She will be going into kindergarten in the fall. How did you work with the school regarding your son’s issue? I’m just wondering if I’ll have to homeschool her if she’s still not toilet trained by then..

    • My son did not go to school in diapers and he had great control for bowel movements. He could hold them in for long periods of time. He could urinate successfully wherever he went.

      You will have to work with the school and talk about your daughter’s toileting issues. Will she have an aide in Kindergarten? Children with special needs have the right to an education and it is the school’s responsibility to provide the support a child needs in order to access education. I would set up a meeting with the school and ask how they will support her needs.

  5. Amy says:

    Ty my daughter will be 6 years old and has autism. It is a struggle to get her potty trained. I am definitely going to listen to your suggestions. Thank you again.

  6. Carolyn says:

    Thank you for this post. I’m currently potty training my 3 year old son who has autism. I was feeling very frustrated after having to clean a wet messy poop off of shag carpeting, and feeling like I should give up. Im going to try some of the tips I’ve read and hopefully he can learn to poop on the potty

  7. Amanda says:

    Help my foster son can’t push a poop out, he has used  balloons and bubbles but they don’t work, even when he is full of soft/ normal  poop.he was extremely constipated when he arrived, his anus was larger than a coin, and he had  liquid/ muddy overflow,he wears nappies, after several months of treatment with movicol  he is no longer constipated but he still won’t empty his bowel by himself ,it just sits there in his bum until the  poop falls out bit by bit like a large skid mark in his nappy and only a micro lax Enema will empty his bum, movicol will now make poop run down his legs several times a day , he just won’t push it out or dosnt know or unable to push he is five , and without the enema he will get constipated again 
    He sees a gastro specialist that says continue with balloons etc but it has been 4 months and he still can’t poop it out, unless I give him the micro lax enema

  8. Lorena says:

    Thank you so much, Maureen, i willl read the article you spotted. I´ll be more patient and watch my son to know when he ´d be ready. Thank you for this helpful blog 🙂

  9. Lorena says:

    My son is 4-year -old, diagnosed with autism at the age of 18 months. I´ ve trying to make him leave diapers, but we were unsuccessful so far.
    He uses toilet when he is not wearing anything (at home), as soon as he wears underwear , he forgets going to toilet. At night, he uses diapers, in the morning, sometimes diaper is dry, some days is wet. I do not know how to go on. He will begin pre-school in September. Even though he spent all this time with me at home, my attempts to get him potty trained failed.

    • Lorena, your son may not be ready yet for toilet training. You can’t decide to toilet train based on chronological age. Here is an article on when to start – https://autismawarenesscentre.com/toileting-when-to-start/ I am not sure where his gross motor skills are at, but having to pull down his underwear or take it off may be an extra step too many right now which is why he can go to the toilet without underwear on.

      It took me 3 years to toilet train my son – it was not accomplished until the age of 9.5. We had urinating mastered at 6 but the bowel movement at 9.5. You can’t rush this process or show your child you are stressed about it as it only makes the situation harder.

      The other thing that comes into play is interoceptive awareness. Receptors located throughout the inside or our body, in our organs, muscles, skin, bones gather information from the inside of our body and send it to brain. People with autism tend to have impairment in this area. This means the signal of a full bladder or needing to eliminate does not reach the brain so there is no impetus to get to the toilet or the sensation of needing to go is felt too late (a full bladder to the point of bursting).

  10. Heather White says:

    Potty Training an older child

    I am the new stepmother of a fourteen-year-old child with autism. He is verbal and communicates well and is mainstreamed in the classroom at middle school. Despite his abilities in other areas, his mother never fully potty trained him even though she was a stay at home mother. He still needs to be reminded to go to the bathroom for number 2. He also still has accidents where he doesn’t make it to the toilet in time.He utilizes wipes when he uses the restroom, which his dad says he needs to help him use the restroom. Sometimes, he will go through almost an entire pack in one sitting. What can we do to help him at this point? We only have him every other weekend an part of the summer.

    • There could be a few issues going on here. One is constipation – he may be using the wet wipes on the end of his finger to dig out impacted feces. When you say he needs to be reminded, this makes me think this is an interoception problem. https://autismawarenesscentre.com/interoception-and-autism-body-awareness-challenges-for-those-with-asd/ This means he is not getting the signal from his body that he has to go. If he is missing this signal and feces are sitting for too long, this can cause constipation which then makes stool painful to pass. You may want to give him some mineral oil to see if that helps. Does he have a regular time for a bowel movement? If so, maybe set some kind of a reminder on an iPhone that can help him be more independent with a bowel movement schedule. Everything must be done with dignity and respect. At 14, this boy needs to have some privacy and independence if that can be done and still allow him to have success.

  11. Joyce says:

    Thank you for your information. I have a minimally verbal  6 year old with ASD. He will bring us a pull-up when he has to poop and will stay in the bathroom to poop in the pull-up. He has never been one to squat while pooping, always standing, so we are struggling with him sitting down on the toilet long enough to release his bowels and he gets quite upset. He will sit to have a pee but always urgent to get off the toilet as quickly as possible. We do explain to him that he will poop easier and faster if he stays seated on the toilet. Any advice would be appreciated. 

    • I am wondering if it would help to have a footstool under his feet to help him feel anchored when on the toilet. You say he is 6 – if he is small, he may also be feeling that he may fall through the opening of the toilet or has to put his energy into balancing on the toilet. Get the type of toilet seat that has a second ring that comes down to make the opening smaller (not an insert). See if a more stable position when on the toilet helps.

  12. Nicole Rivers says:

    Hi there! I have a 5 year old son. We are just learning that he is on the spectrum. He has only had preliminary testing and because of the pandemic we are now on hold for the long psychological tests. But I just wanted to say that everything I have read here I can relate to…thank you so much! I don’t have “mom friends” and was feeling really alone and frustrated. My son fecal smears. He also has an aversion to the potty because he says his poop is “spikey” and hurts. He only eats 3 different foods, however he will drink lots of water. Thank you again so, so much for this! I really thought I was doing something wrong! I am so relieved to hear stories similar to ours!

  13. Erin says:

    Thank you so much for this! My 4.5 yr old who is likely ASD mastered peeing in the potty quickly.  He doesn’t care if he is in a pull-up, diaper, underwear or even naked…. he just poops when he wants.  He’ll even say that ‘Mommy poops in the potty’ and does the same for other family members.  He flat out refuses to poop in the potty and will say, ‘I don’t want to poop in the potty’.  He doesn’t withhold, and bribes/prizes don’t work.   we’ve spent hours with an iPad on the potty day after day, and also tried the approach to just completely ignore it.  Once he poops in his pants, he asks to have his underwear changed.  He clearly understands that he should poop in the potty, and we can’t figure out how to alter this behavior.  Any ideas?  

    • Erin, he may not like the smell or proximity of poop to his body when it is done in the potty. Get him on the toilet with just a ring insert that makes the opening smaller. Put a footstool at the base so that he can stabilize his feet and body. When he poops in his underwear, have him shake it into the toilet so he understands where it goes. See if going on the big toilet helps. I am also curious – how does he deliver a bowel movement when in his underwear? Does he squat or drape his stomach over something like the arm of a chair?

  14. Nancy says:

    Thank you for the information.  I sometimes keep an asd seven yr old girl with toilet issues.  I believe she takes a
    laxative for constipation but I wonder if
    her  great-grandmother (her guardian)
    doesn’t keep her on a healthy fiber diet.  
    The child told me she drinks soda,
    apple juice, chocolate milk and sweet  
    tea at home.  She weighed -about 85 lbs.
    on my scales.  I’m concerned for her
    diet and health.  Can the laxatives
    interfere with her ability to sense a bowel urge ?  She can tell me she needs to pee, but not often.  I’m just curious if water and a good diet will help her do better, but I do realize from your info that it can just take a long time because of the asd.  Thank you.  

  15. Mekenna says:

    Hi, my son Andrew is still waiting to be tested for either sensory processing disorder or autism. He’s currently 5 and we recently did a stay in the hospital for a impaction because he was withholding poop for so long. We have a gastro appt next month, but any other tips for just helping him relax and at least go in his pull up? I don’t want to see him in the hospital again.

  16. Mamalilly says:

    Thank you for your amazing blog. And good luck with your kids. I wandering about “night owls” my kid is a light sleeper I can’t risk awaking her to go to toilet at night. Is there something to do to help making her dey at night.

  17. Galina says:

    Thank you so much Maureen. This is the most helpful advice I’ve read about toilet training. I’m about to embark on the journey with my 5 year old and need all the advice and courage I can find… This may be a long journey. Thank you.

    • Galina, I am so glad I could be helpful in some way. If you encounter things that trouble you along the way, do feel free to write again and I will try and help you troubleshoot any issues.

  18. Sommer says:

    My son wasn’t out of  Pull-Ups until 4-1/2. He is now two months away from turning six and still uses a potty chair. He doesn’t have accidents, and that was never an issue. He hasn’t been diagnosed with ASD, but we take him to a therapist for anxiety, and we’re in the process of testing him for ADHD. Due to extreme anxiety, we slowly acclimate him to certain situations. However, in three months he starts a once a week kindergarten program. I would like to have him using the toilet by the time he starts. Right now if we’re out and he needs to pee, he’ll just go outside and pee behind a tree. I’ll admit, I do let him pee outside while we’re out to avoid two hours of screaming. Do you have any suggestions? Thanks!! 

    • Sommer, this is not a process you can rush. I know you have a deadline, but this may increase anxiety trying to get this job done within the next 3 months. You may want to try and transition him to the toilet by doing the following – have a step stool there to make sure your son’s feet a planted firmly on something for balance. Buy a toilet seat that has a smaller seat within in that you pull down – https://www.homedepot.com/b/Bath-Toilets-Toilet-Seats-Bidets-Toilet-Seats/Child/N-5yc1vZceq5Z1z0m63u. Some children are frightened by the larger opening. He may also not understand that the toilet works the same way as a potty chair. I am wondering if the sound of toilet flushing is too loud for his ears. You may want to put on headphones when flushing to see if muting the sound helps.

  19. Jacque Archer says:

    My 12 year old son has High Functioning Autism . He has just begun to eliminate on his bedroom floor and then hide it . We have had no problems with toileting in the past . We have tried talking about it but he denies it is him , even though we know he is doing it . He starts High School next year so we are keen to get this sorted ASAP . We were concerned that something may of happened that has caused this but he just says every thing is OK . What to do ?

    • Jacque, you may have to do some further investigation here because when behavior changes like that, there is usually a reason. Has there been a growth spurt/puberty changes happening? Sometimes these bodily changes can throw a person with autism off. Your son may also be embarrassed which is why he is hiding it and says he is not doing it. Could you provide him with wet wipes and ask him to take the feces to the toilet? I am also wondering if he is starting to masturbate and he eliminates during this excitement. Could you talk with him about masturbation? I don’t know if I am right, but I am just trying to look at the different angles here.

  20. Lynn Brodsky says:

    Any good resources for night time toileting?  I need some advice on how/when to start and how do you know your child is ready?  Thank you 

  21. Anne says:

    You make so many great points, Maureen. I’m here to say that I wish I’d had this advice when he was 5 but my son is now 14 and hasn’t had any accidents in a year, which was partly because we moved.
    I wish I’d known about having him empty his pull-up or thought to have him change his own pull-up, though when he had accidents at home I made him put his clothes and dirty towels in the washer. He was a dehydrated witholder, because he refused to poop in public—we’ve had to leave places when he had the urge. Thankfully he loves those canned seltzer waters and he’s gotten mire regular he just takes forever to go now.

    This is awesome advice for those of you who are there now!

    • Anne, thank you so much for sharing your insight and story about your son. You’ve done great!

      One thing we also have to give to our son once he was into his teens was PEG 3350. https://www.gikids.org/files/PEG_3350_FAQ_formatted.pdf . It is not approved for pediatric use, but we were told to try this on the advice of our gastroenterologist. It really helped our son be regular and not have hard stools. There can be anxiety and fear built up around the elimination of hard stools because it is quite painful. If you decide to give PEG 3350 a try (available over the counter – sold as Restoralax in North America), please consult your physician first. Our son was so constipated that it was affecting his level of food intake and he lost 30 lbs. Any time I tried to increase his food intake, he would vomit. It became a cycle that I did not understand until he had an abdominal ultrasound at the age of 15 which revealed fecal impaction.

  22. Carrie Romeo says:

    Hello I have an 11 year old daughter with ASD. She has been having accidents, more so now with just fecal smearing and she also still wears pads at night because she is a very deep sleeper and resists waking to use the bathroom at night. Her doctor prescribed a bed wetting alarm but I’m not sure if we will have success with it. When I ask her why she is still soiling herself she said it’s because the poop comes out to fast. Sometimes she’ll also say it’s too hard and hurts her. This has been going on since I tried to first potty train her at 3 years old. She wasn’t diagnosed with ASD until last year when she was 10. But now it all makes sense. Any suggestions?

    • Carrie, have a look at the comment I just made to Anne in the post just after yours about using PEG 3350. You may be able to reverse the nighttime trend of pooping if you can get her regulated during the day. In my personal experience, you really have to get rid of any Pull-ups, pads etc. My son was an expert at withholding all day because he knew he’d get the Pull- Up for nighttime sleeping. You can put a plastic sheet around the mattress to protect it. The poop is probably coming out too fast because she is holding it in for a long time until she no longer can. PEG 3350 will also soften the stool. Please consult your doctor before using this product even though it is available over the counter. https://www.gikids.org/files/PEG_3350_FAQ_formatted.pdf

  23. Maureen Blight, Occupational Therapist, Good Spirit School Division, Saskatchewan says:

    Maureen, thank you for this information. I look forward to reading in detail. I concur toileting is a challenging area for children with autism. We support children and families through out work in the schools. Are there any professional development courses forthcoming on this topic? Thank you again.

    • Maureen, thank you for your kind words. I do not know of any training courses on this topic. There isn’t even that much to read in the literature about it. We have 4 autism specific toilet training books, the best one in my opinion being The Potty Journey. Each person seems to have a different combination of issues when it comes to toileting. Messes and accidents tend to upset people and the setbacks can cause great frustration. I am hoping some of my ideas will keep people preserving as it is such an important skill to have.

Leave a Reply

Your email address will not be published. Required fields are marked *