Bowel and Bladder Function (Continence)


Bowel and bladder dysfunction, including persistent urinary and fecal incontinence (enuresis and encopresis), is an extremely common and challenging co-morbidity in FASD. These issues often persist into adolescence and adulthood, well past typical developmental milestones, and are a major source of stress for the person, caregivers, and whānau.

The Challenges and Causes

Continence issues in FASD are primarily rooted in the brain's impaired executive function and central nervous system control, resulting from the prenatal alcohol exposure. This affects the core skills needed for successful toileting, including:

  • Interpreting Body Cues: Difficulty accurately sensing or interpreting the physical cues of a full bladder or bowel in time to act.

  • Executive Function: Challenges with impulse control (waiting), poor sequencing (the multi-step process of toileting), and difficulty remembering or initiating regular routines.

While the problem is mainly neurodevelopmental, a comprehensive medical assessment is essential to rule out structural or functional differences in the kidneys, bladder, or bowel, which are also more common in people with FASD.

Support and Resources

Support should integrate medical assessment with highly structured, informed behavioural and environmental strategies.

  • Medical Assessment: Initial assessment by a GP or Paediatrician to rule out physical causes (like UTIs or congenital differences) and referral to a specialist.

  • Continence Specialists: Referral to Continence Nurses (often associated with Te Whatu Ora / Health NZ services) or specialised clinics for tailored, non-judgemental management plans.

  • Behavioural Supports: Implementing strict, scheduled toileting routines using visual aids and focusing on positive reinforcement to support habit building, which compensates for executive function deficits.

For specific New Zealand support, whānau / families can be directed to the continence services offered through their local health provider. The following resources offer national and local support:

  • Continence NZ: This national organisation provides education, resources, and a helpline (0800 650 659) to connect people and professionals with local support and resources. Visit Continence NZ

  • Hawke's Bay Children's Continence Service: This specialist service, located in Napier, provides individualised toileting programmes for children and adolescents with complex needs, including those related to neurodevelopmental differences. 

  • Te Whatu Ora - Continence Services: Local continence nurses are available via referral for both adult and paediatric services in most regions. Contact Te Whatu Ora directly for referral pathways.