By Steve Hodges, M.D.
When I was a kid, I steered way clear of the school bathroom. If you tried to poop at my elementary school, students would bang on the stall doors, try to pry them open, or throw wet paper towels at you. If you had to pee during class, the teachers would say, “Mr. Hodges, you will need to hold it until recess!”
So I became a master holder, a habit that set me up for major constipation — and a career as a pediatric urologist.
Given the extent of my constipation, I was lucky I never had an accident in school, but many of my patients aren’t so lucky.
As the new school year gets underway, I can tell you this: Nothing is more mortifying for a kid than having poop drop out of his shorts on the gym floor, being taunted with “You stink!” or having to trudge to the school nurse’s office with pee-soaked pants.
I hear these stories every day in my clinic, from stressed-out kids and their distressed parents.
I’m in no position to stop bathroom bullying, but I’ve made it a mission to help kids with toileting issues by working to educate their teachers. Dysfunctional toileting is epidemic among U.S. kids, and these problems don’t end with the preschool years!
It’s absolutely critical for schools to take accidents seriously — to treat them as a health problem, not a behavioral or psychological problem.
When students pee in their pants, it’s not because they’re anxious or lazy; it’s because their poop-clogged rectum is making their bladder go haywire. When students poop in their pants, it’s because their stretched-out rectums have lost tone and sensation. And when students hold their pee or poop, these problems get worse.
I explain this to teachers in medical notes sent to school with my patients, and I urge teachers to download our free guide, The K-12 Teacher’s Fact Sheet on Childhood Toileting Problems: Why Accidents Must Not Be Ignored.
But often that’s not enough. I’m now excited to have one more tool in my belt: an eye-opening new survey of 4,000 elementary teachers on the subject of toileting health.
The survey, presented at the American Urological Association’s annual meeting, was co-authored by Hillary Copp, M.D., a pediatric urologist at the University of San Francisco, and Lauren Ko, a Harvard University Medical School student.
Among their findings:
•Only 18% of teachers surveyed had received professional training on voiding health or dysfunction.
•76% of teachers are, inadvertently, failing to promote voiding health among their students. In other words, only 24% are taking the key measures to help kids who have accidents.
•Whereas 81% of teachers reported allowing unlimited access to water intake in class, 88% said they encourage students requesting bathroom access to hold their pee. Hmmm . . .
•36% of teachers encourage holding by offering rewards to students who don’t use bathroom passes or punishing those who do.
One encouraging finding: Teachers who’d received professional training on toileting topics were far more likely than their untrained peers to qualify as voiding “health promoters.”
In other words, education works!
“Teachers are pulled in so many different directions and so have many pressures,” Dr. Kopp says, “but they really can make a difference with simple measures, like paying attention when kids bring notes to school, allowing students to use the bathroom when they need to, and opening a dialogue with parents.”
When Kids Have Accidents In the Classroom
The teacher survey was Lauren Ko’s idea. Before starting medical school, Lauren had taught 2nd grade at a charter school in the Bronx. “The discipline was pretty strict at our school, and there were only certain times of the day when students were allowed to use the bathroom,” says Lauren. “I noticed kids having accidents in the classroom, and I know it was really humiliating for them. It’s just a horrifying experience for a kid.”
Lauren noted related problems at the school: Accidents weren’t tracked, and teachers often did not communicate with parents about toileting issues. “The administrators didn’t have a way to say, ‘This student has had three accidents this month.’”
Having worked as a teacher, Lauren is sympathetic to the difficulties of managing a classroom and knows some students will take advantage of bathroom passes. But as a medical student, she knows the consequences of withholding bathroom access. “It’s not tenable to ask kids to hold their pee,” she says. “Holding can be very damaging for their bladders.”
In my experience, one of the best ways to help students with toileting difficulties is to get school nurses involved in educating teachers.
One professional paving the way is Natalie Barganski, a pediatric nurse practitioner in the bedwetting and incontinence clinic at Driscoll Children’s Hospital in South Texas. Natalie frequently speaks to teachers and school nurses in her area and has found, as I have, that many teachers perceive accidents as a sign of behavior problems.
“They think kids are doing it on purpose to get attention or they’re being lazy,” Natalie says. “Or they’ll say, ‘School work is more important.’ I try to help them understand that we’re talking about a bodily function — these kids physically need to use the bathroom. Many teachers don’t realize it’s a health issue.”
Dr. Copp and Lauren’s teacher’s survey rings true to Natalie, who is familiar with the use of incentives to discourage students from using the bathroom during class time. “At the end of the school year, they’ll have a party for students who didn’t use their bathroom passes,” she says. “I’m trying to stop that from happening.”
Just this week I heard from the mom of a third-grader, who described the policy in her daughter’s classroom: "Each child gets three bathroom passes a week, and if they have any left over at the end of the week they get a certificate to use towards a prize.” This mom told her daughter she will get a prize at home if she uses all her passes.
9 Signs a Student is Chronically Constipated
I hope the results of Dr. Copp and Lauren’s survey makes waves and that more nursing professionals like Natalie will take up the cause of educating teachers.
Meantime, I urge teachers and school nurses to download our free guides and to be on the alert for students who:
•Pee or poop in their pants
•Complain of belly aches
•Scratch their bottoms frequently
•Ask to use the bathroom frequently
•Suddenly and desperately need to pee
•Sit in positions that suggest they need to pee
•Strain to poop (maybe you hear this in the bathroom)
•Skip school overnights due to bedwetting
•Take antibiotics for recurrent urinary tract infections
These are signs a student is chronically and severely constipated!
I hope in the coming school year, teachers will not only pay attention to these red flags but also actively encourage their students to use the school bathrooms — and to be kinder to students in the stalls than my fellow students were to me.