Spotting toilet related health problems in children

Thursday 25th March 2010

A  survey of 5 – 16 year olds attending Sheffield Children’s Hospital paediatric outpatient clinics over a four-week period, found that over half avoided using school toilets, with around a quarter prepared to use them only if desperate.

This toilet avoidance can lead to children ‘hanging on’ and only using the toilet when they get home which for young bladders and bowels can be a damaging daily occurrence. Frequent ‘hanging on’ can lead to toilet related health problems such as constipation and wetting. Day and night-time wetting and soiling (leakage when constipated) effect more than one in 12 (about 750,000) five to 16 year olds in the UK.

The general state of the school toilets is often a problem. The toilets may be in a poor state of repair, fixtures may be inadequate or they may lack basic supplies of toilet paper, soap and hand drying facilities. Schools may also restrict access to the toilets during lessons or even to limited times during breaks.

The poor standard of school toilets and rules of restricted access can lead to:

• Children not sitting properly on the toilet or rushing due to feeling uncomfortable in their surroundings. This can mean that the bladder is not fully emptied leading to urinary tract infections, which in the long term can contribute to serious illnesses such as kidney disease.
• Children not wanting to empty their bowels due to unpleasant toilets and a lack of privacy. This can cause constipation and is often the cause of soiling and urinary tract infections.
• Children not drinking enough in order to avoid the toilets and thereby causing or worsening wetting and constipation problems and causing tiredness, headaches, difficulty concentrating: the early symptoms of dehydration.
• The transmission of infections, particularly gastroenteritis, caused by not washing or drying hands properly. This allows bacteria to spread throughout the school community and beyond.

What to look for

• Children rushing home from school desperate for the toilet.
• Children returning home from school dehydrated or overly tired.
• Children becoming constipated.
• Children having wetting accidents.
• Children developing urinary tract infections.

What action to take

Ask your child about their school toilet habits. Do they use the toilet at school and if not ask them why. It is always a good idea to take a look at the toilets yourself - ask to be escorted as this not only demonstrates to the school that toilets are important but also  helps to avoid suspicion as to possible motives.  High costs can be involved in renovating toilets but in the short-term, just maintaining, repairing and cleaning the toilets promptly and to a higher standard can make a considerable difference. Low-budget short-term solutions such as fresh paint, colourful murals, colourful toilet seats and pot plants – can also make a huge difference.

If doing a poo at school is an issue, encourage your child to get into the habit of going to the toilet in the morning before school or at night after a meal, to open their bowels.

For more information on toilet related health issues the national charity ERIC (Education and Resources for Improving Childhood Continence) and their campaign for better school toilets, Bog Standard, can offer detailed advice and support, including tips on improving school toilets. For advice on childhood bedwetting, daytime wetting, constipation and soiling call the ERIC Helpline on 0845 370 8008.

An unpublished survey of toilet problems encountered by pupils in Sheffield schools. Research by Consultant Paediatrician, Dr K Price from Sheffield Children’s Hospital, 2003.

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