You can manage chronic constipation in kids!
You can manage chronic constipation in kids!
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School is in Session - Do you know your school's bathroom policy?

Hello again! After a long break, I’m back to writing about pediatric constipation and all the ways we can help hurting kids have happy and healthy bowels. I have so many things to write about: abdominal massage, the use of e-stim to treat constipation, treating kids with spasticity… But I listened to a Mom and Dad are Fighting episode this week, and I realized I have a more timely - and more significant - issue to address: school bathroom policy. 

For those of you who don’t listen to Mom and Dad are Fighting, it’s a terrific podcast about parenting. (It’s also where I made my podcast debut! I have been on the show twice to talk about chronic constipation in kids. You can find links to the shows here and here). This week, Elizabeth, who recently moved to Japan, spoke about her son’s toileting experience in school this year. 

Her son’s teacher has a policy that they can go to the bathroom any time they want. BUT, if they go to the bathroom during class time, they lose two minutes of lunch or recess. This teacher clearly thinks this is a reasonable policy, because her students can go whenever they want. But, as Elizabeth points out, she is effectively punishing her students for using the bathroom. 

I’d like to say first that this policy is unequivocally unhealthy. Approximately one third of school-age kids suffer from chronic constipation. Many others have chronic UTIs, bowel and bladder incontinence, and nocturnal enuresis (bedwetting). All of these serious health conditions can be attributed at least in part to holding behaviors. That is to say, kids teach themselves how to ignore or resist bowel and bladder urges, and in doing so they cause bigger health problems. 

Any policy that restricts free access to toilets contributes to bowel and bladder dysfunction. This is a serious issue: kids with bowel and bladder dysfunction suffer from bullying, anxiety, depression, angry outbursts, and impaired sleep. If you care about kids learning, you should allow them free access to the bathrooms. 

Sadly, this teacher’s policy is not all that different from many schools across the country (and, it appears, the world). I can’t tell you how many kids I treat who tell me that, while they technically can use the restroom during the school day, they don’t want to because it’ll upset their teacher.

As we all start the school year, now seems like the right time for all of us to advocate for healthy toileting policies in schools. If I were to summarize an ideal policy, it would be that students should have open access to clean, well-stocked bathrooms anytime during the school day. (I adapted this wording from this excellent document from a British nonprofit dedicated to educating about bowel and bladder dysfunction in kids.)

I shared this idea with a group of school nurses who had asked me to present to them on fecal and urinary incontinence. This was a truly caring group of professionals, and I was a little surprised by their response to an open-access policy. The consensus was that this policy is nice in theory, but in practice it would lead to chaos. (I was particularly struck by the high school nurse who said that in his high school, this would lead to kids vaping in the bathrooms all day long.) 

Let me be clear: I believe these nurses - and other teachers -  when they tell me that an open access to toilets policy would be challenging. I also serve on my local school board, and I hear regularly about the behavioral challenges our kids are presenting in classrooms. I’m positive that their concerns are based in a classroom reality that many of us non-teachers can’t fathom. But I think there is room for a policy that preserves bladder and bowel health as well as teacher sanity. 

So here is my best attempt: 

  • Elementary students should be given mandatory bathroom breaks every 2-3 hours at every grade level. Kids will often say they don’t have to go, but we know that using the bathroom every 2-3 hours is a healthy pattern for young kids. So they shouldn’t be given the option. (See also: parents who are potty training should ban the phrase “do you need to go to the bathroom?” from their vocabulary.) 
  • Middle school and high school students should be given “hygiene breaks” in the form of a longer passing period every 2-3 classes. Have you been in a middle school or high school lately? There’s no way kids can get to both their locker and the bathroom in five minutes. They especially can’t if they have to poop or manage their period. 
  • Any child with a documented bowel or bladder condition should be given a medical pass that allows them out of the classroom any time. They should also have access to a private bathroom. 

If your child is struggling with a bowel or bladder issue, I’d strongly suggest that you talk with the teacher first, and then the administration if necessary. Educate them on chronic constipation (you could give them a copy of The Constipation Game Plan, even). Remember - very few people are taught about bowel and bladder dysfunction during the course of getting their teaching or educational administration degree. Just as parents aren’t taught about the perils of chronic constipation when they take their baby home from the hospital. 


ERIC, the British charity for kids with toileting-related health issues, has published some great  resources to help you make your case:

This is the guide they published for managing bowel and bladder issues in schools and daycares. Be aware - they’re British, so you’ll have to do a bit of translating into American English.  

Here is their sample school toilet charter, establishing access to toilets as a human right. This one really gets me thinking, as it’s based on the United Nations Convention on the Rights of a Child, and puts a child’s best interests before all others. 

And here is a sample school bathroom policy that would put the health of the child first. 

I’d love to hear your thoughts on what a manageable and healthy school toileting policy should look like. Given the number of adults who suffer from constipation, IBS, anxiety and incontinence, it seems like healthy toileting habits should be a learning priority for our youth. 

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