When headlines like Primary school punishes children for taking toilet breaks in class time come up in the news media, it’s an opportunity for teachers and school communities to be reminded of the critical role they play in shaping children’s bladder and bowel health, as well as their mental health.

Children can only supress the urge to go to the toilet for so long, and eventually the urine has to come out – whether they are on the toilet or not.

There is ample evidence showing that incontinence in school children can impact their self-esteem and psychological health (1, 2), which in turn gives them a significantly higher chance of being victims or perpetrators of bullying (3).

Faecal incontinence is even more devastating for a child. It often results from constipation (4), which is exacerbated by children not going to the toilet when they get the urge. Constipation affects up to 30 percent of school children at some point 5 and if left untreated, can lead to impaction and subsequent distention (stretching) of the bowel that can cause diarrhoea-like faecal incontinence.

Children put off going to the toilet for lots of reasons; they’re engrossed in play and forget to go during break times, they’re scared of the big kids in the toilets, or the toilets are dirty, smelly or lack privacy. How many times have you watched your own children make a beeline for the toilet as soon as they get home from school?

While the psychological impact of wetting or soiling is often underestimated, the physical impacts can also be long-lasting and serious.

In response to the high incidence of urinary incontinence in primary schools (one in five primary school aged children will wet themselves during the day (6)) and the real risk of lifelong poor toileting habits starting at school (7), the Continence Foundation of Australia launched the Toilet Tactics Kit – a dynamic and interactive educational resource, and part of its recent special project, Healthy Bladder and Bowel Habits in Schools.

Recently the 1000th Australian primary school signed up for the Toilet Tactics Kit, which gives children the know-how to adopt lifelong healthy bowel and bladder habits using familiar, age-appropriate language. They learn about hygiene, how to sit on a toilet correctly, the importance of going when the urge strikes, and how persistent holding on can lead to bladder and bowel dysfunction.

Just as importantly, teachers and parents learn about the importance of encouraging and reinforcing good practices early. It teaches teachers and staff how to recognise the signs a child may be having bladder or bowel issues, and gives them strategies to handle the situations sensitively and effectively.

As more and more schools sign up for Toilet Tactics, fewer children will have to suffer the stresses and consequences of being denied going to the toilet when the urge strikes.

To learn more, or to register your school, go to continence.org.au or phone the National Continence Helpline on 1800 33 00 66.

The Continence Foundation of Australia is the peak national body supporting the 4.8 million Australians affected by incontinence.

References
  1.         Deshpande, A, Craig, J, Smith, G & Caldwell, P2011, Factors Influencing quality of life in children with urinary Incontinence, The Journal of Urology, vol 186, pp 1048-1052
  2.         Ollendick. T., King, N. and Frary, R. (1989)  Fears in children and adolescents: reliability and   generalizability across gender, age and nationality.  Behaviour Research and Therapy.  Vol.  24.
  3.         Croghan, E 2002, A survey of drinking and toilet facilities in local state schools, British Journal of Community Nursing, vol. 7, no.2, pp. 76-79
  4.         Syed Rehan Ali, Shakeel Ahmed, Maqbool Qadir, Khadija N. Humayun, and Khalil Ahmad. Fecal Incontinence and Constipation in Children: A Clinical Conundrum. Oman Med J. Sep 2011; 26(5): 376–378
  5.         Afzal NA, Tighe MP, Thomson MA.Ital J Pediatr. 2011 Jun 13;37:28. doi: 10.1186/1824-7288-37-28
  6.         Sureshkumar P, Craig JC, Roy LP, Knight JF. Daytime urinary incontinence in primary school children: a population-based survey. J Pediatr. 2000 Dec;137(6):814-8.
  7.         Lundblad B, and Hellström A. Perceptions of school toilets as a cause for irregular toilet habits among schoolchildren aged 6 to 16 years. J Sch Health. 2005;75(4):125-128
Main image courtesy of Shutterstock.com

  • Our local school is pretty good at letting the kids out for toilet breaks during class time. But they do stress that recess and lunch are for toilet breaks to avoid them during class time

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  • Interesting article, thank you. I didn’t know schools have been sent this kit. I think I will ask my kids’ school if they have registered.
    My daughter is in kindergarten and recently needed to go to the toilet but her teacher told her to hold on until lunch time (which I think was about half an hour away). She couldn’t hold on and wet herself but was too embarrassed to say anything to anyone until she got home, so she was wearing wet undies and stockings for hours. She was extremely upset about it. She then got a urine infection. I made sure the teacher knew about it and that she shouldn’t be made to hold on because she can’t.
    Some teachers don’t think about the fact that they’re just little kids, not adults.

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  • Excellent article, I can’t beliefe kids are told they can not ho to the loo

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  • My son was told to wait until the teacher had finished and with him when he says he has to go it means then and there. So he wet himself poor kid. The teacher did apologise though.


    • Let’s hope the teacher has learnt his/her lesson!

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  • I can not believe this is still happening. Yes children have to learn that there is a time to go but even adults can not stick to this either.

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  • I agree with you Maria. If adults particularly ladies hang on for too long it can and often does result in a nasty urinary tract infection. Believe me they are not nice at all! If it happens in adults surely it must happen in kiddies.

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  • Very useful article , thank you for sharing all that information.

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  • When that story hits the news it brought back a lot of awful memories for me from my days at school. I still hate using public toilets.

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  • i think thats great i wish they had that at my little ones school. the most they have is keeping spare pants in a plastic bag in the school bag


    • Every primary school in Australia has been sent promotional material about Toilet Tactics, and so far 1500 have registered, but not all have implemented it yet. You could always ask your school if they’re registered – or know about it – and if not, we can send you or the school some information on the Kit. Just phone the Helpline on 1800 33 00 66 or the main office at 03 9347 2522.

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  • Children must be allowed to ‘go’ when they need to and not be chastised for this, it is part of human nature and when nature calls it must be answered, there is all sorts of emotional issues children have with toileting and as adults we must make ‘going’ a positive thing.

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  • Both my boys , ( year 3 and kinder) refuse to use the toilets at school, most of the time they are engrossed in an activity and simply forget to go! I have had one incident so far this year, and I hope it ends there. Definitely registering our school!


    • Wow, neither of your children use the toilets! I wonder if there are other parents with the same issue … Great to hear want to register your school for Toilet Tactics. Best way to do this is ask the school if they’re already registered (they may be, but not implementing it yet), and if not, we can send you or the school some information on the Kit. Give the Helpline a call on 1800 33 00 66 and they can handle it. Good luck!

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  • I was shocked to hear that this happens in our schools in this day and age, I am a 47 year old who is completely incontinent due to kidney reflux, reimplantation of ureters as a child which was done in a way that has caused damage that is irreversible, however I would probably have died from an infection so you live with what you are given, I can recall as a child my mother having to go to the school every teacher change and ensure that I had access to the toilets at all time, as holding on would cause infections and more problems, Unfortunately turns out my problems were hereditary, my daughter has actually lost one kidney, had her ureters reinplanted twice, and like me suffers constant bladder infections, I used to have to attend her school to ensure that she was never denied access to the toilet at any time. As recently as 5 years ago I was forced to become very terse with a principle who did not agree with me, so I returned with a letter from the urologist stating that holding on would possible result in infection which could lead to complications including death if she was denied unrestricted access to a toilet, This principle saw it my way after this and my daughter never had any more problems, But to deny any child a basic human function is disgraceful, I would also call it child abuse.


    • That’s a extraordinary story! So many people are unaware of the risks – I certainly wasn’t before I started working here. I think your story is so interesting, I’d love to write about yours and your daughter’s experiences in our consumer magazine, Bridge. If you’re interested, can you email me at bridge@continence.org.au and we’ll get in touch. Cheers, Maria

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  • can see both sides of the story, surely a one off isn’t going to harm. what if a child has gastro?

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  • I am appalled that this could be happening at my daughter’s school. I understand that they are there to be educated but to deny a basic human right is just wrong. I believe that this should be discouraged in all primary schools. High school could be considered different as the kids are older and should be more aware of their own personal toileting requirements. As a parent raising two girls I have always strongly encouraged them to go to the toilet as soon as they feel the need to go. I also enforce that they at least attempt to go before we get in the car for any short or long trip. I also encourage them to go as soon as we get home too before they get to engrossed in homework or after school playtime.


    • Great to hear your perspective. Just a couple of comments: try to limit the times you ask your girls to go “just in case” because the bladder’s capacity may reduce if it becomes a habit. So, going to the toilet before long car trips is a great idea, but don’t worry too much about short ones. And of course, just before bed, and that should be it!

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  • My son holds on for ages! I’m pretty sure its almost always because he is engrossed in play. Although sometimes it seems like he is being stubborn. He will jiggle around constantly, we call it the ‘wee wee wiggle’! If we ask if he needs to go, he always says no until he can’t possibly hold it any longer. I have to wash his underwear and pants every day because they will always smell a bit like wee. How can I curb this bad habit?


    • He sounds like an active little boy who’s got way more important things to do than go to the toilet. I’ve just spoken to our Helpline nurses who say perhaps he can be encouraged more strongly to go when he shows obvious signs. Does he go after meals? After naps? They’re always good times to take him. If you want more tips call one of our nurses on the Helpline 1800 33 00 66. They’re brilliant.

    Reply

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