October 16, 2015

School Bathroom Habits Impact Life-Long Bladder Health: Opening the Door to the Girls’ Room

If you are one of the 20 million women in the U.S. who have experienced leaking, wet pants, or leaving your seat at the movies or theater to run to the bathroom, take a look at your childhood [1]. Did you sit on your heel, were you told to “wait” or “hold it,” or were you too distracted to go to the bathroom?

If you have children, have you ever seen them behave similarly? Have you ever wondered if your child’s bladder is okay? Did you know that what children fear most, right behind the loss of a parent, is wetting their pants at school [2]?

If you answered “yes” to any of the above, read on. You’re not alone.

Every fall, there’s a significant threat to bladder health as young children attend school for the first time and older students adjust again to their school schedules. Many children of all ages are forced to change their normal toileting habits during school. Parents are in the dark, and teachers are unaware of the damage being done to kids’ bladder health.

A survey of elementary teachers showed that over 80 percent of teachers encouraged students to hold their urine. Many of these teachers admitted that they used rewards and even penalties to enforce toileting rules [3]. In middle school and high school, there are very short breaks between classes, and many students end up holding their urine all day long.

The bladder stays healthy when it fills and empties without getting overfull. This means your child needs to go to the toilet every two to three hours. Drinking water helps flush the bladder, and having a normal daily bowel movement makes it easier to empty the bladder [4]. Problems start when the bladder or bowel movement is forced to be held. Common problems include the need to urinate suddenly or very often, daytime accidents, bedwetting, urinary tract infections, stool accidents, and bladder pain [5]. In young girls, one in five have these problems, and many of them will carry these problems into their adult lives [6, 7].

Hall passes, bus schedules, or classroom rules should not control your child’s toilet habits. Your child, not the school, ought to be in control of their toilet habits.

Keeping in mind that most teachers have not been taught about bladder health, it is important to encourage your child’s, teachers, school nurses, and principals to implement a program to promote good bladder health at school [8]. Ask your child and their teacher about the present classroom toilet rules. Can your child ask to go to the toilet in a way that is not difficult or embarrassing? Are the toilets clean and safe? Is there time to go other than at lunch and recess, when children don’t want to go because they will miss eating and playing? Many children do not understand that they can urinate when they don’t feel full and so they may not go during a set toilet break. Even so, when they need to go, they should be allowed to go. The bathroom should always be open!

This year, the Society for Women’s Health Research (SWHR®) launched its Interdisciplinary Network on Urological Health in Women to promote bladder and urinary tract health across a woman’s lifespan. To learn more about the network or about urological health, visit swhrdev.wpengine.com. To learn more about healthy toileting for children, view this toolkit from the Continence Foundation of Australia.


1. NIH. State-of-the-Science Conference: Prevention of Fecal and Urinary Incontinence in Adults Final Panel Statement. Accessed https://consensus.nih.gov/2007/incontinencestatement.htm on October 6, 2015.

2. Ollendick TH, King NJ, Frary RB, Fears in children and adolescents. Reliability and generalizability across gender, age and nationality. Behav Res and Therapy. 1989; 27:19-26

3. Ko L, Champeau A, Copp H. Dysfunctional voiding in elementary schools- results from a cross sectional teacher survey. Society for Pediatric Urology 63rd Annual Meeting 2015.

4. Burgers R, Liem O, Canon S, et al: Effect of rectal distention on lower urinary tract function in children. J Urol 2010; 184:1680

5. Feldman AS and Bauer SB: Diagnosis and management of dysfunctional voiding. Curr Opin Ped 2006; 18(2): 139-147

6. Buckley BS and Lapitan MC: Prevalence of urinary incontinence in men, women, and children — current evidence: findings of the fourth international consultation on incontinence. Urology. 2010;76(2):265-70

7. Fitzgerald MP, Thom DH, Wassel-Fyr C, et al: Childhood urinary symptoms predict adult overactive bladder symptoms. J Urol 2006; 175: 989

8. Boyt MA. Teachers’ knowledge of normal and abnormal elimination patterns in elementary school children. J of School Nursing December 2005 21: 346-349