  Forced Retention of Bodily Waste: The Most Overlooked Form of Child Maltreatment
Letters from Parents About Denial of Toilet Usage in their Child’s School
The Medical Risks Of Forced Retention of Urine
The Medical Risks Of Forced Retention of Bowel Waste
Personal Stories from Children and Adults who Suffered Forced Retention of Bodily Waste
Personal Experiences of the Editor: Why I Take this Seriously
Media Stories Involving Children Being Denied Use of Toilet
What to Do if Your Child’s Teacher Restricts or Denies Toilet Use
University of Iowa Study: Elementary Schools Need A Lesson In Bathroom Breaks, by C. Cooper, M.D
Parents Attack bathroom Policy: The New Jersey Times Feb, 16, 2004
Letter to the New York Times Re: "Teacher in Urination Flap", by Laurie A. Couture, February 11, 2000
Letter from a Registered Nurse Re: Toilets Locked in PA
Letters from Helpful Organizations
Letter from a retired school teacher who respected children's rights
Teacher Arguments About Toilet Use Restrictions
& Research-Based Answers
IMAGE: First graders, Wesley School, Houston, Texas: "One of the school's special aspects is its regimented bathroom break every morning," Contra Costa Times, February 11, 2001.
The Medical Risks Of Forced Retention of Bowel Waste
© 2004 by Laurie A. Couture, M.Ed, LMHC
""Traditional school schedules... reflect our culture’s denial of the needs of the human body. An examination of these schedules is likely to uncover rigid toileting schedules in lower grades and only short breaks allotted between classes in upper grades." "
-Cheryle B. Gartley
President, Simon Foundation for Continence
""The denial of bodily functions is so deeply ingrained in our culture that it is actually possible for people to be cruelly unsympathetic about the need to use a toilet, even though them have probably been in similar situations themselves."
-Rebecca Chalker and Kristene E. Whitmore, M.D.
Authors, Overcoming Bladder Disorders
The rigid toilet use policies common in most schools run contrary to medical information on healthy elimination habits- and actually place young people at risk for urinary and bowel problems. This article discusses issues in children’s bowel health.
Medical advice for prevention of bowel health problems:
"Drink 1 1/2 to 2 quarts of water... every day. Drink extra fluids in the morning... urges usually occur sometime after meals. Establish a daily routine... Go when you feel the urge. Your bowels send signals when a stool needs to pass. If you ignore the signal, the urge will go away and the stool will eventually become dry and difficult to pass." (Healthwise Handbook, 14th Edition, Steveb L. Schneider, MD, Medical Editor, 1999)
"Drink at least six to eight glasses of water or other liquids every day... Do not resist the urge to move your bowels... To reduce your risks of fecal impaction... Heed the first urge to defecate." (Mayo Clinic Family Health Book, second edition, David E. Larson, MD, Editor-in-Chief, 1996)
"Make a conscious effort to go to the toilet promptly whenever you feel the need." (The American Medical Association: Guide to Your Family’s Symptoms, Clayman and Curry, Medical Editors, 1992)
"Encourage regular toileting". (National Safety Council: First Aid and CPR for Infants and Children, Third Edition, 1998)
"Teach your child good toilet habits. Help your child develop the habit of sitting on the toilet regularly... Your child should remain on the toilet for about 10 minutes, even if he or she does not feel the urge to have a bowel movement." (The American Academy of Pediatrics Information sheet, American Family Physician, Vol. 65, #11/ June 1, 2002)
"Ideally, constipation should be prevented by attention to the diets of young children, by providing advice to parents on pot training, and by revolutionizing the design of school lavatories and the rules about their use... a more child-oriented provision of lavatory facilities in schools and public buildings..." (Pediatric Gastrointestinal Disease, Vol. One Second Edition, Chapter 20, Murphy and Clayden, 1996. [Italics and boldface added])
"It goes without saying that the best treatment for encopresis is to avoid stool withholding..." (Joseph Levy, MD, 2004 My Tummy Hurts)
"Your doctor will... encourage you to take adequate time for moving your bowels and not to suppress the urge to have a bowel movement... Frequent use of laxatives can be just as harmful as deliberately ignoring the need for regular elimination." (WebMD Health, Constipation, and Constipation: Detection and Treatment 2002)
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Health risks associated with fecal retention:
- Constipation
- Stool impaction
- Encopresis (bowel incontinence)
- Weakening of the brain-bowel signals
- Bowel obstruction
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How does delaying elimination put a young person at risk?
Regarding causes of fecal impaction: "Failing to heed the call when your body tells you it’s time for a trip to the bathroom." (Mayo Clinic Family Health Book, second edition, David E. Larson, MD, Editor-in-Chief, 1996)
"Lack of fiber and inadequate water in the diet are common causes of constipation. Other causes include inactivity, (and) delaying bowel movements..." (Healthwise Handbook, 14th Edition, Steveb L. Schneider, MD, Medical Editor, 1999)
"Do you often resist the urge to defecate because you are too busy?... Putting off defecation may lead to a loss of normal bowel reflexes, causing constipation." (The American Medical Association: Guide to Your Family’s Symptoms, Clayman and Curry, Medical Editors, 1992)
"Constipation: What you should know... (Constipation is) sometimes caused by postponing or resisting (the) urge to eliminate." (National Safety Council: First Aid and CPR for Infants and Children, Third Edition, 1998)
Regarding Constipation: "Initiating Factors- The ‘Vicious Circle’ Concept: ...Suggested precipitating factors have included... inappropriately early or overzealous attempts at toilet training and difficulties of access to toilet facilities. Such potential precipitants may lead to increased difficulty with defecation or deliberate withholding behavior. retained stool becomes progressively more difficult to evacuate as a result of prolonged absorption of its water content, leading to a vicious circle in which the rectum is increasingly distended by abnormally firm fecal contents.... Finally, chronic fecal distention may lead to loss of rectal sensitivity and hence of normal defecation urge." (Pediatric Gastrointestinal Disease, Vol. One Second Edition, Chapter 20, Murphy and Clayden, 1996. [Italics and boldface added])
Regarding fecal incontinence: "...Stool retention may begin simply because of a lack of a convenient, private or clean toilet. For example, a yougster may be ona long ride in an automobile... For older children, access to toilets at school can sometimes become a problem, since teachers may ask them to wait to go to the bathroom." (Dorsky and Dorsky, Digestive Health and Nutrition, American Gastroenterological Association, Nov/Dec 1999. [Italics and boldface added])
"Constipation is a very common problem: probably one of every four patients seen by a gastroenterologist is there for stooling difficulties... When a child is constipated, stool builds up and overfills the large intestine. The consequent overstretching causes a diffuse pain below the bellybutton... The stool buildup causes increased pain every time food is taken in, because of the gastrocolic reflex... Prevention is one of the best treatments for constipation...An effective routine to avoid constipation involves attention to the following areas: Sufficient fluid intake, Sufficient fiber intake, Regular exercise (and) Anticipatory guidance to prevent stool withholding." (Joseph Levy, MD, 2004 My Tummy Hurts)
"Encopresis is usually caused by chronic constipation. When stool is withheld, the rectum is progressively overstretched until the child loses the ability to sense the presence od stool. When the message is consistently disregarded, the brain eventually grows to accept the distension as the normal state, and ignores the signals." (Joseph Levy, MD, 2004 My Tummy Hurts)
"(Stool withholding is)...repetitive attempts to avoid passing stool... The child learns to contract the muscles of the pelvis in response to the urge, and a large amount of stool progressively accumulates in the rectum... When the muscles get tired and relax, the child will have an accident, soiling the underpants." (Joseph Levy, MD, 2004 My Tummy Hurts)
"According to Dr. (Wayne) Yankus, 90% of kids today are constipated because they don’t have enough time in the bathroom..." (Parenting New Hampshire, Child’s Health an Important Part of Planning for Back-to-School, August 2003. Note: Dr. Yankus was the former chair for school health for the American Academy of Pediatrics)
"Heed the call of nature Go to the bathroom when you feel the urge to eliminate, not just when it’s convenient." (Natural Health The Scoop on Poop, Martiga Lohn, April, 1999
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Bowel circumstances that rigid school bathroom policies do not take into consideration:
- The urge to defecate can occur five minutes to an hour after meals
- It is normal for people to need to defecate at the same time every day
- The individual’s daily time/s to defecate may be contrary to school schedule
- Individual differences in fluid intake
- Individual differences in food intake
- Individual differences in body type
- Individual differences in digestion transit times and waste production rates
- Individual differences in pain tolerance level
- Individual differences in intensity of brain-bowel signals
- Individual differences in anxiety levels (anxiety increases diarrhea)
- Individual differences in physical health
- Genetic predispositions to inflammatory bowel disease
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