Promoting
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Water, toilets and health This section gives an overview of the problems with school toilets and the health effects this can have. How to improve fluid intake amongst pupils and the role of diet are also covered. If you want, you can print off factsheets which contain some of this information. You can also read about the government's Healthy Schools initiative and on the same page find out about our new School Toilet Award which is being piloted with Healthy Schools. We have written a printable glossary of toilet-related terms which you may find useful. Summary For children and young people to stay healthy, they need to drink water regularly throughout the day. They also need to empty their bladder and bowels regularly and fully when they need to. During term time, children and young people spend at least half their waking hours at school, so how much they drink and how often they go to the toilet are important. Breakfast clubs and staying on after school make this even more critical. Some pupils avoid the toilet at school because the toilets are unpleasant, dirty, smelly, not private enough, lack basic hand washing and drying facilities or are where the bullies and smokers gather. Or pupils may not be allowed to go when they need to. These problems mean they may ‘hang on’, often until they get home, which results in a number of health problems. Pupils may not drink enough, because they don’t want to have to go to the toilet or because they are not allowed to go when they need to. The resulting dehydration and constipation can also cause ill effects, such as tiredness, headaches, and difficulty concentrating. Health effects caused by bad toilet habits also include bladder infections and continence problems. In the long term, these can contribute to serious illnesses, such as kidney disease. Problems of toileting in schools
Health effects of poor toilets and not being allowed to go Bowel Problems
Bladder Problems
Other Health Issues Among the most common causes of constipation in pupils are:
If children don’t empty their bowels when they feel the need to, then the stools are drawn back up into the bowel and the urge to go disappears. If this is done frequently enough, stools build up and constipation results. As the body gets used to carrying more stools, the bowel gets less efficient at signalling it needs to empty. This leads to repeat bouts of constipation. Constipation is also caused by dehydration. As water is very precious, the large bowel normally absorbs a lot of the water back into the body so that all that's left is nearly solid waste (stools). When the body is dehydrated however, the body conserves the water it has by taking extra water than normal from the large bowel. This results in dry and hard stools, which are difficult to pass. Back to topSoiling is the accidental passage of faeces (stools or motions) as a direct result of chronic (long-term) constipation. Regular soiling incidents occur in about 1 in 75 children aged 6 – 10. How can a child be soiling if they’re constipated? What happens is that some stools can bypass the larger ones in the bowels, or some stools can break away and leak out. Soiling may be the first symptom of constipation that the child has. In fact, chronic (long term) constipation is said to be the cause of soiling in 95% of affected children. It is important to remember that the child has no control over this happening so the soiling is never the child’s fault. Daytime wetting affects over 125,000 young people aged 5 – 16. It can often be the cause of great shame, stress and anxiety. Wetting your pants in class, for example, can be seen as a major disaster. The impact of daytime wetting should not be underestimated by parents/carers and teachers. The majority of children achieve full bladder control by the time they are 4 years but some children can take a bit longer without there being any clinical/physical cause. However, for a small number of children, daytime wetting occurs as a result of an underlying bladder problem. It is wise for these children to be seen by a doctor and/or nurse. If children do not drink adequately during the day, their urine becomes concentrated. This can irritate the bladder and may contribute to daytime wetting. Not drinking enough can also reduce the amount of urine the bladder can hold. The bladder is a muscular bag that acts as a reservoir to store and expel urine. A few people will have bladder muscles that are “overactive”, a term used when the bladder contracts before it is full. This gives the sensation of needing to go urgently. The following things can irritate a bladder and cause it to empty before it is full:
The following things can irritate a bladder and cause it to empty before it is full: Signs of an overactive bladder are
Some children (particularly girls) have a problem with their bladders that result in it not emptying properly. Normally every time we go to the toilet to pass urine our bladders empty completely. Some children do not empty their bladders completely leaving behind some urine (residual urine). These children can be encouraged to learn how to sit on the toilet correctly. They can also return to the toilet a short time after a visit to try to pass urine again. This will help ensure the bladder has completely emptied. In order to do this, children need not only the time to do this, but also a clean toilet seat otherwise they will not want to sit on it! Urine left in the bladder after a wee can ‘stagnate’ and lead to a bladder infection. Children with residual urine are at risk of developing urinary tract infections. A urinary tract infection (UTI) is an infection in the urine e.g. cystitis. Not drinking enough can also increase the risk of a UTI, as this allows bacteria to develop in the urine. The infection can sometimes then travel up to the kidneys where it becomes much more serious. Concentrated urine (where it’s too strong due to not enough water being drunk) also increases the risk of kidney stones. Dysfunctional voiding is urination that stops and starts due to muscle contractions that the person has no control over. It usually happens in people with long term bladder problems. It means that the sufferer cannot empty his or her bladder fully. This problem is also associated with residual urine. The child needs free access to clean toilets which are comfortable enough to sit on in the correct relaxed posture. Otherwise, urinary tract infections can result in damage to the kidneys and, ultimately, renal (kidney) failure. Back to topBedwetting (nocturnal enuresis) affects well over half a million young people, or two or three children in a class of 30 ten year olds in the UK. There are 3 main reasons for bedwetting:
Increasing water intake during the day will help to increase the amount of urine the child’s bladder can hold (bladder capacity). The bladder adjusts its size according to how much we drink. The more a child drinks regularly throughout the day, the more the bladder capacity will improve, enabling it to hold onto more urine overnight. It is quite common for children and young people to be unable to use the toilets when there are lots of other pupils around. This is one of the reasons why pupils need to be allowed to go to the toilet during lessons - the only time that offers privacy. Problems with school toilets can lead to embarrassment and anxiety and even to phobias. Bodily development during puberty can exacerbate these. One severe condition that can develop as a result of problems with school toilets is Avoidant Paruresis (AP). This means that it can be difficult or impossible to urinate in the presence, real or perceived, of others. Common names for the condition are Shy Bladder, Bashful Bladder or Pee Shy. A medical description is Psychogenic Urinary Retention. It affects both men and women, of all ages and backgrounds, but is more prevalent in men. It is thought to affect 7% of the population, or 4 million, in the UK. In severe cases, adult sufferers can become virtual prisoners in their own home. Little research has been done into the condition, but a common factor in those who have spoken out about AP is that they may have developed it during their time at school. Many paruretics (sufferers of AP) associate their condition with habitually avoiding using school toilets, holding on until they got home. This behaviour may have been prompted by a single unpleasant or upsetting incident in school toilets. Others cannot recall specific events like that, although they do refer to the state of the toilets, not being allowed to go when they needed to, and uncontrolled, anti-social behaviour in toilets. Sustained school toilet avoidance may be sufficient to initiate the onset of paruresis. Toilets literally may have become a 'no go area'. Later in life, unconscious psychological mechanisms may exert a blocking effect: the roots of paruresis. To read more about this condition read this factseet. This condition can also affect people's ability to defecate, though by its nature this is usually less of a problem. An information site about this may be found at http://home.freeuk.net/parcopresis/ Water is vital for maintaining health and well being. Humans are around 60% water. Water is lost through things like breathing, urinating and sweating, and it is vital that it is replaced daily. If that percentage falls by as little as 1 – 2% we become dehydrated. The early signs of symptoms of dehydration include:
Most children show no obvious visible signs of dehydration. Symptoms of mild dehydration can be difficult for teachers to spot. Lethargy, irritability and lack of concentration may be considered normal during most afternoons in class. However these signs may be due, at least in part, to the effects of dehydration. Being dehydrated on a regular basis can lead to the following bladder and bowel problems:
For more about water see Water, toilets and health – fluid and diet. ERIC also has produced some booklets for parents that can be purchased from the ERIC online shop at www.ericshop.org.uk.
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