Managing Bladder and Bowel Issues in Nurseries, Schools and Colleges
Problems with bladder and bowel control are among the most common medical conditions that children and young people experience. They are thought to affect over 900,000 people aged between 5 and 19 years of age, although this is likely to be an underestimate. Due to embarrassment, stigma and the mistaken belief that they children will grow out of the problems, many families do not ask for help.
There have been lots of press reports in the last few years about increasing numbers of children starting school in nappies.
Sometimes it is thought that families are not trying to toilet train their children. However, this is rarely the case. Most families do all that they can to support their child’s development but may not have any knowledge or experience with toilet training. They may have been advised to wait until their child is ready, without being given any information about what this means. There is some evidence that toilet training later than used to happen in previous generations, may be causing an increase in the number of children who have difficulties with continence (being able to stay clean and dry). Some children may have an underlying problem that makes toilet training more difficult such as constipation, sensory differences or a physical or learning disability.
For primary aged children problems with bladder or bowel control may arise as the result of an underlying condition.
Bedwetting, needing the toilet at short notice (appearing to leave it to the last minute), needing to go more frequently than is typical, or constipation may all impact on school. As bladder and bowel conditions are not talked about very often, there is a lack of understanding that these affect children of all ages. Therefore, teachers may understandably think that the child who is fidgeting because they need the toilet is just not concentrating or has behaviour problems. They may also think that the child who is asking to go to the toilet frequently is trying to escape from classroom routines or difficult work.
For older children and teenagers, management of bladder and/or bowel difficulties in school and college may be especially challenging. There is an expectation that they will use the toilet at break times only, with some schools and colleges even locking toilets at other times. Many young people report feeling isolated. They worry that telling others about their problem may result in bullying, or that teachers will not understand that they have a medical condition. The need to hide the problem and the difficulty of getting to the toilet as and when they need can affect mental health as well as learning.
Over the last few years, the national charities Bladder & Bowel UK and ERIC, the children’s bladder and bowel charity, have had numerous calls to their helplines from worried parents, carers and school staff.
We have also had conversations with school nurses and children’s continence nurses who all told us that there was a lack of understanding of the causes of the problems and a lack of awareness of the role schools can and should play in supporting those affected by these conditions. The schools are very keen to help but need support.
Consequently, Bladder & Bowel UK and ERIC have come together and written a new document to fill the gap. ‘Managing Bladder and Bowel Issues in Nurseries, Schools and Colleges Guidance for School Leaders, Proprietors, Governors, Staff and Practitioners’ was published on 8th October 2019 and is available on the charities websites. It aims to be a comprehensive guide for education settings to help them to understand the numbers of children affected, the causes of the problems and what they can and should be doing to help. It includes the relevant legislation for the four countries of the UK, a sample intimate care policy, a sample care plan and a comprehensive index of continence conditions as well as a directory of sources of help.
Bladder & Bowel UK also have a confidential helpline for those who have bladder and/or bowel issues, for their families and for the professionals who support them at email email@example.com or on telephone number 0161 607 8219.
Bladder & Bowel UK have more information about toilet training, day and night time wetting, constipation and other children’s and adults’ bladder and bowel health issues, on their website at www.bbuk.org.uk.
This post was written by Davina Richardson, Children’s Specialist Nurse at Bladder & Bowel UK.