What is the impact of continence problems at school?

Daytime continence problems can have a significant impact on self-esteem, wellbeing and socialisation, as well as learning for the children affected. School staff are not health trained and many do not understand that children can have a medical problem affecting their bladder and/or bowel and are often at a loss to know how to help.

Many adults do not appreciate that children, particularly younger ones may not be aware that they are wet or have soiled and may assume that the child has a behavioural problem. Rules around access to the toilet and drinks can adversely affect all children, but tend to have a disproportionate impact on those with continence difficulties and disabilities.

The role of the healthcare professional
This leads to the question of what can healthcare professionals working with children and young people do to support. The impact of transfer of school nursing and health visiting to a public health role with constraints of commissioning and budgetary restrictions seems to be increasing, but the problem cannot be ignored. There are some simple and fairly quick measures that can be put into place, which are likely to have positive effects:
Health nurses can discuss timely toilet training and explain issues around bladder and bowel health with families at developmental checks. They can signpost to appropriate sources of information, such as those on our website and alert families to early signs of constipation and how to address these.

School nurses can be alert to signs of continence problems at school entry, provide first line advice and refer on if necessary. They can explain continence problems to school staff, ensuring that they understand that inadequate or dirty toilets, which provide poor levels of privacy and where poor student behaviour is unchecked, can discourage students from using them. This may result in pupils avoiding drinking and withholding urine and faeces during the school day.

Schools should be encouraged to consider their policies with respect to access to water bottles and toilets during the day. Staff may also need explanations of normal fluid intake in school age children and to be reminded of the educational and health benefits of children being reminded and encouraged to drink regularly throughout the school day.