‘Later toilet training may be associated with an increase in bladder and bowel issues’

That is not surprising. Although incidence reduces with increasing age, continence difficulties are among the most common medical problems to affect children and young people.

The expectation that continence will be achieved by the time a child is ready to start full-time education remains. However, this is a skill that is being taught later than in previous generations due to changes in parenting styles, culture and resources.

Furthermore, disability may result in assumptions that toilet training will inevitably be delayed.

Little or no support may be offered to families in areas where there is no children’s continence service and this may result in issues such as constipation being missed.

There is now some evidence that later toilet training may be associated with an increase in bladder and bowel issues.

Furthermore, the private nature of toileting makes this an area of development and health that is not easily discussed and professionals with limited time may not initiate a conversation about it.

"Without treatment, continence conditions may continue to negatively impact quality of life for the whole family into adolescence and beyond"

Bladder and bowel problems at any age are associated with stigma, shame and embarrassment. This may be one reason why families do not seek help for younger children and that symptoms remain largely hidden in those attending secondary schools and colleges.

Without treatment, continence conditions may continue to negatively impact quality of life for the whole family into adolescence and beyond.

They result in social isolation, reduced self-esteem, cause behavioural and psychological problems and may lead to inappropriate punitive responses from desperate or frustrated parents.

Educational establishments are facing huge demands against a background of a long period of austerity resulting in reduced resources.

Increasing numbers of learners in mainstream schools have additional needs; schools have to identify learners with mental health issues, tackle problems around knife crime and gang culture, ensure learners are protected from radicalisation and extremism, understand safety online, as well as focus on safeguarding, progress, attainment and a myriad of other issues.

Teachers want to support learners, so that they reach their potential. They care and they work hard. However, if they do not have the correct information, they may make assumptions.

Some of the concerns that children and families express are about students not being allowed open access to the toilet, dirty or poorly stocked school toilets, parents being called in to assist a child to change after an ‘accident’, or children missing school due to continence-related symptoms or appointments.

The latter two have an impact on educational achievement and parents’ employment, with some even having to give up working altogether.

However, if educators are not informed about the nature and impact of the problems, they will not be able to provide appropriate responses.

It was against this background and enquiries from school nurses and health visitors about what schools legally have to provide that Bladder and Bowel UK and ERIC decided to write a comprehensive document to plug the gaps.

Managing Bladder and Bowel Issues in Nurseries, Schools and Colleges was published in October 2019 and is free to download from both the Bladder and Bowel UK website and on the ERIC website. It has been widely reviewed and is supported and/or endorsed by several professional organisations.

The new guidance document includes sections on the impact of continence issues on children, how children develop continence, why some children have difficulty toilet training, the causes of continence problems, how schools can promote good bladder and bowel health, health and safety, safeguarding, an index of continence issues and aids and treatments to support continence conditions, as well as a section about relevant legislation in the different countries of the UK.

There is a sample intimate care policy and care plan which are also available in word versions on the respective web pages, so that educational establishments may adapt them for their own use.

Both Bladder and Bowel UK and ERIC continue to provide confidential helplines and information leaflets to support professionals, families and young people who are affected by continence conditions.

Davina Richardson is a children’s specialist nurse at Bladder and Bowel UK