A pediatric urologist explains why young students should have free access to the bathroom during school.

By Steve Hodges, M.D.
September 28, 2015
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Should K-12 students have open access to school bathrooms so they can freely heed nature's call? Or should teachers limit bathroom passes so kids don't disrupt class or screw off in the hallways?

Controversy erupted on this issue last week when a Houston mom vented on TV about the policy at her son's school. According to the mom, Sarah Moreno, students were told they could earn restroom passes—"coupons"—for good behavior. Said Moreno: "We should all just have the right to go to the bathroom, period, because we're alive on Earth."

The school district countered: "The restroom...coupon is simply one of many incentives created by classroom teachers to motivate and encourage students to maximize their instructional time."

Then a parenting blogger mocked Moreno on Facebook, unleashing charged retorts on both sides.

As a pediatric urologist, I stand with Moreno.

Though I'm sympathetic to the challenges of managing a classroom, I believe students must be allowed to use the restroom when the urge arises—not 10 or 20 or 60 minutes later. It's a health issue, and it's no joke. Suppressing the urge to pee can damage a growing bladder, thickening and aggravating the bladder wall and increasing a child's risk for accidents, bedwetting, and urinary tract infections.

Ignoring the urge to poop wreaks even more havoc, as I explain in our free download, "The K-12 Teacher's Fact Sheet on Childhood Toileting Problems." Stool piles up, stretching the rectum and pressing against the bladder. Constipation, epidemic among U.S. children, causes increased urinary frequency and urgency and is the direct cause of virtually all bedwetting as well as daytime accidents. Some of these accidents occur in the classroom or on the gym floor.

Yet school districts nationwide routinely restrict restroom access, by limiting passes and even by locking restrooms at lunchtime or after school, when kids head to the bus. (Never mind that students may have a 45-minute ride home.)

Other schools dangle prizes for not using bathroom passes. Students can earn trinkets, "money" for the student store, even pizza parties—all for ignoring their bodies' signals.

I know this happens because my patients tell me and because I talk to teachers and school nurses. A new University of California at San Francisco survey of 4,000 elementary teachers confirms these practices are common. In the survey, presented at a recent American Urological Association meeting, 36 percent of teachers reported rewarding students who don't use restroom passes or punishing those who do.

Guess what happens when kids are rewarded for holding their pee? They hold it!

As one mom posted on Facebook: "My daughter was holding her bladder—or, at worst, coming home with damp panties because she couldn't hold it—so she wouldn't 'waste' her pennies on a potty break." (Students in that class earn "pennies" for good behavior and can use their pennies to "buy" a bathroom pass or shop at the class store.)

Schools may consider this evidence that these policies work. Students stay in class! The halls are clear! But what "success" really means is that kids are damaging their internal organs—and self-esteem. Truly, nothing is more mortifying for a child than having to traipse to the school nurse with pee-soaked pants.

Few teachers receive training on childhood toileting problems—only 18 percent, according to the UCSF survey — so it's unsurprising that teachers may not realize their bathroom policies pose health risks to students.

Still, it surprises me when teachers assume students requesting to use the bathroom are trying to game the system.

One Facebook commenter, a former teacher, insisted that when students ask for a bathroom pass, it's for reasons unrelated to biology, including "boredom, curiosity, to play around in the bathroom, because their friend needed to go, to get out of doing other things."

She wrote that Sarah Moreno and her defenders "obviously never had to try and teach a class full of children who need to go to the bathroom all day long."

This woman obviously has never worked in a pediatric urology clinic! When kids need to use the bathroom urgently or frequently, it's often because constipation has irritated their bladder nerves, causing the bladder to hiccup. If a student frequently and/or urgently requests to use the bathroom, that's a red flag for constipation (see our free download, 12 Signs a Child Is Constipated"), and the teacher should alert the parents and school nurse.

This former teacher continued on Facebook: "I don't get up during meetings to go to the restroom. That's not how life works, people."

Yikes, harsh! This person is an adult—with a fully grown bladder, unlimited bathroom access, and no fear of being bullied in a restroom stall at lunchtime.

Interestingly, the UCSF teachers survey was conceived and co-authored by a former teacher, Lauren Ko, now a Harvard University medical student. Before entering med school, Ko taught second grade at a Bronx school that limited bathroom access to certain times of the day.

"I noticed kids having accidents in the classroom," Ko told me, "and I know it was really humiliating for them."

I know teachers have the very tough job of managing a classroom on top of countless other stresses, and I know there will always be students who take advantage. But if students who claim they have to pee are in fact roaming the hallways, surely measures can be taken that are unrelated to restricting bodily functions.

As one mom posted on Facebook: "Using the bathroom is a biological necessity, not a privilege to be earned or denied."

I couldn't agree more.

Steve Hodges, M.D., is an associate professor of pediatric urology at Wake Forest University School of Medicine and co-author, with Suzanne Schlosberg, of It's No Accident and Bedwetting and Accidents Aren't Your Fault.

Comments (2)

September 1, 2019
I am a teacher, and I ALWAYS go to the restroom during meetings! I would like to let my kids go when they need to, but other teachers have suggested I stop doing that. They complain about my kids when they go to the restroom! I kid you not. Also, my principal is inconsistent re bathroom use. One year, she said she was going to put kids in diapers. On the other hand, when one student asks to go to the restroom, I always say yes, but then two minutes later ALL the kids ask to go. So, I have 5 minutes between requests policy. I also have restroom breaks after playtimes and eating times. Still, all this is hard to do when my entire school limits restroom use and the principal's policies blow with the wind.
December 21, 2018
As a student, I can definitely confirm a lot of these bathroom rules. At the school I am currently attending, we have passes for the bathroom given to us every day. We are allowed to use them twice throughout the day. However, in order to use the restroom, we must have a teacher sign the pass with the time, and our name, and the date must be on it. Along with that, there is a key, and only one person is allowed in the bathroom at a time. This may seem like a good idea, especially with a small student population, but it gets on my nerves when I have to go at lunch, and they make me go to the bottom floor, get a pass signed, and come all the way back up to the third floor, get the key, and then I can use the restroom. That takes ten minutes at least, and it takes away from my eating time, which is limited to 30 minutes. So I get at max 20 minutes to eat and socialize, leaving very little fuel for my body. THE REAL WORLD IS NOT THAT STRICT! I can't wait until college, where you at least feel like an adult.