Doctors say it’s not good for pupils to ''hold it in''
The Virginian-Pilot, December 5, 2003

When you gotta go, you gotta go. So let them go, a group of doctors is advising elementary-school teachers.

In a recent issue of a medical journal, five urologists from the University of Iowa found that most elementary teachers don’t allow children to go to the bathroom if it’s not during a scheduled break.

That may fit the teacher’s academic schedule, but it might imperil children’s health, warned the study’s lead author, Christopher S. Cooper.

Before they gain full control of their bladders, the holding-it-in approach could lead to problems such as incontinence and urinary tract infections.

Principals at local elementary schools, including Norfolk Collegiate, Pembroke Meadows in Virginia Beach and Young Park in Norfolk, say their teachers are bathroom-permissive. Usually, they said, students may take bathroom breaks throughout the day.

“To protect instructional time, we hope we can take care of all the necessities at given points during the day,” said Laguna O. Foster, from Young Park. “But we fully understand that there are individual needs.”

Dr. Carolyn Riegle, though, regularly sees children with problems whose bathroom times she feels are too regimented by teachers.

“Some of it can come from a child embarrassed to ask the teacher to use the bathroom,” said Riegle, a pediatrician with CHKD Medical Group’s Pediatric Associates. “Sometimes young children don’t ask because they’re frequently told no by the teacher.”

And some “say that the teacher will say things like: 'When I’m finished with this lesson, we’re going to have a break in 10 minutes. If the child already has a problem, then 10 minutes is too long.”

Riegle said: “I am very against legislated bathroom breaks in schools and for children. I think children should be allowed to use the restroom when they have to.”

Another pediatrician, Dr. Glenda Karp, believes “most teachers regularly use very good judgment.” But sometimes youngsters “feel rushed when they go,” said Karp, from CHKD Medical Group’s Tidewater Children’s Associates. “The teacher is waiting for them. They empty just what they need to, but not completely.”

And that, she said, “can set them up — both boys and girls — for urinary tract infections.”

The clinical term for the problem is “dysfunctional voiding.” The article by the Iowa professors, published in the Journal of Urology, is titled: “Do Public Schools Teach Voiding Dysfunction?”

They surveyed nearly 500 elementary teachers in Iowa. Overall, 40 percent permitted children to go to the bathroom anytime. The “most favorable bathroom conditions” occurred in kindergarten, where 69 percent of teachers didn’t limit breaks.

Cleanliness is also a problem: Forty-eight percent said the conditions of boys’ bathrooms became “progressively worse” during the day. The number was 36 percent for girls.

For Cooper, the most glaring result was that 18 percent said they had been taught anything about “normal or abnormal voiding.”

Karp said it’s important to know that young children go to the bathroom four to seven times a day. That means they may have to go three to five times during school, she said.

Cooper knows the constraints binding teachers — his wife and father-in-law are teachers — but he’d still like to see children getting free passes to the bathroom. It might even help their education.

“If a child is sitting in class and has to go to the bathroom and isn’t allowed to, they’re going to have a hard time concentrating on anything except not wetting their pants.”

Reach Philip Walzer at 222-5105 or

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