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Dysfunctional elimination behaviors and associated complications in school-age children

Mary Kistner1

  • 1General Surgery Department at Children's Medical Center Dallas, 1935 Medical District Drive, Dallas, Texas, USA.

The Journal of School Nursing : the Official Publication of the National Association of School Nurses
|February 24, 2009
PubMed

Insights

School bathroom conditions can cause children to withhold urine and stool, leading to dysfunctional elimination syndrome (DES). Addressing environmental factors and respecting individual needs are crucial for prevention.

Area of Science:

  • Pediatric Health
  • Environmental Health
  • School Nursing

Background:

  • Inadequate school bathroom facilities (lack of privacy, hygiene, safety) can lead to children withholding urine and stool.
  • Chronic withholding behaviors can result in dysfunctional elimination syndrome (DES), characterized by abnormal voiding and stooling patterns.
  • DES can cause serious health complications, including urinary tract infections, vesicoureteral reflux, and incontinence.

Purpose of the Study:

  • To highlight the role of school environmental factors in the development of dysfunctional elimination syndrome (DES) in children.
  • To emphasize the need for school officials to recognize and address the impact of bathroom conditions on children's elimination habits.
  • To advocate for improved school bathroom access and conditions to prevent DES.

Main Methods:

  • Review of existing literature on DES and environmental factors affecting children's elimination.
  • Analysis of the contributing factors within school environments that may lead to withholding behaviors.
  • Discussion of the responsibilities of school officials in preventing DES.

Main Results:

  • Poor school bathroom conditions and rigid scheduling contribute to learned urine and stool withholding in children.
  • DES is a significant consequence of these withholding behaviors, leading to potential urological and gastrointestinal complications.
  • School nurses are identified as key stakeholders in advocating for and implementing evidence-based improvements.

Conclusions:

  • School officials must create supportive bathroom environments that respect children's individual needs and promote healthy elimination habits.
  • Proactive measures by school staff, particularly school nurses, are essential for preventing DES and its associated health issues.
  • Improving school bathroom accessibility, privacy, and hygiene is critical for pediatric health and well-being.

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