Continence problems are among the most common paediatric health problems. It's commonly believed that continence problems resolve with age in all children. However, severe incontinence in childhood can persist into adolescence. New research has found teenagers with incontinence are at greater risk of underachieving academically, and need more support to remove barriers so they can reach their academic potential.
The prevalence of urinary incontinence in teens is around three to four per cent and around one per cent suffer from bowel incontinence.
The research by academics at the University of Bristol, and published in the British Journal of Health Psychology, explored the impact of the secondary school environment on young people with incontinence and is the only detailed qualitative study carried out in this area in the UK.
The researchers interviewed 20 young people aged 11 to 19 years [11 female and nine males] with continence problems including daytime wetting, bedwetting and soiling. Participants were recruited through five secondary care paediatric continence clinics (four in England and one in Scotland), and three through ERIC, The Children's Bowel and Bladder Charity and the only children's charity dedicated to bowel and bladder health. Seventeen of the participants were in full-time education, two attended sixth form college, and one had recently begun university.
Five themes relating to school experiences were produced from the data: boundaries of disclosure - friends and teachers; social consequences of avoidance; strict and oblivious gatekeepers; intimate actions in public spaces and interrupted learning.
The study found it was rare for young people to speak about continence problems at school to both friends and teachers, due to fears of being stigmatised, bullied or teased.
Not being able to tell teachers and other school staff, such as pastoral care staff, creates challenges in how best to support these young people. The study found there is a need to increase teachers' awareness of the frequency of continence problems in young people, and to provide guidance on how best to provide support at school.
The Medical Research Council-supported research recommends young people with continence problems need unrestricted access to toilets during the school day and adequate toilet facilities. There is also a need for schools to revise policies relating to toilet access and improve toilet facilities.
A worrying finding from the study is the impact of continence problems on learning and academic performance and the disadvantages faced by young people with continence problems. Participants said that their lessons were disrupted due to frequent toilet visits and those with severe daytime continence problems reported leaving the classroom three or four times during a lesson to use the toilet.
Participants in the study said they often fell behind during lessons, or missed out on time during exams due to needing to use the toilet. When toilet access was not allowed their concentration was affected either by the need to go to the toilet, or by feeling anxious about a possible accident. This is a particularly troubling finding as academic performance in secondary school has a direct impact on further education opportunities, and future employment.
Dr Katie Whale, Research Fellow in Qualitative Health Research in the Bristol Medical School, said: "Addressing the challenges faced by young people with continence problems at school could help remove the barriers so they can manage their symptoms successfully.
"It is particularly worrying that young people with incontinence are at greater risk of underachieving at secondary school. Increased support at school is essential to help young people with continence problems to achieve their academic potential."
Dr Carol Joinson, Reader in Developmental Psychology in the Bristol Medical School: Population Health Sciences and co-author on the paper, added: "Whilst the stigma of incontinence has been recognised in the past, the extent and level of stigma described by the participants in our study is powerful and surprising.
"Work needs to be done to improve the school experience of young people with continence problems and we are developing a prototype smartphone app to support young people to manage daytime urinary incontinence."
Early next year, Drs Joinson and Whale will start work with ERIC and teachers from secondary schools to produce online information resources for secondary school teachers and other educational services professionals. These resources will raise national awareness of continence problems in young people, increase teachers' understanding of their support needs, and provide an improved quality of life for those young people.
Juliette Randall, ERIC Chief Executive, said: "We hear time and again from parents calling our confidential helpline about the traumatic experiences their children and teenagers face at school. The powerful stories described in this research give us a strong basis for engaging with schools.
"We are delighted to be collaborating with Drs Joinson and Whale on this new project which will involve working with schools to co-create materials, raising awareness of the impact of continence issues as well as providing strategies to improve the school experience for young people."
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'Left behind and left out: The impact of the school environment on young people with continence problems' Whale, K, Cramer, H, and Joinson, C, British Journal of Health Psychology, 2017.