Poor Perception of School Toilets and Increase of Functional Constipation

Abstract

Objective A suggested mechanism of functional constipation (FC) is the refusal against painful bowel movements and a vicious circle of holding back stool, hardening, colonic dilatation and further painful defecation. The aim of this study is to describe perception of school toilets, prevalence of functional abdominal pain (FAP) and constipation in elementary schools. Design and Setting All elementary schools in Giessen County, Germany were contacted. Parents received a questionnaire on perception of toilets and criteria of functional abdominal pain and constipation in two consecutive years. Results 212 (76.5%) families responded the child would use the school toilet for passing urine always, commonly or regularly (ACR), only 92 (33.2%) did so for passing stool. 46 (16.6%) were always disgusted by their school toilets, further 145 (52.3%) reported to be disgusted commonly or regularly. 126 parents reported their child would retain stool to avoid using the school toilet (45.5%). Children who were disgusted by and avoided using the school toilet showed significant higher prevalence of abdominal pain ACR (23.6% vs. 11.2%, p=0.0103) Conclusions Prevalence of abdominal pain and constipation is high and increased after one year. Negative perception of school toilets with consecutive avoidance behavior could be an important and improvable influence.

Knowledge about Hand Hygiene and Related Infectious Disease Awareness among Primary School Children in Germany

“…Lower school children from Sweden gave a median of “3” in the evaluation of school toilets (1, terrible; 5, excellent) [ 46 ]. A parent survey conducted in Giessen (Germany) asked whether their children used the sanitary facilities at school [ 47 ]. Similar to our study, children´s avoidance behavior was evident in relation to toileting at school.…”

“…Similar to our study, children´s avoidance behavior was evident in relation to toileting at school. In addition, over 75.0% of parents indicated that children predominantly use the sanitary facilities to urinate only, but less for bowel movements [ 47 ]. Swedish school children also stated that the sanitary facilities at school were more likely used for urinating [ 46 ].…”

Paediatrics: how to manage functional constipation

“… 16 Children may also be deterred from using public toilets because of a lack of privacy or, more commonly, the absence of toilet paper and poor sanitary conditions. 17 , 18 Travelling disrupts the normal toilet routine and toilet facilities may not be easily accessible. A disturbed parent–child relationship and emotional stress may also result in irregular bowel habits in children.…”

Cows’ Milk Allergy-Associated Constipation: When to Look for It? A Narrative Review

“…Environmental, behavioural, immunological and genetic factors may contribute to functional constipation [ 9 , 12 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 ]. The typical mechanism is behavioural stool withholding because of pain, inflammation or anal fissure, which can lead to a vicious cycle of large, firm, painful stools and further withholding [ 12 , 18 , 19 , 20 , 21 , 22 ].…”

“…Environmental, behavioural, immunological and genetic factors may contribute to functional constipation [ 9 , 12 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 ]. The typical mechanism is behavioural stool withholding because of pain, inflammation or anal fissure, which can lead to a vicious cycle of large, firm, painful stools and further withholding [ 12 , 18 , 19 , 20 , 21 , 22 ]. Children with autism, neurological or motor disorders, developmental, psychiatric and behavioural conditions, atopy and food allergies and children exposed to abuse, violence or psychological stress are more prone to develop constipation [ 18 , 19 , 20 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 ,…”