Holding behavior for pee and poo is likely for our children in school. This causes “border conflicts” between the colon and the bladder in the lower abdominal area creating confusion and instability of both organs. This can increase the risk for both bladder and bowel accidents. The second most common onset of encopresis is associated with going to school. Why is this? Moving about in the classroom may be seen as disruptive and there is a tendency by teachers at teaching moments to ask the child to “hold” for a bathroom visit for just a bit, which then is forgotten and the child may experience less urgency. Even a teacher’s unguarded, automatic look of disapproval or irritation may intimidate the child to not annoy the teacher. Holding is even more likely in the school lavatories because of noises, the awareness of the presence of others, filth, smells, farting sound, lack of toilet paper, etc. for what is regarded as a very private act. Toilet paper may be lacking. The child may have concerns about “germs” because of home teachings. Our culture promotes all manner of negative associations and concerns with what is often viewed as this private, sexual, dirty area of our bodies.
School can be stressful and exciting for a child which sets up a much less active GI tract during the majority of the school day, a sympathetic nervous system dominant state. This promotes a drying out of stool. Also, the child is likely to drink much less during the day causing more drying out the stool and helping the child to avoid having to pee. However, as the end of the school day approaches the child is much more likely to relax anticipating their return home. This can cause a “rebound,” a para-sympathetic dominate effect, which promotes a much more active GI tract and the likelihood of accidents. If he/she has been avoiding drinking then they will drink more after school and be more subject to bladder accidents for that reason as well.
An important and highly readable book, It’s No Accident: Breakthrough Solutions to Your Child’s Wetting, Constipation, and UTIs, and Other Potty Problems was published in 2012 by a Pediatric Urologist from the Wake Forest Medical School. The author is Steve J. Hodges, MD with Suzanne Schlossberg. Be sure to have a look at www.itsnoaccident.net. Dr. Hodges has some excellent ideas for prevention and treatment. He notes the use of enemas as a legitimate option for a sustained period of time which is one of the features of the Soiling Solutions protocol set forth in detail in my Clean Kid manual.