Teenagers with incontinence are at risk of underachieving at secondary school

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.”

Paper

‘Left
behind and left out: The impact of the school environment on young people with
continence problems’ by Whale, K, Cramer, H, and Joinson, C in British Journal of Health Psychology