When kids get stomach aches at school, we can be quick to jump to the conclusion that either a greasy lunch or anxiety is to blame. But there is another common reason which frequently gets overlooked: “holding it.” A lot of kids just don’t want to go the bathroom at school. And from what I have observed, that kind of stool withholding can set some children up for chronic constipation.
Why hold it? There is not just one answer. Some kids don’t like to go anywhere but home (as is also true for many adults). Some don’t want to have to ask to be excused, or don’t want to feel rushed, or are grossed out by unsanitary school bathrooms, or are self-conscious, or are afraid of being bullied in the bathroom. (It’s a problem both for urination and for bowel movements. One group of researchers found that 88% of elementary school teachers “encouraged holding urine.”)
For a child who is holding their stool during the day, a few simple interventions can help. Just talking about it and offering reassurance can be useful. Another option is to help a child alter their bathroom habits to have a bowel movement before school or in the evening (although a change of timing may require getting up a little earlier in the morning). It’s also possible to request that the child be able to use the toilet in the nurse’s office or in some other relatively private area.
If it becomes clear over time that bathroom issues are persistent and problematic, you may need to explore the problem further and consider additional solutions. Whether it’s a referral for counseling for an underlying anxiety issue, treatment with stool softeners or laxatives, or some other next step, your pediatrician or a GI consultant should be able to advise you.