The Incontinence Epidemic

[Keepstanding, ASN, RN]

To My School Nurse Support System,

I need your feedback and suggestions. Thank you in advance for always giving me your input on things that trouble me with my job !

Have you noticed and upsurge in students of elementary ages having incontinence issues ?

I'm talking urine and BM. I have large numbers of kids who range from Kindergarten to Sixth grade who are constantly in my clinic for soiling or wetting their clothes.

These are not occasional accidents either. These kids are coming in once and sometimes twice each day. I have many kids who have 504's specifically stating that they are to come to the private clinic bathroom each day and they are to sit on the toilet for 20-30 minutes so that they will become "potty trained".

These daily kids are tying up my only bathroom and I have no other source of water if I need to wash my hands or deal with a student with a nose bleed, loose tooth..etc.

I have a small storage closet that I keep many bags of clothes for upward of 15-20 students who's parents want me to house spare clothes for their child, in case they have an accident. I am over run with these bags and I am running out of room.

My clinic smells like a johnny house most of the day and students, teachers and parents make comments about the odor when they enter the clinic.

Teachers expect me to thoroughly clean up these kids when they poo themselves, but I do not. Will not. Cannot. I will however, lay out their clothes, wipes, bag for them to change themselves. If they have no supplies or they cannot do this task on their own, I will then call the parent to come clean them or take them home for a bath.

The expectation that teachers and parents have of me is unbelievable. I believe that, even with a witness/staff member being in your presence is not good enough in this day and age. Kids lie about disturbing things all of the time and there is no way that I will risk my license and lively hood on one false accusation of touching inappropriately or harming a child.

To say that this just doesn't happen these days, is to bury your head in the sand ! All it takes is one parent to turn to social media and construct lies about what you did to their little snowflake and your career is over.

Please friends, please tell me how you handle these situations. Tell me how this is solely a nursing problem. Why the school nurse. When did poop in the pants become more important than my diabetic's, my students with asthma, my students with a feeding tube.... ???

I appreciate your feedback !

[NurseBeans, BSN, RN, EMT-B]

I have these issues with my k-4 set as well. I currently have a second-grader who visits fairly often, and who has---wait for it--pull ups in my office in case he wants to wear them. This is a 7 year old still wearing potty training undies. It is bordering on inappropriate if you ask me, but no one did...

Anyways, encopresis is a real thing, seems to be getting bigger and bigger. I blame chronic constipation from garbage diets and too little water, too little activity, and then somehow Miralax is supposed to be the replacement for good toileting habits. I can speak from experience, I had my own child who was being difficult to toilet train and who finally, at 3 1/2, got off the chronic constipation/Miralax/constant soiling merry-go-round. What happens is they get constipated, and then parents give Miralax (which isn't actually approved for peds or long-term use), and the kiddos "leak" poo around the blockage in their bowel. A big ol' poo can hang out in there for quite some time, letting Miralax liquid poo leak around it. And it stinks like nobody's business.

Except it seems to have become the nurse's business. I do what you do, I lay out clothes and undies and wipes, give specific instructions about not putting wipes in the toilet, and then close the door. I answer requests to wipe buns with a solid "nope" and steady, uncomfortable eye contact. About the third time the same child visits I make it clear they know where their clothing resides (I put them in the bathroom in plastic baggies with their names on them) and let them figure it out. Wiping their own butts and changing clothes is a life skill. Learning to poop somewhere other than home with their mom ready with the moist towelettes is a necessity. We all did it.

If teachers question me or ask me to "check" if a kid pooped their pants I do the same thing I do to the kids--"nope" and steady uncomfortable eye contact.

[Flare, ASN, BSN]

Anyways, encopresis is a real thing, seems to be getting bigger and bigger. I blame chronic constipation from garbage diets and too little water, too little activity, and then somehow Miralax is supposed to be the replacement for good toileting habits.

YES to this!! ^^ A thousand times yes!!

Also, I am wondering, Praiser, why you are expected to house the clothing changes? Is there no room in cubbies / lockers?

I would talk to your admin about your bathroom being tied up with toilet training for 30 minutes at a clip. It creates an unsafe environment for the rest of the students requiring your services when you can't get to running water in your office to cleanse a wound, rinse an eye, wash your hands, etc.

Like other E-colleagues, I do not assist children in the bathroom habitually. I do the same as you - give them the supplies and send them in to task. But, of course there are the times that the student (always the littles) had just had too big of an accident to handle themselves. I will assist then - but always always with another adult present (i try to get same gender as student) and I refuse to lock myself in the bathroom with them.

My office bathroom is then spreayed down with lysol or sanitex and the kids take their soiled clothing with them. I have had teachers complain and wonder why it can't stay in my office - well, first of all, they will forget it at the end of the day. I don't do laundry for students. And second - why do I have to house soiled clothing because it's a medical office? If it stinks, double bag the one it's already in and tuck in the kid's backpack. Their parents can and should have a little stake in this too.

[MrNurse(x2), ADN]

Thank you, Lord that my children are potty trained and this is a rarity to the tune of once or twice a year. Amen.

[kidzcare]

If teachers question me or ask me to "check" if a kid pooped their pants I do the same thing I do to the kids--"nope" and steady uncomfortable eye contact.

Hahahahahha!!! I love this!

Recently, I joked before an IEP meeting that I was going to shake hands with the parents and then use a massive handful of hand sanitizer while maintaining eye contact with them.

I have not had this issue, thank goodness. I'm flabbergasted by the 7 year old in pull ups. (only because they are for convenience as opposed to being necessary for a medical diagnosis or developmental delay)

[JenTheSchoolRN, BSN, RN]

Are the days where a students needs to be toilet training prior to entering school gone? I don't ask this to be a butt, but I do wonder. Or do doctor's note exist for all these students? Given the 504 plans, I am assuming they do, and if this is a chronic enough issue at your school, they may need to provide a very specific bathroom just for these students separate from the ones needed in your office.

Or they need to put an additional sink outside the restroom in your office. (I feel your pain - my only sink is in my restroom in my office as well. And it has one of push down knobs that has to be pushed back down every ten seconds for the water to continue.)

Can you sit down with your boss/admin to discuss with evidence to support this need?

And YES! to constipation! This issue continues well into the teen years. I recently referred a student out for chronic stomach pain that I suspected may be related to constipation. Poor kid had, as another poster put it, a big ol' poo in there that was just stuck. Doc went straight to Miralax, but really it didn't dislodge it. I wondered why Miralax in that situation, but that is another thread .

I don't clean kiddos. But I do also deal with the older ones.

PS: I miss the poop icon.

[Flare, ASN, BSN]

I think that the potty trained requirement has fallen by the wayside as we've become a society that doesn't want to offend anyone - including a parent that hasn't put in the time or effort to potty train a child. For the most part, my students in reg ed pk and up are potty trained, but accidents happen with regularity in the school, especially the young grades. The pk and k students are told to bring in a change of clothing. Most do, some don't or don't replenish it when it gets used. I am an advocate for all the students to have a spare pair of pants and undies - even the older kids. I get as many requests for clothing changes either due to falling (playing) in the mud in the spring or spilled milk / food as I do toileting accidents. (That and trying to correct a dress code violation).

[Farawyn]

Yea, I had a 14 year old poop his pants this week. Completely unfazed by it, as was his mom when I called her to discuss it.

So.

[JerseyTomatoMDCrab, BSN]

PK-5 here and I may as well be reading a narrative describing my own office these days.

I have a third grader and a second grader who both refuse to use the toilet at school and therefore poop their pants. They are, like Far's 14 year old student, totally unfazed. They don't even say anything; they get sent to me because the teachers notice that they smell. They also both lie and deny when I ask them what happened. I feel almost comical calling home about them because it's just so absurd. But I always do and now both of them are on "toileting schedules" in my office.

I have a first grader who poop his pants almost weekly and doesn't say anything. He walks around until pieces of it start falling out of his pant legs and then denies it when the teacher asks if he had an accident. Last week they had to clear the entire classroom because someone stepped it in and it got into the carpet and on most of the tile. His father insists he has a GI problem but all signs point to behavioral. All the "clean" undies that get sent in from home are stained on the butt so it doesn't appear to be just a school thing, either. He told the speech therapist that he "goes like this" (crouches in the corner) and poops his pants at home. There are several other issues going on and DSS had been involved.

I have another first grader who pees her pants weekly. Her mom never returns my clothing. Gr.

It always smells in here. Toilet training is an expectation for enrollment in school, I do not know why this is so hard for parents to grasp.

[Flare, ASN, BSN]

i get so annoyed at my clothing not getting returned. And I get livid when I see clothing that I know was mine make it into a kid's wardrobe rotation. Usually not children that can't afford clothing - just laziness in the parent following through. I try to keep track of who is borrowing what so I can make a call but it's low priority with the thousand other things I have to do. I figure if I run out, i'll let the admins know - maybe if they have to buy clothing they will begin to treat non returns as a problem and act the same as the library and charge the parents when it's not returned.

[NurseBeans, BSN, RN, EMT-B]

I wonder, why is the nurse's office bathroom the spot for the daily training? I know that's the standard, setting a daily time to sit and either poop or just sit, but why does it have to be the nurse's office? Any toilet will do, especially since the student needs to be wiping their own behind. Maybe see if this 20-30 minutes can be spent on another toilet.

I'm not sure about anyone else, but I have a handful of these kids that will poop their pants but not one doctor's note from any of them. No documentation at all, really. I did have one mom that told me of her son's issues, and I explained what worked with my son, which is what the pediatrician told us to do, and she listened to my whole speech and said "nah, that won't work". No explanation, just a statement that it won't work. Okaaaaaay...so just keep supplying me with wipes and clean underpants then? How long do we continue this? Is the kid going to be at Sr prom pooping in a rented tuxedo?

[Julius Seizure]

Asking because I don't know for sure:

Is having to sit on the toilet for 20-30 minutes an effective way to be "potty trained"?

Also, what are they missing to come do that? Class time? Lunch time? PE class?