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Teenagers with incontinence need more support in school settings, suggests study

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Teenagers with incontinence are at greater risk of underachieving academically, and need more support to remove barriers so they can reach their potential, according to pioneering UK research.

The researchers, from the University of Bristol, noted that the prevalence of urinary incontinence in teens was around 3-4% and that around 1% experienced bowel incontinence.

“It is particularly worrying that young people with incontinence are at greater risk of underachieving”

Katie Whale

Their research 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 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 the children’s charity ERIC. Seventeen of the participants were in full-time education, two attended sixth form college, and one had recently begun university.

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 or pastoral care staff created challenges in how best to help the young people, noted the researchers in the British Journal of Health Psychology.

The study identified 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 extent and level of stigma described by the participants in our study is powerful and surprising”

Carol Joinson

The authors recommended that young people with continence problems needed unrestricted access to toilets during the school day and adequate toilet facilities.

There was also a need for schools to revise policies relating to toilet access and improve toilet facilities, according to the authors of the Medical Research Council-supported study.

They said a worrying finding from their study was the impact of continence problems on learning and academic performance and the disadvantages faced by young people with continence problems.

Participants said lessons were disrupted due to frequent toilet visits and those with severe daytime continence problems reported leaving the classroom three or four times 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.

Dr Katie Whale, a research fellow in qualitative health research from Bristol, 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,” she said. “Increased support at school is essential to help young people with continence problems to achieve their academic potential.”

“The powerful stories described in this research give us a strong basis for engaging with schools”

Juliette Randall

Study co-author Dr Carol Joinson, a reader in developmental psychology, said: “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,” she said.

Early next year, the researchers plan to begin work with ERIC and educators to produce online information resources for secondary school teachers and other educational services professionals.

ERIC chief executive Juliette Randall added: “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,” she said. “We are delighted to be collaborating with Drs Joinson and Whale on this new project.”

She said it would involve working with schools to co-create materials, raise awareness of the impact of continence issues and provide strategies to improve the “school experience” for young people.

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