Lower urinary tract symptoms (LUTS) in children and adolescents have significant impact on one’s ability to develop healthy voiding behavior as an adult. There are many barriers to maintaining proper habits including time constraints, social environment, rules, structure, location, and school. The objective of this research is to conduct a cross-sectional, de-identified quantitative survey of middle school and high school students to better understand their perspective on urinary habits and the school environment surrounding toilet use.

Males and females ages 12-17 were recruited via ResearchMatch, a national health volunteer registry. A total of 2627 volunteers received an email entitled “Voiding habits in adolescents” to complete a de-identified, electronic survey about the school environment and its effects on bladder habits. To classify participants based on presence of LUTS, the Dysfunctional Voiding Scoring System (DVSS) for children was used. Participants were then asked to answer additional questions specific to voiding habits regarding the school day and the bathroom environment at school.

A total of 39 volunteers completed the survey for a response rate of 1.5%. Of these volunteers, 16 were male and 23 were female with a mean age of 16.4 ± 1.7. The average school size of the schools attended by the participants were 1762 ± 1851 students, with an average class size of 68 ± 186 students. The average length of class for the students was 64.2± 26.4 minutes. 62% of student responders attended schools in a suburban setting, and 54% attended public school (Figure 1). In overall responses, 51% of students agreed to having a difficult time finding time to go to the bathroom between classes or during lunch breaks, and when they did find the time to use the bathroom, 33% of students experienced long waiting lines. Regarding attitudes toward using the bathroom during school, 36% felt embarrassed to go to the bathroom in the middle of class and 54% of students say they avoid using school bathrooms if they can help it or hold it (Figure 2). Based on DVSS Score, 17 participants (44%) were considered to have LUTS and 22 (56%) were without LUTS. Responses to school specific questions were compared between students with LUTS and students without LUTS.

Barriers exist for adolescent students to use the bathroom when the need arises, both logistically and mentally. Particularly concerning is that over half of students indicated they avoid using school bathrooms and have a difficulty finding time to use the bathroom between classes. No significant difference was seen in answers to the school related questions between students with and without LUTS.

Barriers to healthy voiding habits are shown to be present in the school setting for adolescents in this study. One third to one half of students experienced a barrier to using the bathroom, whether it be lack of time in the day or their social feelings toward bathroom use. There was no significant difference in attitudes or behavior of students with LUTS compared to those without LUTS. By recognizing and acknowledging issues students have when accessing the bathroom during school, future studies can assess the feasibility of  interventions to improve these conditions and promote healthy voiding behaviors in adolescents.