Recently I assessed a 6.5 year old boy who I have followed intermittently for constipation and soiling since about four years of age.
His bowel health is no longer a problem. He poops every day, either after lunch at home or after school, and he has not had soiling for years. He still wets the bed and we are waiting for him to mature a bit more before we start a bedwetting alarm.
His daytime bladder control is usually very good but during December of his grade one school year he had problems with daytime wetting. Over that month he needed a change of clothes several times a week, but only at school. At home he was dry. He had enjoyed good daytime bladder control for a long time and the first few months of grade one were fine. Clearly something changed in December.
His Dad is a terrific bladder and bowel detective and he had the answer ready before I asked. “It was the fire alarm,” Dad reported. “My son was in the bathroom when the fire alarm went off, and he refused to use the school bathroom after that.
This was the second grade one child in six months who came to my office with the same story. School bathrooms are not built to muffle sounds. The walls, porcelain fixtures, tiles, and metal all reflect and accentuate the sound. I can imagine this would be a scary experience for many early elementary-aged children. Time and a lot of reassurance from Dad was necessary before the boy felt confident enough to use the school bathroom again. By January he was back into a normal routine.
While many elementary aged children might be frightened by the alarm only a few would stop attending the bathroom for this. This boy had a history of other toilet fears and also some anxieties that were not related to the bathroom. At 4 years of age he didn’t like the sound of “poop splashing.” He put his hand over his ears to block out the “flushing noise.” He was concerned about the “toilet plugging.” The automatic flushing toilets were a real concern for him in kindergarten. In the grade one bathroom, he is not comfortable with the urinals and he will only pee standing up in a cubicle and with the door closed. If there are too many boys in the bathroom he won’t go in.
Anything that restricts access to a bathroom is a potential trigger for daytime wetting. Toilet-related anxieties are one of the common triggers.