Health Risks to Children Associated With Forced Retention of Bodily Waste
A statement by healthcare professionals

The practice by school teachers and other caretakers of delaying or preventing children from eliminating body waste is commonplace. The so-called 'bathroom privilege' in schools is often seen as precisely that: a privilege, not a necessity or a right. Sometimes, denial of students' access to rest rooms is done for punitive reasons. More commonly, rigid scheduling or denial of toilet use is done for the sake of the caretakers' convenience. Denying youth the opportunity for prompt relief when the need arises can have serious, long-lasting physical and psychological consequences. For individuals of any age, forced retention of body waste not only carries serious health risks, but constitutes a violation of a fundamental human right.

Risks to health

  • urinary tract infection,
  • urgency incontinence,
  • overflow incontinence,
  • poor drainage of urine from the kidneys,
  • epididymitis – inflammation of the epididymis,
  • reflux of urine up towards the kidneys,
  • deterioration of kidney function over time from backpressure,
  • kidney infections,
  • loss of bladder elasticity,
  • over-stretching the bladder beyond its normal capacity,
  • accumulation of urinary waste products in the blood (uremia),
  • spasms of sphincter muscles,
  • involuntary retention of urine (uroschesis),
  • inflammation of the bladder walls,
  • inability to empty the bladder fully,
  • painful urination,
  • desensitization of the brain to cues that signal the need to empty the bladder or bowels,
  • constipation,
  • bowel obstructions,
  • irritable bowel syndrome,
  • absorption of toxic fecal products,
  • bowel incontinence,
  • sexual fetishes involving retention/elimination of urine (urolagnia),
  • sexual fetishes involving retention/elimination of feces.
We, the undersigned, deem the practice of denying, delaying, discouraging, penalizing or interfering in any way with a child's normal bodily function of waste elimination, or failure to accommodate that need, to be forms of child abuse and neglect. We call upon educators, school administrators, education policymakers and others in positions of public influence to strongly discourage these practices, and to inform all caretakers of the involved risks.


  • Laurie A. Couture, M.Ed., Author of Instead of Medicating and Punishing, Parenting Consultant and Mental Health Counselor,, Exeter, NH
  • Robert E. Steckler, MD, FACS, FAAP; Head – Section of Pediatric Urology, St. Christopher’s Hospital for Children, Drexel University College of Medicine, Philadelphia, PA.
  • William Sears, M.D., co-author (with Martha Sears, RN) of numerous books on infant health and child rearing. Web sites: and
  • Steven Oglevie, M.D., Newport Beach, California
  • Christopher S. Cooper, M.D., FACS, FAAP, Associate Professor of Urology, Director of Pediatric Urology, University of Iowa
  • Michael A. Keating, M.D., Clinical Professor of Urology in Surgery, The University of South Florida and Co-Director of Pediatric Urology, Nemours Children's Clinic, Orlando, Florida
  • Anthony H. Balcom, M.D, Pediatric Urologist, Assistant Professor of Urology, Medical College of Wisconsin, Children's Hospital of Wisconsin
  • David B. Joseph, M.D. FAAP, FACS, Professor of Surgery, University of Alabama at Birmingham, Chief of Pediatric Urology, Children's Hospital, Birmingham, AL
  • C.M. Khurana, M.D., Board Certified Pediatrician and Infectious Diseases, Chicago, IL
  • Colette G. Kirchhoff, M.D., Medical Director, Evergreen Health and Rehabilitation Center; Medical Staff, Bridger Clinic; Former Chief of Family Practice, Bozeman Deaconess Hospital; Board Member, Battered Women's Network, Bozeman, MT
  • Colin Kopes-Kerr, M.D., Medical Director, Family Practice Center, State University of New York, Stonybrook, NY
  • V.A. Naidu, M.D., Chicago, IL
  • Merry Susan Lopez, L.V.N., Pediatric Home Health Care Nurse, Medcare Professional Group, Houston, Texas
  • Martha Sears, RN, childbirth educator, co-author (with William Sears, M.D.) of numerous books on infant health and child rearing. Web sites: and
  • Daisy Lee Myers, RN, Miami Beach, Florida
  • Viviane Oglevie, M.F.C.C., With Child Protective Services in Riverside Country for six years, now in private practice, Newport Beach, California
  • Alice Miller, psychoanalyst, author (For Your Own Good: Hidden Cruelty in Child Rearing and the Roots of Violence, 1983, and many others.)
  • Stephen H. Guerin, Psy.D., Clinical Psychologist, Fayetteville, TN
  • Robert E. Fathman, Ph.D., Clinical Psychologist, Columbus, OH
  • Jan Hunt, M.Sc., Counseling Psychology, Black Creek, British Columbia, Canada
  • Murray A. Straus, Ph.D., Professor of Sociology, University of New Hampshire, Durham
  • Dan Neuharth, Ph.D., Licensed Marriage and Family Therapist, Greenbrae, CA
  • Diana O. Chu, M.D., Psychiatrist, Bloomington, IL
  • Robert K. Denton, Ph.D., Professor of Anthropology & American Studies, State University of New York, University at Buffalo College of Arts and Sciences
  • Cheryle B. Gartley, President, The Simon Foundation for Continence
  • Lynn S. Dworsky, M.D., Child Psychiatrist, Bethesda, MD
  • Irwin A. Hyman, Ed.D., professor of school psychology and director of the National Center for the Study of Corporal Punishment and Alternatives, Temple University, Philadelphia
  • Madeleine Y. Gómez, Ph.D., President of PsychHeath, Ltd., Assistant Clinical Professor, Northwestern University Medical School; Clinical Supervisor, Hartgrove Hospital; Adjunct Visiting Professor, Roosevelt University; Consultant, Zurich Corporation
  • Madeline Gómez, M.D., Clinical Assistant Professor of Psychiatry, University of Illinois; Past Faculty and Supervisor, Family Institute of Chicago; Past Medical Director, Ravenswood Hospital Community Mental Health Center; Retired Medical Staff, Ravenswood Hospital Medical Center, Chicago, IL.
  • H. Patrick Stern, M.D., Professor of Pediatrics and Child Psychiatry, East Tennessee State University, Johnson City, TN
  • Randy Cox, MSW, Licensed Clinical Social Worker, Little Rock, AR
  • Sayed Saboor, M.D., Psychiatrist, Elgin, IL
  • Maleeha Ahsan, M.D., Psychiatrist, Downers Grove, IL
  • D.H. Reddy, M.D., Psychiatrist, Board Certified, Waukegan, IN
  • S. Jayachandran, M.D., Psychiatrist, Hammond, IN
  • Sidney Moragne, M.D., Psychiatrist, Chicago, IL
  • Andrew Martorana, M.D., Board Certified Adult and Adolescent Psychiatry, Clinical Assistant Professor in Psychiatry at the University of Illinois, Chicago, IL
  • Harold McGrath, M.D., General Psychiatry, Medical Director of the McGrath Clinic, Orland Park, IL
  • Judith Stoewe, M.D., Psychiatrist, Director of Child and Adolescent Services, University of Illinois, Chicago, IL
  • Jack Krasuski, M.D., Psychiatrist, Assistant Professor of Clinical Psychiatry, University of Illinois, Chicago, IL
  • Evaristo Gómez, M.D., Professor of Clinical Psychiatry, University of Illinois, former Medical Director, Charter Barclay Hospital, Chicago, Illinois; Honorary Staff Member, Hartgrove Hospital, Chicago Illinoois; Former Senior Supervisor, Family Institute of Chicago
  • Charles L. Kyle, Ph.D., Principal, H.B. Stowe Fine Arts Academy, Chicago IL
  • Robert Marshall, Ph.D., Director of Psychology, Hartgrove Hospital, Chicago, IL
  • Karan Latza, Ph.D., Clinical Psychologist, Chicago, IL
  • Robert Puls, Psy.D., Clinical Psychologist, Chicago, IL
  • N. Aseen Chaudhry, M.D., Board Certified Psychiatrist, Medical Director, Rock Creek Center, Lemont, IL
  • Ross Lynn Garber, R.N., M.A., Chicago, IL
  • Bruce Gómez, LCSW, Home Intervention Specialist, PsycHealth, Ltd., Evanston, IL
  • Rad Gharavi, M.D., Chicago, IL
  • John G. Sonnenberg, Ph.D., Director of Scientific Operations, Forest Foundation, Chicago, IL
  • Lynne E. Jones, R.N., Practice Manager, Community Mental Health, Chicago, IL
  • Michael J. Reinstein, M.D., Board Certified Psychiatrist, Chicago, IL
  • S.C. Mohan, M.D., Psychiatrist, Chicago, IL
  • Shephali A. Patel, M.D., Psychiatrist, Chicago, IL
  • Maxim A Chasanov, M.D., Board Certified Psychiatrist, Chicago, IL
  • Daniel M. Potter, MS, LCSW, BCD, Chicago, IL
  • Lissa Schwartz, LCSW, Chicago, IL
  • Danielle Segal, LSW, Chicago, IL
  • John Mayer, Ph.D., Chicago, IL
  • Michael Lamport Commons, Ph.D., Research Associate and Lecturer, Program in Psychiatry and the Law, Department of Psychiatry, Harvard Medical School, Massachusetts Mental Health Center, Boston, MA
  • Colleen M. McKenna, M.Ed., Licensed Mental Health Counselor, Amesbury, MA

Sponsored by Parents and Teachers Against Violence in Education(PTAVE), P.O. Box 1033, Alamo CA 94507-7033. Principal research: Laurie A. Couture. This document can be viewed on the Web at Signatory list updated August 2011.

See related materials:

  1. Bathroom break denial: Learning obedience to authority the wet way, By T. P., November 28, 2009

  2. Are Your Children Safe in School? - Confronting the Issue of Teachers who Deny Toilet Use, by Laurie A. Couture

  3. University of Iowa Study: Elementary Schools Need A Lesson In Bathroom Breaks, University of Iowa Press Release, August 11, 2003

  4. The Medical Risks Of Forced Retention of Urine, by Laurie A. Couture, M.Ed., 2003
    (Use your browser's "back" button to return to this index.)

  5. Letters from Parents About Denial of Toilet Usage in their Child’s School
    (Use your browser's "back" button to return to this index.)

  6. Forced Retention of Bodily Waste: The Most Overlooked Form of Child Maltreatment by Laurie A. Couture, 2001

  7. Using the Bathroom Is Your Right, Not a Privilege! By Laurie A. Couture

  8. Letter to the New York Times Re: "Teacher in Urination Flap", by Laurie A. Couture, February 11, 2000

  9. IMAGE: First graders, Wesley School, Houston, Texas: "One of the school's special aspects is its regimented bathroom break every morning," Contra Costa Times, February 11, 2001.

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