The effect of school toileting behaviors and environment on the development of bowel and bladder dysfunction symptoms in children aged 5‑10 years

BACKGROUND: Bladder and bowel dysfunction (BBD), a common condition affecting school‑age children, is characterized by lower urinary tract symptoms, recurrent urinary tract infections, and bowel elimination issues. Toileting habits are often overlooked in clinical assessment as a contributor, leading to frequent clinic visits without properly addressing the problem. MATERIALS AND METHODS: This study assessed school toileting behaviors in children and the prevalence of symptoms suggestive of BBD. Study population comprised of children between 5 and 10 years old, attending schools regularly across the cities of Al Khobar, Dammam, and Al Qatif. Data were collected between December 2023 and March 2024 through an invitation to participate in a web‑based questionnaire distributed through social media platforms (WhatsApp groups and “X”), open only to parents reporting having children within our age limits and cities of assessment. Using both the Dysfunctional Voiding Scoring System and school toileting behavior and environment questionnaire, a multivariate regression model was used to assess the predictive factors for BBD. RESULTS: A total of 290 participants were included in the study, and they were evenly distributed across various age groups. There were slightly more females (56%) than males. Most children (98.3%) were Saudi nationals and reported attending government‑funded schools (62.1%). Data analysis showed that 111 (38%) children had symptoms suggestive of BBD of which 68% were females. Age, type of school attended, and satisfaction with cleanliness of toilet did not emerge as significant predictors of BBD in our study group (P > 0.05). CONCLUSION: While BBD symptoms were prevalent in our study population, most reported satisfaction with their school toilet environment. Further studies across other regions of Saudi Arabia can provide more insight and guide school officials accordingly. Fostering a supportive, safe, and hygienic school toileting environment will promote an overall healthy elimination habit of children.