Laxatives and nappies: how schools are coping with constipation in pupils

The Guardian

18-02-2025

Laxatives in the school medical cabinet, nappies in case of accidents, and hospital admissions for the most severe cases are being reported by teachers in England, suggesting that constipation is an increasing problem for their pupils.
While constipation is known to be a common problem in children, teachers say they are being asked to administer more laxatives like Movicol which have been prescribed by GPs to their pupils. In the most concerning cases it can lead to surgery, while in others school avoidance, because of embarrassment and discomfort.
Guardian analysis found that more than 44,000 children were admitted to hospital with constipation last year, based on NHS data for England and Wales that also shows a 60% rise in hospital diagnoses of constipation in primary schoolchildren in the past decade.
Sarah Smith, executive headteacher of two primary schools in Blackpool, Christ the King and St Cuthbert's Catholic academies, said potty training and toileting problems were an issue in both schools – as in many others across England. However, the issue of constipation has received less attention.
'We don't really know the extent of the issue of constipation. Because that is something that families wouldn't necessarily tell us,' said Smith.
'But the local health authority in Blackpool give a product called Movicol in an attempt to make kids go regularly and that is a product that we have in our school medical safe that children are prescribed, and we do administer that to children in a number of classes.
'If I'd said that word [Movicol] 10 years ago, very few staff would have known what it was. Whereas if I say it now, I would say 90% of my staff would know it's for a bowel problem.'
Smith said as well as diet and exercise, lack of water was a factor in constipation. 'We have water bottles coming out of our ears and we encourage every child to bring water in, but there is a massive reluctance for kids to drink just plain water.' Juice is discouraged, other than at break and lunchtimes, because of tooth decay.
She also raised concern about cuts to health visitors and the impact that might be having on toileting issues. 'I had so many visits as a mum of a toddler. Every other month there was something else, but they have been massively cut, so new mums may struggle.'
On Movicol, she said: 'I look after two schools and we have kids on that product and I am certain there will be more, but often we only find out by accident – maybe they have an accident in school – but it's not talked about confidently like perhaps it would if they're struggling to read.'
In school, the children who have been prescribed Movicol are given hot-water bottles if they get tummy ache, and the school will ring home to inform the parents.
'The other thing I find most bizarre is the increasing number of kids who have a phobia of a toilet and they can't poo on another toilet,' said Smith. 'The last couple of years we have had at least one child in our school that's been unable to go to the toilet, generally to go for a poo. It's only post-Covid we've seen that.'
Smith said she and colleagues in other schools would soon be receiving details of their new intake for the next year and discussing the challenges that lie ahead. 'What we generally talk about is how things feel as though they're getting harder and harder in every sense of the word, whether it's speech, whether it's toileting, whether it's behaviour.
'Covid is still the gift that people have forgotten about, and it is still giving, because of what happened in those months when nobody went to see these people.'
Dr Babu Vadamalayan, a paediatric gastroenterologist working in the NHS and private hospitals in London, said the causes of constipation are multi-factorial and children across all socioeconomic groups are affected.
It can be triggered by dirty school toilets, while there is also concern about lack of free access to toilets at school. A survey of 900 secondary schoolchildren by Eric, the children's bowel and bladder charity, found almost half (48%) are not allowed to go to the toilet during lessons.
If a child's constipation is not addressed effectively early on, it can become chronic. 'When it becomes a soiling issue, it's a huge embarrassment for them,' said Vadamalayan.
Simone Beach, head teacher of Sacred Heart Catholic primary school in Barrow-in-Furness, Cumbria, is also aware of more children in her school suffering from constipation and is concerned about the impact it can have on their education.
'There are lots of reasons why children are suffering from constipation and it affects their education,' she said. 'Some of our children might have a drop in attendance and it's because they are having issues in that way. Some children require hospital admission in really severe cases.'
Beach believes the cost of living crisis and child poverty, which affect many in the community the school serves, may be playing a part. 'That always has an impact on a child's physical and mental health,' she said. 'The truth is that if you are a family living in poverty, life is tough.
'There are a number of children who regularly have Movicol. We have 218 children on roll and a handful will be having daily sachets of Movicol. They may have tummy ache. Then there's that worry that they might have an accident, especially as they get older and that's when you start to see it affect attendance.
'A few years ago, we would have been giving Movicol to one child in school, now it's five or six. It's all age groups.'
Some children may have to wear protective Pull-Ups in case of accidents. 'We had one child in the past who needed nappies right the way through juniors till they left.'
For Beach, it's all part of a school's work. 'Sacred Heart, probably like lots and lots of other schools, it's not just about teaching them maths and English. You are there to support their families, in all sorts of ways.'