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The TikTok Bathroom Challenge is Damaging My Patients' Bladders

By Steve Hodges, M.D.

As a stodgy, clueless dad, I’m not usually on top of TikTok trends. But I also happen to be a pediatric urologist who specializes in bedwetting, and I know all about the latest social-media “challenge” — vandalizing school restrooms in pursuit of online views — because it’s harming my patients.

Media reports have, naturally, focused on the outrageous property damage. Students are ripping out toilet seats, soap dispensers, toilet paper holders, and hand dryers. They’re shattering mirrors, clogging toilets (with laptops and furniture parts!), and attempting to unbolt urinals and toilet stalls. And they're posting videos — over 94,000 of them — to TikTok, encouraging others to join in.

Great thinking, kids!

This is happening at middle schools and high schools everywhere: Kansas, Colorado, Nebraska, Texas, Florida, California, Minnesota, and North Carolina, where I live.

In response, exasperated administrators have drastically restricted restroom access and shut down many bathrooms entirely.

Psychologists and educators have been debating what this trend says about social media, peer pressure, and the pandemic. That’s all way out of my league.

But what I do know: shutting down bathrooms has health consequences for many students, including those with enuresis (bedwetting and daytime pee accidents), encopresis (poop accidents), and chronic urinary tract infections.

Those kids are my patients, and as part of their treatment, they must use the toilet when the urge strikes — not 20 minutes or 2 hours later or after school.

Most folks think of bedwetting as an issue faced by 5-year-olds. Doctors often tell families, “Don’t worry – she’ll outgrow it. No one ever went off to college wetting the bed.”

That’s untrue. I have plenty of teenage bedwetting patients, many of them panicked about college. I also run a private Facebook support group for parents of teens and tweens with enuresis and encopresis.

Among teens, bedwetting is more common than autism. That’s right: About 1 in 50 teens have enuresis. With autism, it’s 1 in 54.

A big-city high school, with 2,000 to 4,000 students, typically has 40 to 80 students with enuresis, a condition caused by chronic constipation.

(No, bedwetting is not caused by deep sleep, stress, poor diet, hormonal imbalance, or an underdeveloped bladder! Accidents happen because the stool-stretched rectum presses against and aggravates the bladder nerves, causing the bladder to hiccup and empty without warning.)

Numerous other students struggle with UTIs, urinary urgency or frequency, and stomach pain, conditions also caused by the build-up of stool in the rectum.

When kids vandalize school restrooms, they’re jeopardizing the bladder and bowel health of their classmates and causing them major distress.

For my patients, treatment typically involves a regimen of enemas and laxatives (the Modified O’Regan Protocol, aka M.O.P.), as well as frequent peeing, sometimes on a schedule.

The best way to make an overactive bladder worse? Hold your pee and poop. Thanks to the TikTok “bathroom challenge,” that’s what my patients are being forced to do.

One mom in our teen/tween support group posted that her 14-year-old son, who works hard to follow M.O.P., is supremely frustrated by the restroom closures at his Arizona high school.

On a campus of 3,000 students, she says, only three boys’ bathrooms are open, “and the line is huge.” Due to a shortage of security guards (to monitor the restrooms!), students are prohibited from using the toilet during the first and last 10 minutes of each class period. The 5-minute passing periods don’t allow for enough time to get through the line, pee (forget about pooping!), and get to the next class.

“My son is angry that kids are being so stupid, but he’s even more livid with the administration,” this mom reports. “The idea that a huge population has to be penalized because a few kids do something wrong makes him crazy. Using the bathroom is important to his health. The administration is not considering medical needs at all. They have no idea.”

An administrator did agree to let her son see the nurse when he needs to pee, but she says it’s unrealistic for him to walk 15 minutes across campus to the nurse's office every time he needs to pee. “He’s just not going to do that. That’s a form of shaming.”

High schoolers with enuresis already shoulder plenty of shame and blame, from a society that doesn’t understand their condition. These kids have been told, often by doctors, to eat healthier foods, avoid fluids before bed, avoid soda, and get more sleep — measures that do nothing to resolve bedwetting but do plenty to make teenagers feel like bedwetting is their fault.

Even before the TikTok challenge, students at all grade levels faced restroom restrictions, an issue I’ve written about here and here.

At some high schools, students who need to use the restroom during class must scan a QR code upon exiting and re-entering the classroom, so their exact time out of class can be recorded. This kind of policy is a disaster for my patients, for whom relaxing on the toilet and fully voiding is enough of a challenge, without the added surveillance of a QR code.

Many high school students only get three bathroom passes per semester per class, and some earn extra credit for returning unused passes at the end of the semester. Yes, students are rewarded for NOT listening to their bodies!

Whoever dreamed up that idea needs to spend a day at a pediatric urology clinic.

A University of California study found 81% of elementary teachers reported allowing unlimited access to water intake in class, yet 88% encouraged students requesting bathroom access to hold their pee. Some 36% of the teachers surveyed offered rewards, like trinkets and pizza parties, to students who didn’t use bathroom passes or punished those who did.

All that is bad. But locking restrooms is worse.

The Arizona mom in our support group reports that her son, a 9th grader, is particularly frustrated because he’s nearing the end of a lengthy treatment process that has gone well.

This kid's backstory is the same one I hear daily: For years, the boy wet the bed every night, but his pediatrician dismissed his mom’s concerns. Eventually, a GI doctor ordered an x-ray and pegged constipation as the cause of the boy’s bedwetting, but the doctor felt a daily enema program was “too aggressive.” It wasn’t until middle school, after lesser measures had failed, that the boy began M.O.P.

“My son was on board,” his mom says.

Gradually, as his rectum shrunk back to normal size and stopped bothering his bladder, his accidents diminished. In the last month, he has only wet the bed once a month. He’s in the home stretch of treatment and will soon begin weaning off his regimen.

“My son has worked so hard for so long to get where he’s at,” says his mom. “He’s so close to the end. And now this.”

Trashing school bathrooms is nothing new, of course. At my own middle school, students would purposely clog the toilets and hurl wet paper towels into the stalls to torment the kids who were in there. If you tried to poop, kids would bang on the doors or try to open them.

I was terrified of setting foot in our school restrooms, and that fear contributed to the constipation I suffered as a kid.

But holy moly — social media seems to have taken restroom destruction to a level I could never have imagined.

I feel for my patients and for the beleaguered administrators, custodians, and teachers, too.

Another mom in our private Facebook support group has experienced the issue from all angles. She has a child on M.O.P., and she teaches at a middle school where students stole all the restroom soap dispensers, pulled a sink off the wall and smashed it, and stomped on plastic bags they had just peed in.

The school’s bathrooms are now locked except for during scheduled times.

She posted: “As much as my child needs to be able to use the restroom, I can't see any other options. As it is, we have two sets of bathrooms that are completely closed due to vandalism. If this continued, there wouldn't be any bathrooms left to use.”

I have no idea what will put a stop to this insanity. I suppose kids will get bored with bathroom vandalism and move onto the next thing. But I was dismayed to read about a TikTok video one student posted in response to a frustrated administrator.

The kid urged fellow students to avoid getting caught. “But keep doing it, cause it’s even funnier now.”

If that kid had to spend a day in my patients’ shoes, he wouldn’t think it was so hilarious.


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