Who Are The Restroom Challenged

Why should we care?

“People vary widely in how often they need to use the bathroom.  During the daytime, most go 1 to 6 hours between bathroom breaks.”  For those at the high end, the availability of a toilet is of little concern in the routine of daily life.  Those at the other end of the spectrum hesitate to travel or participate in outdoor activities that put them out of range of toilet facilities.

For a small but significant percent of population, those at the left of the curve, life is more difficult.

The “restroom challenged” occasionally have an urgent need to use a restroom less than an hour after departing.  Shopping, visiting, or commuting to work is an ordeal.  Fortunately, indoor Malls, major retailers, and ‘most’ public transits systems have public restrooms.  Respondents to a recent Parks and Recreation Citizen Survey chose drinking fountains and public restrooms as the most important improvement that would help them use the Park and Trails.(https://americanrestroom.org/restrooms-in-parks-along-trails-and-in-public-space/)

Our society will freely discuss almost anything. However, mention of a spastic colon will quiet a room.  On a more discrete level, one finds ‘restroom duress’ a broad concern, affecting …

  • Middle age women
  • Pregnant women
  • Parents touring with young children
  • Children in school
  • Women experiencing an irregular menses
  • People suffering certain congenital defects
  • Those with bladder cancer
  • Some wounded Combat Veterans
  • Victims of abdominal or nerve trauma
  • Women being treated for Vaginal Candidiasis
  • 10 to 40% of stroke victims )
  • Otherwise healthy persons suffering bowel incontinence
  • People with Interstitial Cystitis
  • Those suffering Irritable Bowel Syndrome, Ulcerative Colitis
  • The Elderly (Functional capacity is halved as we age)
  • Patients suffering the diuretic effect of blood pressure medicine
  • Men suffering an enlarged prostate
  • Diners experiencing the diuretic effect of coffee or alcohol
  • Patients on medications that act as bowel or bladder irritants
  • Ostomy pouches require prompt attention when at capacity

For those using a wheel chair,  problems compound (see note below).  They disproportionately suffer these conditions, while facing a greater challenge finding accessible facilities.

Increasing the availability and distribution of public restrooms benefits everyone. Anyone can suffer the effects of food poisoning.  If it happens to you in a toilet free area, expect to experience the panic the ‘bladder challenged’ face daily.

From Advocates

“…This really is a cause that ties into our mission word for word  in regard to patients inflicted with these diseases. It’s important to let the public know there are certain situations and diseases that require people to use the restroom unexpectedly….”
Robert J. Milanchus
Crohn’s and Colitis Foundation
The Journal V65#15 )

Medical studies show the importance of regular urination, with women generally needing to void more frequently than men. Adverse health effects that may result from voluntary urinary retention include increased frequency of urinary tract infections (UTIs), which can lead to more serious infections and, in rare situations, renal damage. UTIs during pregnancy have been associated with low birthweight babies, who are at risk for additional health problems compared to normal weight infants  Medical evidence also shows that health problems, including constipation, abdominal pain, diverticuli, and hemorrhoids, can result if individuals delay defecation.
Source:  National Institutes of Health (NIH) Publication No. 95-2754, July 1995  29 CFR 1910.141(c)(1)(I)

“The U.S. Department of Health and Human Services Deputy Assistant Secretary for Women’s Health, Dr. Wanda Jones has noted research showing that obesity is an important risk factor for incontinence among women.  The limited research available indicates that women afraid of bladder leakage are less likely to report engaging in physical activities that put them out of range of toilet facilities.”
Email from Dr Jones dtd July 25, 2003 10:18 AM

The issue of free and immediate access to restroom facilities is one which I have championed for more than a quarter century. While initially I attacked the use of pay toilets as one of gender inequity, I have broadened my perspective to now see this as a health concern as well. I applaud all governmental efforts to guarantee free and easily accessible restroom facilities for all visitors, customers and patrons in need of them.
Email dtd 8/2/04 from Dr. March Fong Eu, Former California Secretary of State (1975-1993) and Retired Ambassador, Federated States of Micronesia (1994-1995). (http://www.sacramentochinese.com/section_is/section_cp/ms_march_fong_eu/main_march_fong_eu_eng.htm)

When school children are not allowed sufficient restroom breaks, it impacts their physical health and reduces their classroom concentration. Many school teachers view toilet use as a privilege rather than a human need.
L.A. Couture, M.Ed,  Author: Forced Retention of Bodily Waste: The Most Overlooked Form of Child Maltreatment

The F-bomb I drop now is “fiber,” and if you ask me directions, chances are I can not only tell you where to turn, but how many public bathrooms you’ll find en route, even if I can’t make them out without the glasses I am too vain to wear.
Annette John-Hall, Reporter Philadelphia Inquirer Dec. 20, 2006

Medical Studies

Urodynamic patterns of normal male micturition: influence of water consumption on urine production and detrusor function
Schmidt F, Shin P, Jorgensen TM, Djurhuus JC, Constantinou CE.
J Urol. 2002 Oct;168(4 Pt 1):1458-63. PMID: 12352417

Urinary voiding patterns of apparently normal women
Glenning PP.
Aust N Z J Obstet Gynaecol. 1985 Feb;25(1):62-5. PMID: 3862404

Diuresis and voiding pattern in healthy school children
Mattsson S, Lindstrom S.
Br J Urol. 1995 Dec;76(6):783-9. PMID: 8535727

Voiding patterns and prevalence of incontinence in women. A questionnaire survey
Sommer P, Bauer T, Nielsen KK, Kristensen ES, Hermann GG, Steven K, Nordling J
Br J Urol. 1990 Jul;66(1):12-5. PMID: 2393793

Measurement characteristics of a voiding diary for use by men and women with overactive bladder
Brown JS, McNaughton KS, Wyman JF, Burgio KL, Harkaway R, Bergner D, Altman DS, Kaufman J, Kaufman K, Girman CJ.
Urology. 2003 Apr;61(4):802-9. PMID: 12670569

The 24-h frequency-volume chart in adults reporting no voiding complaints: defining reference values and analysing variables
van Haarst EP, Heldeweg EA, Newling DW, Schlatmann TJ.
BJU Int. 2004 Jun;93(9):1257-61. PMID: 15180618

Normative patterns of diurnal urination across 6 age decades
Burgio KL, Engel BT, Locher JL.
J Urol. 1991 Apr;145(4):728-31. PMID: 2005688

Bother arising from urinary frequency in women
FitzGerald MP, Butler N, Shott S, Brubaker L.
Neurourol Urodyn. 2002;21(1):36-40; discussion 41. PMID: 11835422

Micturition patterns in a healthy female population, studied with a frequency/volume chart
Larsson G, Victor A.
Scand J Urol Nephrol Suppl. 1988;114:53-7. PMID: 3201170

Voiding Frequency in a sample of asymptomatic American Men
Journal of Urology. 172(3):980-984, September 2004

Variability Of 24-Hour Voiding Diary Variables Among Asymptomatic Women
Journal of Urology. 169(1):207-209, January 2003

Urinary habits among asymptomatic women
Am J Obstet Gynecol 2002 Nov;187(5):1384-8

Urinary Habits Among Asymptomatic Women Working the Nightshift
M. FitzGerald & L. Brubaker; Loyola University Medical Center

Letters In Support of Public Restroom Initiative

Letters from Advocates to Public Officials in support of the Public Restroom Initiative

From Cheryle Gartley, President of the Simon Foundation for Continence
Dear Mr. Graham:

I write to you today in my capacity as President of the Simon Foundation for Continence, an internationally recognized non-profit organization dedicated to serving people with incontinence – the loss of bladder and/or bowel control.  It is estimated that over 20 million Americans are affected by incontinence, a medical condition which does not discriminate by sex, race, age, wealth or social status.

In your upcoming role as Chair of the Metrorail Operations Board, I trust you are becoming well educated to the many health conditions such as benign prostate hypertrophy (BPH), prostate cancer, multiple sclerosis, paraplegia, irritable bowel syndrome, spinabifida and urinary tract infections, to name just a few, that demand ready access to a bathroom.  A ready access that is all too often denied – leading people to cope by remaining in their homes where they can be assured of reaching a bathroom in time.

It is my understanding that although Washington subway stations are equipped with significant toilet assets, current policy denies use of these facilities to riders.  I urge you to make changing this policy your number one priority.  For millions of Americans, access to a washroom is not a convenience, but rather the difference between getting out into the world and becoming a contributing member of society or remaining hidden at home.  By providing access to washrooms throughout the D.C. area, you will not only liberate friends, neighbors, and perhaps even family members, but also set an example for the rest of our nation to follow.

If I or any of the dedicated medical professionals on the Simon Foundation’s Board can provide you with medical information or further help in reaching this goal, please do not hesitate to call upon us.

Cheryle B. Gartley

From Ingrid Nygaard M.D., Co-author of Void Where Prohibited

I am a urogynecologist at the University of Iowa College of Medicine, and as such, spend my days trying to protect and improve women’s bladder health.  I write to you in your capacity as the chair of the Metrorail Operations Board.  Issues related to bathroom access are not widely discussed, but are integral to people’s ability to use public transportation.  Millions of Americans suffer from urinary incontinence, urinary urgency, urinary tract infections, and other diseases that require ready bathroom access in order to function well in society.  It is my understanding that current Washington subway station restrooms are available only for employees (obviously, also very important!) and urge you to work towards extending this same right to urinate to your passengers.  If I can provide you with any medical information about this issue, please feel free to email me.

Sincerely yours,

Ingrid Nygaard, MD
Associate Professor
Department of Obstetrics and Gynecology
University of Iowa

Comments from Readers

Dear Sir/ Madam:

As an IC patient myself, I was shopping [deleted reference] about two years ago when I had sudden bladder spasm.. that left me gasping in pain. I asked the manager if I could use the restroom and she haughtily proclaimed “No.” I said “I have a medical condition and a medic alert card. Would that make a difference?” She said “No” and urged that I walk a block (impossible at the time) to another store to use their public restroom. Funny, I was buying more than $200 worth of merchandise… and yet that wasn’t worth anything in her eyes. So, I raised my voice slightly… said something about recently having surgery. She shook her head… and other customers came to my defense. About five agonizing minutes later, she grudgingly allowed an employee to escort me to their bathroom.
Source: Email: Jan 04, 2003 8:10 AM From J.O.

On your list of medical conditions causing increased/ unexpected urinary voiding, I suggest that you add bladder cancer.

Bladder cancer is the 5th most common type of cancer in the US and commonly results in increased voiding, even after successful treatment.  The cancer also results in considerable pain when the need to void is overdue.

I am a bladder cancer patient, and I have personally been inconvenienced by Metro’s locked restroom policy.  I am an otherwise healthy 55 year old man in excellent physical condition, so the attendants are unlikely to admit me to the Metro restrooms.  Since I have a long commute to work, I have been forced to leave Metro to seek a restroom half-way through my trip.  On other occasions, I have had to race out of the parking lot in considerable pain to search for a restroom at the end of my trip.

I hope your efforts meet with success.
Source: Metroped Feedback dtd 5 Jan 03 From J.C.

I have MS and stopped at a bread store after work. I was the only person besides the one clerk who worked there. All of a sudden I had to use the restroom. She said she was unable to allow it because it was store policy. I told her to take my car keys and purse and just please let me use the rest room. Well the answer was no! It was a night with strong winds and very cold.(Iowa winter) I wet myself and froze when I left. I called the main office the next day and was told it was the store policy and there wasn’t anything I could do about it
Source: Metroped Feedback dtd 24 Jan 04 From V.K.

Don’t forget on your list of those who are the “restroom challenged”…those of us with ostomys. I am in a wheelchair AND have an ileostomy. Finding a restroom is virtually impossible
Source: Judith via Metroped Feedback dtd 3 Jan 04

I had a very upsetting situation yesterday. I was in a Waldenbooks store. It was a stand alone building, not in a mall. It was cold and rainy and I lost my car keys. My husband was on his way to get me when my 3 year old said he needed to go to the potty. The store refused to let us use their facility due to company policy. About 4 minutes later, my child urinated in his pants and on the floor. This was a large store and it is hard for me to believe that they are not legally suppose to have a public facility. This was in Raleigh NC. What is the legality of this situation?
Source Email Feb 16, 2003 5:46 AM From: “RM”

I have MS and also have had a good portion of my colon removed due to colon cancer, so urgency is a real problem.  Finding a restroom is often difficult, finding one that is clean and maintained even harder.
Source: Email: Nov 10, 2002 7:09 PM From K.M.
Thank you so much for publicizing this issue.  Until I read the story, I didn’t know that there were restrooms in the metro stations.  I wish I had…on the 4th of July, I volunteered at the Folklife Festival all day.  It had been hot, humid and sunny, and by the time I left, around 6 PM, I was feeling very ill from the heat, with a headache, clamminess and rising nausea. I was afraid I was going to throw up, but what could I do–no restrooms and no trash containers on the platform b/c of security.  I thought I could make it, but was sick just as the train pulled into Grosvenor.   If I had known there were restrooms, I would have got off and insisted they let me use one.
Source: Email: Jul 08, 2002 12:32 PM From E.C.

Portland OR – I was at Wells Fargo in Portland, OR today to do some banking. It was noonish, and I was enroute to home for lunch. I made my deposit, and then asked to used the restroom, which I was told there wasn’t a public restroom.  I am a customer and 8.5 months pregnant. I left the bank in search of a bathroom, which took 15-20 minutes of unfamiliar territory, used the facilities of a public building, sat down for some lunch, and then back to my car, to find it had been towed away.  $200 later, I get my car back and no resolution from the bank for towing my car.  E.B.
Soruce: NARA Feedback dtd March 03, 2006 8:23 PM



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Phone:  800-247-3864
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