Read: Using the restroom: A privilege—if you’re a teacher

A majority (84 percent) of respondents in the recent survey, which was distributed among school nurses serving all grade levels nationwide, said students often have ulterior motives when they ask to use the bathroom—maybe they don’t have to go and just want to meet up with a friend, for example, or perhaps they intend to skip the bathroom altogether and cause a ruckus in the hallway. A little more than half reported that kids misbehave in the bathroom. Underlying these assumptions is the fact that few schools have written policies on students’ bathroom use—just 8 percent of nurses said such rules existed, while fewer than half said students on their campus can use the bathroom whenever they please, with permission required only as a formality.

And the survey’s results suggest that such realities persist despite growing recognition of the health consequences. More than a third of respondents expressed concern about the adequacy of kids’ bathroom-break time—and three in four said they were aware of bladder or bowel problems among kids at their school.

A separate 2015 study underscores the disconnect between discipline-focused bathroom policies and kids’ health. While 81 percent of the more than 4,000 elementary-school teachers said they allow kids unlimited access to water, 88 percent also said they encourage their students to hold their pee; 36 percent of participants, meanwhile, indicated they had a “protocol in place to encourage students not to use the bathroom during class time.” Also notable: About eight in 10 of those educators said bullying, misbehavior, vandalizing, or other negative behavior happens in the restroom.

Some experts point to bed-wetting—which according to the American Academy of Pediatrics affects 20 percent of 5-year-olds and can be a symptom of an acutely dysfunctional bladder—as attributable largely to kids holding in their urine or feces. This “voiding dysfunction,” as medical practitioners refer to it, can have severe, long-lasting physiological consequences—a swollen colon can damage the nerves feeding into the bladder, for example—not to mention psychological ones .