BACKGROUND: Restroom access legislation provides individuals with inflammatory bowel disease emergency access to retail store employee bathrooms. Stores in jurisdictions that do not have this legislation may inconsistently allow use of restrooms. A variety of reasons have been reported for not permitting bathroom use, including concerns related to property loss, safety, potential for abuse and hygiene. However, it is unclear if retail store managers who deny access are able to offer options to individuals in need of a bathroom. This study surveyed retail store managers who are unable to offer the use of an employee bathroom about the options that are given to individuals with medical needs.METHODS: Managers of Washington, DC retail stores with employee bathrooms who were unable to offer bathroom access were surveyed about the options that are given to individuals with medical needs. Stores within 1 mile of a university medical center were included. There were no exclusion criteria. None of the stores were in a mall what offered a public bathroom. The store type, manager gender and options offered were obtained. Statistical analysis was performed using Fisher Exact test. The study was approved by the university institutional review board.RESULTS: The managers of the 31 stores with only an employee bathroom were surveyed. Seven managers (23%; 3 male, 4 female) would provide emergency access to employee restrooms. Twenty-four managers (77%; 13 male, 11 female) indicated that they could not provide emergency access to employee restrooms. There was no significant difference (P = 0.6851) in the rate that male and female managers offered restroom access. Only 11 of 24 managers (46%; 5 male, 6 female) who were unable to allow bathroom access indicated that they offered options to requesting individuals. Nine managers referred individuals to restaurants for bathroom access, 1 suggested the use of the bathroom in a neighboring retail store and 1 indicated that emergency personnel ("911") would be contacted. There is no significant difference (P = 0.7247) in the rate that male and female managers offered options for individuals with medical needs.CONCLUSIONS: Individuals with inflammatory bowel disease and other medical illnesses may periodically require emergency bathroom access. Legislation has been passed which allows for individuals with medical concerns access to employee bathrooms in retail stores. Washington, DC does not have restroom access legislation and is bordered by a state that has passed and a state that did not pass laws permitting restroom access. The majority of the retail store managers who were surveyed were unable to provide bathroom access. However only a limited number of these managers were able to offer options to individuals expressing a medical need that required restroom access. Managers offering bathroom options most commonly suggested use of neighboring restaurants. Enhanced awareness of the needs of individuals with inflammatory bowel disease may encourage managers to allow emergency bathroom use or offer options for those with urgent medical concerns.(C) Crohn's & Colitis Foundation of America, Inc.