The Restroom Access Act, also known as Ally's Law, is legislation passed by several U.S. states that requires retail establishments that have toilet facilities for their employees to also allow customers to use the facilities if the customer has a medical condition requiring immediate access to a toilet, such as inflammatory bowel disease or Crohn’s disease.
The law is named for Ally Bain, a 14-year-old girl from Illinois who had a flare-up of her Crohn's disease while shopping at a large retail store and was subsequently denied use of the employee-only restroom, causing her to soil herself. Bain's mother vowed it would never happen to anyone else. The two met with Illinois State Representative Kathy Ryg, helped her draft a bill, and testified before a committee at the state capital. The bill was signed into law in August 2005, making Illinois the first U.S. state to do so.
As of January 2024, at least 20 U.S. states had passed versions of the law. They include Arkansas, California, [1] Colorado, Connecticut, Delaware, [2] Illinois, Kentucky, Louisiana, [3] Maryland, Massachusetts, Michigan, Minnesota, New Hampshire, [4] New York, Ohio, Oregon, Tennessee, Texas, Wisconsin, and Washington. [5] [6] A Virginia bill, which levies fines of $100 for non-compliance, was adopted in the 2024 General Assembly session and went in to effect on July 1, 2024. [7]
There is support for a federal version of the act, but some small-business people object to the public using their employee bathrooms. [8] [5]
In general, each state requires that the customer present a document signed by a medical professional attesting that the customer uses an ostomy device or has Crohn's disease, ulcerative colitis, or other inflammatory bowel disease or medical condition requiring access to a toilet facility without delay. In at least two states, Oregon and Tennessee, the customer can present an identification card issued by a national organization advocating for the eligible medical condition. [9] [6]
Some states also include pregnancy as a covered medical condition. [5]
The Restroom Access Act of Illinois states:
- Sec. 10. Retail establishment; customer access to restroom facilities. A retail establishment that has a toilet facility for its employees shall allow a customer to use that facility during normal business hours if the toilet facility is reasonably safe and all of the following conditions are met:
- (1) The customer requesting the use of the employee toilet facility suffers from an eligible medical condition or utilizes an ostomy device.
- (2) Three or more employees of the retail establishment are working at the time the customer requests use of the employee toilet facility.
- (3) The retail establishment does not normally make a restroom available to the public.
- (4) The employee toilet facility is not located in an area where providing access would create an obvious health or safety risk to the customer or an obvious security risk to the retail establishment.
- (5) A public restroom is not immediately accessible to the customer. [10]
In Australia, the association Crohn's & Colitis Australia (CCA) encourages businesses to support people with such medical conditions by recognizing the Can't Wait Card issued by the CCA. [11] The CCA states:
Other countries including the UK have similar programs of voluntary participation by businesses, one such program in the UK is the Bladder & Bowel Community's Just Can't Wait Card. [14]
A card with no country specific indications is available explaining the possibility of legislation and the gravity of the card holders disability and need for restroom access.[ citation needed ]
Crohn's disease is a chronic inflammatory bowel disease characterized by recurrent episodes of intestinal inflammation, primarily manifesting as diarrhea and abdominal pain. Unlike ulcerative colitis, inflammation can occur anywhere in the gastrointestinal tract, though it most frequently affects the ileum and colon, involving all layers of the intestinal wall. Symptoms may be non-specific and progress gradually, often delaying diagnosis. About one-third of patients have colonic disease, another third have ileocolic disease, and the remaining third have isolated ileal disease. Systemic symptoms such as chronic fatigue, weight loss, and low-grade fevers are common. Organs such as the skin and joints can also be affected. Complications can include bowel obstructions, fistulas, nutrition problems, and an increased risk of intestinal cancers.
Ulcerative colitis (UC) is one of the two types of inflammatory bowel disease (IBD), with the other type being Crohn's disease. It is a long-term condition that results in inflammation and ulcers of the colon and rectum. The primary symptoms of active disease are abdominal pain and diarrhea mixed with blood (hematochezia). Weight loss, fever, and anemia may also occur. Often, symptoms come on slowly and can range from mild to severe. Symptoms typically occur intermittently with periods of no symptoms between flares. Complications may include abnormal dilation of the colon (megacolon), inflammation of the eye, joints, or liver, and colon cancer.
Defecation follows digestion, and is a necessary process by which organisms eliminate a solid, semisolid, or liquid waste material known as feces from the digestive tract via the anus or cloaca. The act has a variety of names ranging from the common, like pooping or crapping, to the technical, e.g. bowel movement, to the obscene (shitting), to the euphemistic, to the juvenile. The topic, usually avoided in polite company, can become the basis for some potty humor.
Hematochezia is a form of blood in stool, in which fresh blood passes through the anus while defecating. It differs from melena, which commonly refers to blood in stool originating from upper gastrointestinal bleeding (UGIB). The term derives from Greek αἷμα ("blood") and χέζειν. Hematochezia is commonly associated with lower gastrointestinal bleeding, but may also occur from a brisk upper gastrointestinal bleed. The difference between hematochezia and rectorrhagia is that rectal bleeding is not associated with defecation; instead, it is associated with expulsion of fresh bright red blood without stools. The phrase bright red blood per rectum is associated with hematochezia and rectorrhagia.
Inflammatory bowel disease (IBD) is a group of inflammatory conditions of the colon and small intestine, with Crohn's disease and ulcerative colitis (UC) being the principal types. Crohn's disease affects the small intestine and large intestine, as well as the mouth, esophagus, stomach and the anus, whereas UC primarily affects the colon and the rectum.
Colitis is swelling or inflammation of the large intestine (colon). Colitis may be acute and self-limited or long-term. It broadly fits into the category of digestive diseases.
Mesalazine, also known as mesalamine or 5-aminosalicylic acid (5-ASA), is a medication used to treat inflammatory bowel disease, including ulcerative colitis and Crohn's disease. It is generally used for mildly to moderately severe disease. It is taken by mouth or rectally. The formulations which are taken by mouth appear to be similarly-effective.
Toxic megacolon is an acute form of colonic distension. It is characterized by a very dilated colon (megacolon), accompanied by abdominal distension (bloating), and sometimes fever, abdominal pain, or shock.
Ileostomy is a stoma constructed by bringing the end or loop of small intestine out onto the surface of the skin, or the surgical procedure which creates this opening. Intestinal waste passes out of the ileostomy and is collected in an external ostomy system which is placed next to the opening. Ileostomies are usually sited above the groin on the right hand side of the abdomen.
In medicine, the ileal pouch–anal anastomosis (IPAA), also known as restorative proctocolectomy (RPC), ileal-anal reservoir (IAR), an ileo-anal pouch, ileal-anal pullthrough, or sometimes referred to as a J-pouch, S-pouch, W-pouch, or a pelvic pouch, is an anastomosis of a reservoir pouch made from ileum to the anus, bypassing the former site of the colon in cases where the colon and rectum have been removed. The pouch retains and restores functionality of the anus, with stools passed under voluntary control of the person, preventing fecal incontinence and serving as an alternative to a total proctocolectomy with ileostomy.
Rolf Joachim Benirschke is an American former professional football player who was a placekicker in the National Football League (NFL). He played for the San Diego Chargers from 1977 until 1986. He is probably most known for missing a potential 27-yard game-winning field goal in overtime of the playoff game known as the "Epic in Miami” but then getting a second chance and connecting from 29 yards fourteen minutes into overtime to win the game on January 2, 1982.
Blood in stool looks different depending on how early it enters the digestive tract—and thus how much digestive action it has been exposed to—and how much there is. The term can refer either to melena, with a black appearance, typically originating from upper gastrointestinal bleeding; or to hematochezia, with a red color, typically originating from lower gastrointestinal bleeding. Evaluation of the blood found in stool depends on its characteristics, in terms of color, quantity and other features, which can point to its source, however, more serious conditions can present with a mixed picture, or with the form of bleeding that is found in another section of the tract. The term "blood in stool" is usually only used to describe visible blood, and not fecal occult blood, which is found only after physical examination and chemical laboratory testing.
In the anatomy of humans and homologous primates, the descending colon is the part of the colon extending from the left colic flexure to the level of the iliac crest. The function of the descending colon in the digestive system is to store the remains of digested food that will be emptied into the rectum.
Proctocolectomy is the surgical removal of the entire colon and rectum from the human body, leaving the patients small intestine disconnected from their anus. It is a major surgery that is performed by colorectal surgeons, however some portions of the surgery, specifically the colectomy may be performed by general surgeons. It was first performed in 1978 and since that time, medical advancements have led to the surgery being less invasive with great improvements in patient outcomes. The procedure is most commonly indicated for severe forms of inflammatory bowel disease such as ulcerative colitis and Crohn's disease. It is also the treatment of choice for patients with familial adenomatous polyposis.
Biological therapy, the use of medications called biopharmaceuticals or biologics that are tailored to specifically target an immune or genetic mediator of disease, plays a major role in the treatment of inflammatory bowel disease. Even for diseases of unknown cause, molecules that are involved in the disease process have been identified, and can be targeted for biological therapy. Many of these molecules, which are mainly cytokines, are directly involved in the immune system. Biological therapy has found a niche in the management of cancer, autoimmune diseases, and diseases of unknown cause that result in symptoms due to immune related mechanisms.
The Crohn's & Colitis Foundation is a volunteer fueled non-profit organization in the US that works to fund research to find cures for Crohn's disease and ulcerative colitis, collectively known as inflammatory bowel disease (IBD), and to improve the quality of life of children and adults affected by these digestive diseases. Founded by Shelby and William Modell, Suzanne and Irwin Rosenthal, and Dr. Henry Janowitz, it was launched publicly on September 12, 1967, as the National Foundation for Ileitis and Colitis. It was incorporated on December 17, 1965. The Foundation serves millions of patients diagnosed with IBD in the U.S., through its national headquarters in NYC, and more than 30 chapters nationwide.
Vedolizumab, sold under the brand name Entyvio, is a monoclonal antibody medication developed by Takeda Oncology for the treatment of ulcerative colitis and Crohn's disease. It binds to integrin α4β7, blocking the α4β7 integrin results in gut-selective anti-inflammatory activity.
The Journal of Crohn's and Colitis is a monthly peer-reviewed medical journal covering inflammatory bowel diseases. It was established in 2007 and was originally published by Elsevier, but has been published by Oxford University Press since January 2015. It is the official journal of the European Crohn's and Colitis Organisation. The editor-in-chief is Laurence J. Egan. The journal has a 2022 impact factor of 8.0. In 2022, it was ranked 7th by Scimago journal rankings in the field of Gastroenterology and Hepatology.
David T. Rubin is an American Gastroenterologist and Educator. He is the Joseph B. Kirsner Professor of Medicine and Professor of Pathology at the University of Chicago, where he is also the Chief of the Section of Gastroenterology, Hepatology and Nutrition. He also serves as the Director of the Inflammatory Bowel Disease group at the University of Chicago. He is also an associate faculty member at the MacLean Center for Clinical Medical Ethics, associate investigator at the University of Chicago Comprehensive Cancer Center and a member of the University of Chicago Committee on Clinical Pharmacology and Pharmacogenomics.
Segmental colitis associated with diverticulosis (SCAD) is a condition characterized by localized inflammation in the colon, which spares the rectum and is associated with multiple sac-like protrusions or pouches in the wall of the colon (diverticulosis). Unlike diverticulitis, SCAD involves inflammation of the colon between diverticula, while sparing the diverticular orifices. SCAD may lead to abdominal pain, especially in the left lower quadrant, intermittent rectal bleeding and chronic diarrhea.
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