Many older people in the Netherlands have opted not to go on an outing because there are not enough public toilets and if there are, they are too dirty to use, according to a survey among 5,500 people over the age of 65.

Almost all the respondents were unhappy with the number of public toilets available in the Netherlands, particularly in city and village centres, the survey showed.

Women are most often hard put to find a loo when visiting the countryside, whereas fewer men said that is a problem. Four in 10 men said they would simply pee “in the wild” (wildplassen) and a quarter of women would do the same if brought to the brink. Some respondents said they used incontinence pads or a bottle to pee in as an alternative solution.

“The shortage of toilets is keeping a much larger group of elderly at home than previously thought,” said Simon van Herpen, chairman of seniors union ANBO-PCOB, which carried out the survey. “People stop going for walks in the woods or park. They won’t go shopping because it is stressful not to know if you can find a loo in time,” he told the AD.

Some 60% of elderly need the toilet more often than the population at large because of illness and one in 10 need an adapted toilet. “But it is not just the elderly who need toilets, families with young children are also caught out,” Van Herpen said.

Better access to loos in bars and restaurants would also relieve the problem, respondents said.

However, some 57% of respondents said they had been refused access or had to buy something before they could use the facilities. In shops or supermarkets, toilets are usually “staff only”.

Many of the respondents wondered why other countries manage to have a network of clean toilets while the Netherlands has just 500, including 350 urinals, nationwide. Paris alone has 750 public toilets.

The union has formed a Toilet Alliance with digestive system charity MDL Fonds to urge local councils to do something about the problem. And Amsterdam said last year it is spending €4 million on public toilets for women. At the time, there were just nine official loos for both men and women inside the ring road.

“They have to realise that in 2040 there will be 5 million over-65s in the Netherlands and they will all have to go,” Van Herpen said.