The dictionary definition of choice is “a situation in which you can choose between two or more things” (Cambridge Dictionary) such as choosing which colour jumper to wear. But often within the field of healthcare making a choice between two treatment options can be particularly difficult as you may not know enough about either option to enable you to make this decision. So, this is where the term informed choice comes in as “an act of choosing when you have enough knowledge or information to help you do this” (Cambridge Dictionary).

Where do you get the additional information needed to make an informed choice?

It is the role of the healthcare professional to provide enough information to enable you to make this choice. Though it is often considered a good idea to get your information from a variety of sources rather than just one source to avoid bias in the information. However, it is important to make sure that the information is of high quality and comes from a reliable source. This has become even more important in recent years with the increase in the use of social media, where everyone has an opinion, advice or knowledge to give. This additional information can be written information or practical information gained by experience. The experience of the patient (past or present), the experience of a fellow patient in a similar situation or the experience of a healthcare professional with previous patients.

When discussing a new topic such as intermittent self-catheterisation (ISC), it is very easy to become overwhelmed with information, making the choice of a catheter to start with even more difficult, rather than easier. Another term that is frequently used in healthcare is the ‘expert patient’. There is no-one who knows your body better than you do. But in the situation of learning a new skill, you are the novice and need to develop knowledge and experience to become the expert.

Your healthcare professional may try to help you, by choosing a catheter for you to start learning the skill of ISC, based on their knowledge of catheters and what they have learnt about you. As you become more proficient at the skill of ISC you will gradually gain a better understanding of what you want from your catheter, what your routine is, and where you use your catheter.

Where do you get the additional information needed to make an informed choice?

The length and diameter of the catheter.

Catheters are manufactured in 3 lengths. Standard (Male), Paediatric and Female lengths.

• Standard (Male) 40-45cms
• Female 15-30cms
• Paediatric 15-25cms

The lengths chosen are usually self-explanatory but sometimes a female may choose a longer catheter if they use a wheelchair or have a higher BMI.

The diameter of the catheter (or size) is measured in Charrière (Ch), which is a third of a millimetre and range from 6Ch – 26Ch (2mm – 8.6mm). Most people use a 10 – 14ch catheter. Here there is a balance between comfort (a smaller size) and urine flow (larger size is quicker to drain the bladder). The smaller sizes are used for children and the larger sizes are used when there are blood clots or mucous in the urine.

Handle of the catheter

Some catheters have a more obvious chunky handle or place to hold the catheters which can be useful if you have reduced dexterity. Some also have a “gripper” on the length of the catheter to make it easier to insert, particularly for men as they have longer catheters.

Integrated drainage bag

It is possible to have a catheter that has a drainage bag already attached to the catheter. This can be very useful if you are a wheelchair user or are unable to drain your bladder directly into the toilet.

Coating

Most catheters on the market today have a hydrophilic (water-loving) coating that makes the catheter easier to insert. It is activated by water (either that you need to add or thar is already in the package – useful if you don’t have access to running water). Some coatings are a gel coating that is applied to the catheter as you remove it from the packaging. Gel is an option if the water-based coating stings on insertion or feels like the catheter is drying out or sticking as you try to withdraw it, or you just prefer the sensation of a gel coating.

Discreet packaging

It may be important to you that the catheter packaging is discreet, particularly if you will be catheterising at work. Does it fit in your jacket or trouser pocket? Would it blend in if you dropped your handbag?

Easy to open packaging

This can be particularly important if you have reduced hand dexterity. As you can see there are many features for you to consider that can make catheterising easier particularly in a public place. Don’t think that you are limited to one style of catheter. It might be a good idea to “mix and match” your catheters, so that you have a variety to suit the different days that you might experience. When talking to your specialist nurse about ISC, give some thought to what is working well and parts of the process that aren’t working so well. Make sure to consider where you might be catheterising, and what equipment might you need.

Further information

Find more information about bladder and bowel health in our information library at www.bbuk.org.uk.

You can also contact the Bladder & Bowel UK confidential helpline (0161 214 4591).

For further advice on bladder and bowel problems speak to your GP or other healthcare professional.

Download as a PDF

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It is the purpose of this project to uncover and unite the fragmentary discourses surrounding the incontinent body that began to emerge in multiple professions and industries from the 1870s, including public health, psychology, psychoanalysis, childrearing, social care, social work, medicine (including surgery, pharmacology and gerontology) and commerce (through the sale of remedies and technologies aimed at curing incontinence) 

Urinary incontinence has been common to the human experience throughout history, but it was from the late nineteenth century that the incontinent body came to be identified as a significant moral problem in Britain.  

The rise of the public health movement signalled the state’s desire for greater control over the nation’s water supply, the simultaneous medicalisation, commercialisation and stigmatisation of incontinence demonstrated a shift towards the desire for greater control of the flow of urine from the individual body. Incontinence was deemed polluting to the body politic, but fixable by new surgical, pharmaceutical, psychological and technological interventions. When not fixable, incontinent bodies were deemed burdensome by the sufferers themselves, their families, the medical profession and the state and given as a major cause of hospital bed-blocking and mental health problems.  

Yet, while urine incontinence became an intense subject of focus between 1870 and 1970, it has attracted little historical research. Incontinence has gained fragmentary interest amid growing sociological work on the leaky body, but historical work on the body remains largely segmented by class, gender, sexuality, race and (dis)ability and aspects of health and disease maintained within bodily boundaries; medical histories too are only just beginning to take incontinence seriously. 

It is thus the purpose of this innovative project to go beyond the boundaries of historical subfields by identifying the significance of the incontinent body to medical, commercial and public discourses and tracing how these discourses shaped experiences of incontinence chronologically and through the life cycle, from toddler to pensioner. By drawing on interdisciplinary approaches from sociology and anthropology and by drawing together histories of medicine, the body and social and cultural history, this project will demonstrate the centrality of incontinence, and by extension the urinary body, to everyday life in modern Britain.  

The research, which is designed to help reduced current social taboos on incontinence, intends to look at:

1) How significant was incontinence to contemporary discourses in commerce, medicine and associated fields between 1870 and 1970?  

2) To what extent were these discourses stigmatising and thus responsible for creating new social norms surrounding incontinence and urination more broadly?  

3) To what extent did such discourses shape individual and collective experiences of incontinence?  

4) How did such discourses and experiences change throughout the life course and vary according to class, race, gender and ability?  

5) How might this novel focus on incontinence offer new perspectives on the history of the body, the social history of medicine and to wider humanities and social science disciplines? 

6) How might this historical work challenge the contemporary stigmatisation of incontinence? 

We spent this first meeting reviewing papers, looking at the history, having discussions and formulating a plan for our next project meeting in November to be  hosted by Juliette in Bristol. We will keep you updated as the project progresses.    

If anyone is interested in learning more about the project, or in taking part, then they can get in touch directly with Dr Claire Jones  – C.L.Jones-26@kent.ac.uk 

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Prevalence of Incontinence  

This article discusses the importance of considering sustainability when selecting/recommending incontinence management solutions. It is estimated that 14 million men, women, young people and children of all ages are living with bladder problems. 1 in 10 of the population are affected by faecal incontinence. Over half a million adults suffering from faecal incontinence. Urinary and faecal incontinence are conditions affecting one in three people living in residential care. As well as, two in three nursing home residents.

Anyone of any age or with any medical condition who has a continence problem should seek healthcare professional support and advice. Often there solutions to resolve the problem or reduce the impact. However, for some, achieving continence is not possible, so effective containment is vital to quality of life, independence, dignity and self-esteem. 

We are all aware of the importance in reducing our climate footprint. How can we be more sustainable when it comes to incontinence products?

 Sustainability

Sustainable healthcare is a major goal both worldwide and for the NHS. Single-use products are a key contributor to plastic waste (Sustainable Development Unit, 2020). Incontinence management is heavily dependent on single-use products; many of which contain non-biodegradable materials including plastics. These include urinary drainage sheaths and catheters as well as containment products. NHS Inform (2020) estimates that three million to six million people in the UK experience urinary incontinence and that demand for containment products is likely to rise because risk factors for incontinence are increasing. These include advancing age, lifestyle factors, dementia, neurological conditions, complex comorbidities and obesity.

A more sustainable approach to containment product provision currently depends on a reduction in use of single-use products and their substitution with reusable alternatives. There are advantages and disadvantages to both washable (reusable) and single-use products. A ‘mix and match’ approach is key.

For many people, the introduction of washable products may be acceptable. However, some will only be able to manage these in combination with other single-use versions for specific times of the day. Working towards strategies for sustainability in continence care; such as reduce, reuse, recycle – requires a thorough understanding of the lifecycle of products and associated processes. This is the responsibility of us all. This includes product manufacturers, policymakers, purchasing agencies, prescribers, researchers, health professionals and end users.

Environmental sustainability

Both cloth and disposable containment products have environmental impacts. Some of these include: the consumption of natural resources, energy usage, health issues, air and water pollution and waste disposal. However, the damaging impact from cloth containment products is less than that of disposable containment products.

Disposable containment products are usually made with wood pulp, oil and plastics. Cloth products are often made of cotton or other natural fibres. Choosing cloth instead of disposable containment products represents a significant way to reduce oil and tree consumption.

Billions of containment products end up in landfills and an estimated three billion disposable containment products are thrown away every year in the UK. This accounts for 2-3% of all household waste, according to recycling charity WRAP. Methane is released into the air during the decomposition of disposable containment products. This contributes significantly to global warming. Disposable containment products have a negligible recycling rate. The absorbent gels and plastic components found in disposal containment products take up to 500 years to decompose.

For the millions of people who are affected by incontinence, management products are an important part of their lives and ensure dignity, self-esteem and allow them to continue with their usual activities

Introducing Washables Incontinence Underwear

Washable incontinence underwear is largely produced from natural materials such as cotton or bamboo, biodegradable and renewable resources. A pack of seven washables can be used up to 250 times per pair – lasting about two years at very low cost. Therefore, healthcare providers can save significant amounts of money each year and increase sustainability by sensibly switching to washables for the right patients according to a good clinical care pathway.

Washable pants may provide adequate absorbency during the day for some patients who have light to moderate bladder leakage, or those who experience only occasional light leakage (perhaps just after urinating) and want some form of protection “just in case”. They are very good at staying in place and are relatively discreet. They may be the best solution for those who are physically active. Overnight use of washable containment products may be better suited for men and women who sleep on their backs with light leakage. When selecting washable containment products, it is important to consider whether they are the right size, the right absorbency, and whether the patient and/or their carers/relatives can manage them.

Most washable containment underwear for adults is adapted to fit either male or female anatomy. With more padding at the front for men and more padding in the middle for women. There are a diverse range of styles available, ranging from classic briefs to boxers for men and full cut pants through high leg, lace and mid-rise to bikini styles for women. Similarly, for children there are pant and boxer styles available.  

Initial Preparation & Washing:

The garment should be washed once before using. Underwear can be washed in a normal wash cycle without bleach or fabric softener. The garment must be fully dry before it is worn.

In a care home setting, it can be useful to label underwear with indelible ink. It may also be helpful to put the used product into the washing machine in a net bag to ensure easy identification.

To conclude, sustainability is vitally important to us all. The NHS is the first health service in the world to commit to reaching carbon net zero. This is in hopes to address the increasing threat to human health of climate change.  All those with an interest in continence care should be adopting solutions that maintain the dignity, independence and quality of life of patients while reducing the reliance on disposable single-use containment products.

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We provided much of the information for the frequently asked questions. Therefore we are delighted that there are links to Bladder & Bowel UK’s children and families information library and to our website.

What is Bedwetting?

Bedwetting, sometimes called nocturnal enuresis, or simply enuresis, affects approximately 20% of 5-year-olds and 10% of 7-year-olds. It is considered to be a medical problem once children have passed their fifth birthday.

It used to be thought that children would grow out of the problem. However, without treatment many children will continue to wet the bed into late childhood, or their teens. It can sometimes last into adulthood which demonstrates the importance of effective treatment and management.

‘Supporting ALTURiX in the creation of the DreamDry® app from concept to release has been a rewarding process. The app provides helpful information for children and families as well as recording children’s progress and use of any prescribed medication or alarms. A positive development is the means to support open communication between parents and healthcare professionals, fostering a collaborative approach to managing bedwetting.’ – Davina Richardson, RGN/RSCN, Children’s Specialist Nurse.

Why DreamDry®?

This app has reliable information that may be helpful when tackling bedwetting – but also allows parents, guardians, and caregivers to quickly log the child’s wet and dry nights.

Additionally, DreamDry® facilitates record keeping and enables the healthcare professional to see a record of how well the child is managing to adhere to treatment and its effects.

The digital platform means the family do not have to keep track of bits of paper and will have the information safely stored on their device when they speak to the healthcare professional.

There is also a function which allows the user to export the information to CSV or PDF.

‘‘We are thrilled to have recently launched DreamDry® and are extremely grateful to Bladder & Bowel UK for providing their absolutely essential support with input on research and information that fuelled the six-month development journey. Working together, we hope we have created an App which makes a meaningful impact in the lives of parents and children.’ – Team ALTURiX

Our involvement

DreamDry® was funded by ALTURiX, and developed with support from Bladder & Bowel UK, and ERIC, The Children’s Bowel & Bladder Charity and is a free App published on the Apple App Store, and Google Play.

Download DreamDry®

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