Incontinence (leakage of wee or poo), difficulties with toilet training, or other issues with toileting can result in difficulties at home, nursery, school or in the wider community. They are a source of stress and frustration for families, not only due to the difficulties of practical management of ‘accidents’, but also because of the impact on your child.  

Children who are struggling with learning the skills required for toilet training, or who have toilet trained but have new or continuing wetting or soiling (urinary or faecal incontinence) are often embarrassed and upset about the problem. However, some children will behave as if they do not care about an issue that they cannot control. This may make you feel the wetting or soiling is deliberate, laziness, or naughty behaviour. This is very rarely the case. Childhood incontinence, or issues such as appearing to leave it to the last minute to go to the toilet, is nearly always caused by a bladder and/or bowel health problem. Most of these can be successfully treated. 

Wetting and/or soiling in children and young people may be associated with emotional problems, difficulties with mental health, poor self-esteem and reduced social opportunities. Furthermore, the additional washing and clothing needed may be expensive. Therefore, it’s important you know where to turn for more help and information.  

In this blog post, we outline what you should be able to expect from the different professionals who may work with you and your children within health or education.  

Nursery

Nurseries should ensure that all children in their care are kept safe and supported to learn and develop according to their individual needs. This includes providing support for bladder and bowel health. 

• It is reasonable to expect nursery to support the needs of your child, as an individual, whilst in their care and review this support regularly.  
• Staff at nursery should be trained in supporting you and your child with learning the skills that they need to be successful with toilet training. You should not be expected to wait until a particular age for this. 
• Healthcare professionals can train nursery staff to complete any procedures your child needs for their bladder or bowel health e.g. catheterisation. 
• If nursery identify a cause for concern, they should discuss this with you and suggest that you contact your local GP or health visitor for further assessment, advice, and support.  

Health visitors

Health visitors are qualified nurses that sit under the umbrella of universal services. This means they should be available to all families with children who have not yet started full time primary school. They work to identify health needs as early as possible and to improve young children’s health. Your health visitor should meet you when your baby is about ten days old. They will see you either at home, in a local child health clinic, or at your GP surgery. 

• Health visitors should be trained in children’s bladder and bowel health and assessment of any possible issues.  
• Health visitors are often the first point of contact for assessment and guidance of your child’s bladder and bowel issues.
• It is reasonable for these health professionals to discuss your child’s bladder and/or bowel issues with their GP. They may also, with your consent, talk to other professionals supporting you with your child e.g. social worker or family support worker or other healthcare professionals.  
• Once they have completed their assessment they will work with you, your child and your child’s GP to provide a plan of care. This may include some treatment or referral for more specialist support. 
• You should be provided with verbal and written information about your child’s bladder or bowel issue and any treatment options.

School nurses

School nurses are trained nurses that are also part of universal services and work with children aged 5 -19 years old. They work in schools and other settings to promote health, identify health needs and offer suggestions to prevent health issues getting worse. They can also refer to other services as required. School should be able to provide you with information about how to contact your school nurse.  

• School nurses should be trained in children’s bladder and bowel health and assessment of any issues. 
• You can contact your child’s school nurse if you have any concerns about your child’s bladder and/or bowel. 
• If your child is at secondary school, they may be able to ask to see the school nurse at a regular ‘drop-in’. They do not have to say why they want to see the school nurse.  
• They should be able to offer initial assessment and suggestions to help. 
• The school nurse may discuss your child’s bladder and/or bowel health with their GP. They may also ask your consent to talk to other professionals who are supporting your child e.g. social worker, family support worker, other healthcare professionals.  
• Once they have completed their assessment they will work with you, your child and  your child’s GP to provide a plan of care. This may include some treatment or referral for more specialist support. 
• You should be provided with verbal and written information about your child’s bladder or bowel issue and any treatment options. 

General Practitioners

General Practitioners (GPs) are doctors who treat common medical conditions and can also refer on for more specialist advice and treatment if this is required.  

• You can contact your GP if you have concerns about any aspect of your child’s bladder and or bowel health. You do not have to have seen a health visitor or school nurse first. 
• Your GP will review any assessments completed by your child’s health visitor or school nurse, if you have already spoken to them, and discuss with treatment options and provide general lifestyle advice to help. 
• It is reasonable to expect that they may wish to complete a face-to-face physical assessment of your child. This may include examining their tummy or asking for a urine or stool sample.   
• Dependent on your child’s condition and/or progress they may refer your child for further assessment and treatment with another health professional in a specialist service. This can be a specialist nurse, therapist or paediatrician. Referrals may take some time as many services are very busy and have long waiting times. 
• You should be provided with verbal and written information about your child’s bladder or bowel issue and any treatment options. 

School or collage

Schools or colleges are often able to identify health concerns in children and young people. They should discuss any such concerns with you and they may also ask the school nurse for support and advice.  

Schools have a duty to support children and young people with medical conditions. There is more information about what you can expect from school if your child has a bladder or bowel issue in the guidance: Managing Bladder and Bowel Issues in Nurseries, Schools and Colleges.

• Professionals in school such as your child’s teachers, teaching assistants, special educational needs coordinator (SENCO) may raise any concerns with you.  
• Education staff may ask for the school nurse to contact you and request consent to assess your child or they may ask you to contact the school nurse or your GP, and, as appropriate, seek further advice from your GP regarding your child’s continence. 
• Schools must make reasonable adjustments to meet your child’s bladder and bowel needs whilst they are in their care. This includes during school trips and sports sessions 
• Schools should provide safe, clean, and accessible toilet facilities for your child. They should allow them access to these as required. 
• Schools should allow children and young people to drink water regularly during the day, to ensure they stay well hydrated.
• It is reasonable to expect that school will discuss a care plan for your child with you and with your child if this is appropriate for their age and development. 
• School may request that other professionals involved in your child’s care contribute to any care plan to ensure that your child’s needs are met, and difficulties addressed promptly. 
• School may request support and training from a specialist team, if they are involved with your child’s care and your child needs support for interventions that need to be carried out in school e.g. catheterisation or stoma care. 
• Schools should be able to make suggestions about where you can get further information and support about your child’s bladder and/or bowel issue.  

Specialist services

Specialist services for children and young people’s bladder and bowel health vary across the UK. Some areas have a nurse-led, community-based children’s bladder and bowel service. Where these are not available your child may be referred to a paediatrician at their local hospital, if it is felt that a specialist service is needed.  

• A specialist service will assess your child’s bladder and bowel health. It is likely this will involve asking lots of questions about their general health and usual bladder and bowel habits. You may be asked to complete some forms that include information about their drinking and toileting patterns.  
• The service should explain what they think is causing any bladder and/or bowel issues and may provide written information about this and any treatment suggestions. 
• The specialist service may make suggestions about drinking and toileting routines and other lifestyle adjustments that may help. They may also recommend other treatments. 
• The service should offer regular reviews and treatment adjustments after discussion with you and your child (depending on their age and level of understanding) until the bladder and/or bowel issue has resolved.  
• Some children may require onward referral for further investigations and treatment options. Reasons why this may be recommended should be discussed with you and your child if required.  

Further information

There is more information about children’s bladder and bowel health and problems on the Bladder & Bowel UK website.

The post Who can help me if I am concerned about my child’s bladder and/or bowel health?  appeared first on Bladder & Bowel UK.

Incontinence is a very common condition. In fact, urinary incontinence is said to affect approximately 14 million people in the UK alone, while nearly half a million people are estimated to experience some form of bowel incontinence. 

However, despite these high figures, many people who struggle with incontinence can be reluctant to talk about it. This can be for all sorts of reasons, such as embarrassment or generational differences. At the same time, family members may find it hard to broach the subject as well, either due to the nature of their relationship or a lack of knowledge about the condition. 

But talking about incontinence is an important step towards getting your loved one the help they need, and preventing them from suffering in silence.  

In this blog post, we’ll provide you with some practical tips on how to approach a family member you believe may have incontinence with sensitivity and a positive mindset. We’ll also outline the steps you can take to help your loved one manage their condition. 

Conversation tips 

While incontinence may be a tough subject to talk about, if you believe your family member is experiencing incontinence, having that difficult conversation can make a huge difference to their overall wellbeing. It can feel tricky to start the conversation so you might want to try using an article, leaflet or advert as a prompt for the initial chat. 

Acknowledging that it’s an awkward topic can make the conversation a little easier for those who don’t like talking about bathroom habits. 

Remind them that incontinence is a very common problem and that there is plenty of help available. 

Another important aspect when talking about incontinence is to mirror the language your family member uses. For instance, if they refer to it as ’pee’ instead of ’urine’, match the terminology they use.  

Using language that is too formal could also make your conversation feel too clinical if your family member doesn’t usually talk in that way.   

It can also help to start the conversation side by side rather than face to face, for example, while out on a walk or in the car. Being side by side stops the conversation feeling like an interrogation and your family member may be more comfortable opening up. 

What is needed for a positive conversation? 

Making the conversation about incontinence a positive one gets you both off to a good start. Don’t rush the conversation and make sure to talk to them when you know you won’t be interrupted. It’s important to give the conversation the time and attention it needs. 

It’s also important for your loved one to feel relaxed, in control and free from judgement during your conversation. So, try not to talk about their situation with other people without their consent. Even though it may be coming from a place of love and concern, if your loved one found out, it could make them feel embarrassed or reluctant to talk about it at all.  

It can be useful to explain to your family member that incontinence is just like any other health problem, and encourage them to talk about it with their loved ones even if they feel embarrassed.

To ensure the conversation stays positive, maintain a sense of dignity and privacy throughout and respect their decisions. Keep the conversation confidential but let them know the door is always open if they want to discuss it further. 

Next steps 

Knowing what to do next is important for both you and your family member. This way, the conversation will be seen as productive and help promote their independence. One of the most important first steps they can take is to see a healthcare professional to rule out any potential underlying health conditions. 

Let your family member know there is a lot that can be done to help with incontinence. Even something as simple as assisting them when booking an appointment with the doctor can be enough for them to regain some confidence and control over their health.  

Arming yourself with information about incontinence before you have a conversation with your family member can also help you support them in making an informed decision. By ensuring they have more knowledge of their condition, they may feel confident enough to speak with you and a healthcare professional further.  

Helping them choose the right incontinence product can also be a big help. With so many options available, your loved one may feel overwhelmed. But by sharing the job between the two of you, they will feel supported and more secure in their decision. 

Visit Bowel & Bladder UK for printable resources which you can offer to your family member. They could read them in their own time and then talk with you about it afterwards.  

With different resources, you can provide them with a range of options and methods of support. Whether it’s their GP, a continence nurse, Bowel & Bladder UK or elsewhere, with the right help, your family member can feel confident in their incontinence management.

The post How to talk to a family member about incontinence appeared first on Bladder & Bowel UK.

Incontinence is a common issue that can affect people of all ages. But incontinence doesn’t affect everyone and is not an inevitability of ageing.  

There are also varying degrees of the condition, with some people only experiencing small leaks now and then, while others can lose control of their bladder or bowel completely if unable to reach a bathroom in time. 

In this article, we discuss the signs of incontinence across all age ranges. We also provide you with practical tips on how to support family members with incontinence and some of the best preventative measures that can be used to help.  

Signs to look out for in people of all ages

A lot of people will often feel embarrassed about their incontinence, and it is common for people of all ages dealing with incontinence to hide the fact there is a problem at all. 

When this happens, your loved one won’t receive the help and support they need to manage their condition, which can worsen their condition and lead to increased feelings of anxiety and isolation.  

If you discover one of your family members is dealing with incontinence, it’s normal to feel stressed about the situation – especially if you’re going to be caring for them. It’s important your family member doesn’t feel ‘caught out’ or as though there is something to feel ashamed of.  

People with incontinence deserve the same dignity and respect as those without the condition, so knowing how to support them during such a challenging time is essential.  

Some of the key signs of incontinence – to look out for in people of all ages – can include:  

• Choosing different drinks – for example, drinking decaffeinated drinks instead 
• Stopping drinking after a certain time of day 
• Hiding incontinence products  
• Being secretive about going to the bathroom 
• A smell on their person or in their home 
• A strong scent of cleaning products in the bathroom on a regular basis 
• Personal hygiene issues 
• Staining of their underwear 
• Frequent changing or washing of clothes 
• Buying toilet rolls more often due to increased use 
• Finding tissue in their underwear or washing machine 
• Avoiding social situations 
• New changes to their diet 
• Carrying spare clothes whenever they leave the house 
• Going to the toilet more frequently 
• Needing to get to the bathroom quickly 
• Staying in the bathroom for longer than usual 
• Using sanitary pads 
• Wearing more than one pair of underwear 
• Changes in their mood 
• Finding laxatives in their home that weren’t there before 

If you spot any of these signs, it’s important to speak with your family member in a way that displays empathy, sensitivity and understanding.  

Try to have possible solutions and support in mind before having the conversation. That way, you can help give your loved one hope and ensure they feel fully supported.

Incontinence in children

Children can also experience incontinence. Although you might think it’s easier to spot, children are still good at hiding things they are embarrassed about.  

Here are some signs that a child might need help with their incontinence: 

• Finding wet or soiled underwear 
• Denying wetting or soiling themselves despite their underwear or bedding being wet or soiled 
• Needing to use the toilet more often  
• Often needing to go at the last minute  
• Withholding (standing or sitting in different positions, such as with their legs crossed, to prevent accidents) 
• Avoiding social situations, especially ones like sleepovers or school trips  
• Excessive use of sanitary products  
• Needing to leave the classroom a lot to use the bathroom 
• Trying to avoid going to school – such as claiming to be unwell or becoming angry in the mornings or Sunday evenings

It’s worth remembering that bullying and mental health problems can be linked to incontinence in children. Sometimes changes in behaviour can be misconstrued as ‘naughtiness’. However this isn’t the case; incontinence can not only cause feelings of shame in children but also cause them to behave in ways that they feel will be most helpful to manage the wetting or soiling.

What to do next

If you think a family member or someone close to you is struggling with incontinence, it’s important to talk to them about it from a place of understanding and sincerity. Try to encourage them to speak with a healthcare professional as well so that they can get the support they need.  

If they are embarrassed about the situation, you could even offer to assist them when talking to the healthcare professional. 

In our article, How to talk to a family member about incontinence, we provide further tips and information on how best to approach this difficult subject, such as finding out more information and researching different incontinence products to help them manage the incontinence while they wait for assessment and treatment.  

Doing your own research, for example, can help ease the pressure on your family member’s shoulders. By providing them with options you can help them feel less overwhelmed and ensure they are on the way to getting the right support for them.

Bladder & Bowel UK is a registered charity that has multiple resources to help loved ones support and spot signs of incontinence in both adults and children. They also have a confidential helpline where you can receive specialist continence advice. 

Finding support for both you and your loved one is important when dealing with incontinence. Whether you help them speak to a healthcare professional or find the right incontinence product, showing that you’re there for them can make a big difference. 

The post Signs a family member may need help with incontinence appeared first on Bladder & Bowel UK.

Incontinence can have a serious impact on wellbeing for the person experiencing the issue. What is less often talked about is how hard it can be to support someone suffering with incontinence. 

In fact, we know that in some serious situations, difficulties with managing incontinence can contribute to families making the tough decision to move loved ones to supported housing or care homes.  

Struggling with bladder and/or bowel control can create feelings of isolation, but it is important to know you are not alone if you, or someone you know, are affected. Silence around the issue can be a barrier to getting the help you and your loved one needs, which is why it’s important to shine a light on the issue. 

In this article, we look at the different ways incontinence can impact anyone giving support, including family members and friends, and why it is such an important issue. 

Difficulties for caregivers 

If someone we care about is struggling with incontinence, it is normal to want to help them. However, it’s realistic to acknowledge how difficult this can sometimes be.

Challenges in communication, or wanting a reluctant family member to seek medical help, can cause strain in relationships. Supporting with intimate care, including helping an individual change, use the toilet or washing wet or soiled clothing, may cause physical or emotional strain and impact the caregiver’s own well-being or mental health.

Emotional impact of incontinence

Not only can incontinence be distressing for the individual, causing embarrassment, frustration, or anxiety, practical support may be required from family members which can be difficult to accept. This can lead to a decline in self-esteem, a reluctance to engage in social activities and cause difficulties with mental health. If it is happening during the night, it can also affect sleep, which has an impact on daytime functioning and mood for both the individual and those caring for them.

Family members may experience stress and worry about their loved one’s well-being. They may also feel a sense of responsibility and frustration that impacts their own psychological and emotional wellbeing, mental health and feelings of struggling to cope. Adjusting to a new role of carer, particularly when this involves supporting with intimate care tasks, may be difficult.

Financial impact of incontinence 

Money worries can worsen stress when supporting someone struggling with their bladder and/or bowel.  

There is a financial cost to disposable continence products (pads), as well as for toileting aids, additional clothing and washing. There can also be increased expenses related to medical care, such as travel to appointments for assessment and treatment, and the cost of medications that may be recommended to help. Some people may require home modifications to make their living environment more accessible. Some family carers may have to also give up work or reduce their hours to provide required support, adding to financial strain.

Social isolation

Incontinence may impact a person’s confidence to develop new friendships or relationships, or continue existing ones. Fear of leakage, odour, embarrassment, or a lack of accessible toilets in the community may result in the person with incontinence withdrawing from social activities. It may also limit or deter participation in previously enjoyed activities that may exacerbate the incontinence, such as high impact sports, distance running, remote camping, or long country walks. All of these, together with the time it takes to provide practical support, can also impact their life partner or family members.  

Family members might be hesitant to engage in activities that could be challenging for the person with incontinence, or that they previously enjoyed together. Being unable to leave their loved one, or becoming too tired or emotionally drained to continue with their usual activities will also worsen the situation. 

Changes in daily routine

Those providing care may need to adapt their schedules and routines to accommodate an individual who is living with incontinence. This may include assisting with regular bathroom visits, including at night, helping with personal hygiene, changing of pads and being mindful of the availability of suitable toilets in public spaces. These may impact their ability to work, enjoy leisure and maintain social activities and friendships. 

There may be additional washing and cleaning as well as anxiety about controlling odour, avoiding damage to furniture and managing if car seats or wheelchairs need to be cleaned and dried.  

Communication challenges

The misconception that incontinence is always inevitable, along with taboos surrounding bladder and bowel issues, make it difficult to discuss incontinence or know how to access help. These can reinforce feelings of isolation and make it difficult for family members to offer support, search for solutions or improved management options.  

While open communication is key, discussing incontinence can be a sensitive topic that requires empathy and understanding. Challenges may be compounded when there are gender issues, such as a son talking to his mother, or a father to their teenage daughter, or where to do so would breach cultural norms. 

To address these difficulties, it is crucial for the family member to foster open communication, encourage and support those that they care for to ask healthcare professionals for support, and explore available resources. Community support can also be valuable, and connecting with others facing similar challenges can be beneficial for both the individual suffering from incontinence and their caregivers. Seeking medical advice and implementing recommended practical strategies for managing incontinence, can help mitigate the impact on both the individual and the family. Additionally, support groups and counselling may be beneficial for the emotional wellbeing of both the person with incontinence and their caregivers. 

The post Supporting someone with incontinence: Shining a light on the impact on families   appeared first on Bladder & Bowel UK.

Jane is an outgoing 58-year-old mother from Liverpool, but behind her bubbly exterior is many years of pain due to a complex history of surgery.

Following complications after a total hysterectomy and large bowl resection in 2005 Jane found herself living with the symptoms of a functional bowel disorder, including chronic constipation and faecal loading.

Constipation is a common condition, affecting around 20% of men and woman of all ages in the UK. It can cause stomach pain and make you feel bloated and nauseous.

While many people find that simple changes to their diet or lifestyle can help improve their symptoms, others, like Jane, have underlying problems which means the condition persists.

The limits of lifestyle changes

After an abdominal operation in 2016, Jane was admitted to hospital several times due to recurring faecal loading. It impacted her confidence and her mental health began to decline.

Despite following the guidelines about healthy living and strictly adhering to her oral laxative regime, she grew increasingly frustrated with healthcare professionals who kept suggesting further lifestyle changes.

It was only after her fifth hospital admission in 2018 that she was finally diagnosed with a functional bowel disorder. Though the damage couldn’t be undone, she was referred to a specialist who suggested she try transanal irrigation (TAI).

Help with managing constipation

Transanal irrigation (TAI) is a way to help manage constipation and faecal loading. It’s a simple procedure in which body temperature water is passed through a soft silicone cone or a catheter into the rectum, to assist in the safe evacuation of stool from the lower section of the bowel. 

Jane explains that there was a bit of trial and error before she was comfortable with the procedure but was glad she stuck with it because ‘within a few months my life changed completely.’

After years of feeling like her life was on hold, she was suddenly able to look forward and plan ahead.

‘It’s really changed my life.’

This article is part of the Education Spotlight on Constipation, supported by Renew Medical. You can also read more about constipation in our information library.

The post How transanal irrigation helped one woman get her life back after years of ‘tremendous pain’ appeared first on Bladder & Bowel UK.

Associate Isabel Harper from Clarke Willmott’s serious injury and medical negligence team specialises in helping clients who are seeking a compensation claim for bowel incontinence following childbirth, personal injury or because of medical negligence.

Isabel explains the rehabilitation process after a bladder or bowel injury and why you may wish to seek legal advice.

Who is affected by bladder and bowel problems?

Bladder and bowel problems can affect anyone at any stage of life, but sometimes they can happen unexpectedly because of an accident or following medical treatment.

At Clarke Willmott, we have found that the types of treatment that lead to these types of injuries include, general surgery, bowel cancer, spinal tumour, infection / sepsis, prostate problems, stroke, and neurological conditions. Women are also often effected by bowel and bladder injuries following childbirth.

Some people may have also been injured as a result of a road traffic accident, or an accident at work, for example.

Where can you get help if you have bladder and bowel problems?

If an injury has occurred suddenly, you may wish to prioritise treatment in addition to rehabilitation in order to manage and minimise your symptoms. It is important that you seek help from a GP or a healthcare professional. You may wish to consider asking for help from the following:

1. Clinical Colorectal or Urology Consultant: They are able to provide you with specific advice on further treatments that may be available to you.
2. Physiotherapists: There are specialist pelvic health physiotherapists who will be able to provide an assessment, treatment, and support for those who struggle with their pelvic floor. They see patients with a range of symptoms. Including those who suffer from pelvic pain, faecal incontinence, and urinary incontinence (including, urgency and frequency) etc. If you are suffering from these symptoms as a result of childbirth, there are physiotherapists who also specialise in women’s health.
3. Pelvic floor clinics: These clinics treat people who have problems with their bladder and bowel, including bowel disfunction, bowel incontinence, irritable bowel syndrome (IBS), constipation, urinary incontinence, bladder pain, urinary tract infections (UTIs) etc. They usually carry out a multi-disciplinary approach. This means that they work closely with a range of health services. For instance, they may work with specialists in the fields of gynaecology, colorectal, urology, physiotherapy, pain medicine.
4. Psychologist / Psychiatrist: Suffering from a bowel or bladder injury is traumatic. It is no surprise that you may be suffering from psychological symptoms as a result. There are a number of therapies and treatment available that can help to alleviate the symptoms that you experience. It is important that you speak to GP or other healthcare professional. This way, they can ensure you are signposted to the right services.

If you are unsure about where to turn, you could contact the Bladder & Bowel UK Helpline on 0161 214 45910. Moreover, the helpline can help to provide advice on bladder and bowel health, continence promotion and options for managing incontinence, products, as well as signposting to services. They offer general information, advice and signposting for bladder and bowel issues. For personal medical advice, we recommend that you speak to your GP.

What products can help you manage your bladder and bowel problems?

As well as the above, there are several products available to help you manage your injuries on a day-to-day basis. In addition, you may wish to consider the products available on the Countrywide Health & Mobility website who are associated with Bladder & Bowel UK, as well as ordering the Just Can’t Wait card from Bladder & Bowel UK.

Why might you need legal advice if you have a bladder & bowel problem?

If you wonder whether your bladder or bowel condition has been caused by a medical mistake, a solicitor can obtain expert reports from experienced clinicians to ascertain what might have gone wrong. If you have been injured in a road traffic accident or accident at work, then a solicitor can investigate the cause of that accident to assess if you have a claim. This is an important first step in bringing a claim as it will be necessary to show someone else has negligently caused your injury.

What will a solicitor do if you have a compensation claim?

As well as looking at how the treatment may have been negligent or how your accident could have been avoided, the Solicitor may also look at ways to minimise the effect of your injury and to minimise the discomfort caused by your bowel and bladder symptoms. They are likely to look at:

• What the impact has been on your employment.
• What your care and assistance needs are.
• If you would benefit from funding any future treatment, therapies, or rehabilitation.

If your solicitor can secure an admission of liability, you may wish to ask them to request an interim payment of damages to fund any treatment, care or rehabilitation that you may need.

Speak to an expert solicitor

Clarke Willmott have a significant amount of experience in acting for those who have suffered from a bowel or bladder injury, including those who struggle with incontinence / urgency issues, or those with stomas following negligent medical treatment. If you think you might have a compensation claim, you can speak to us by requesting a free call back.

Clarke Willmott is a national law firm with offices in Birmingham, Bristol, Cardiff, London, Manchester, Southampton and Taunton. For more information visit www.clarkewillmott.com.

Clarke Willmott is a member of our legal panel. The Bladder & Bowel UK Legal Panel is a group of clinical negligence and injury specialists with expert knowledge of bladder and bowel care.

This article was written by medical negligence solicitors, Clarke Willmott.

The post Guide to rehabilitation after a bladder or bowel injury appeared first on Bladder & Bowel UK.

INTRODUCTION

A 42-year-old woman (Lucy, pseudonym) presented to a pelvic floor unit with symptoms of tenesmus, a feeling of incomplete evacuation and a sensation of pressure in her vagina. These symptoms have been present since the birth of her second child. She has noticed them becoming more problematic, particularly in the past 2 years.

Lucy lives with her partner and two young children aged 9 and 11 years. She is a primary school teacher and works part-time. On ‘bad’ days she can visit the toilet multiple times, which is especially difficult to manage if she is at work, as she is unable to leave the classroom during lesson time.

ASSESSMENT

Assessment is a fundamental part of the treatment process for a patient and is considered the first step of individualised nursing care. The information that is collated from the assessment is significant to the development of a plan of action that augments health outcomes relevant to the patient.

Lucy’s assessment began with her GP, although she found it embarrassing discussing her bowel symptoms. However, in recent weeks she suffered episodes of post defaecation seepage and experienced leakage during sexual intercourse, which prompted her to visit her GP for advice. This led to a referral to the pelvic floor services at her local hospital who assessed holistically taking into account physical, psychological and social wellbeing.  Her assessment revealed the following:

Bowel symptoms

• 2 bowel movements per week, type 2-3 stool (Bristol stool chart). For as long as she can remember she has been ‘prone to constipation’ and is used to moving her bowel infrequently.
• A feeling of incomplete evacuation. She has read on the internet that she should avoid straining.
• Post defaecation seepage, which is unpredictable and left her feeling unclean, therefore location of toilets is important to know.
• Feels a pressure rectally/vaginally after having a bowel movement.

Medications

• Has tried a variety of laxatives, but experienced abdominal pain and their unpredictability of effect was very difficult to manage. In our clinical practice, it is noted that many patients prefer not to take laxatives for these reasons, despite the impact of symptoms on their quality of life. It is useful to identify constipation which occurs due to evacuation disorders as this does not respond well to laxative therapy¹.
• No other medications taken.

Diet

• 3 meals per day
• Tries to be as healthy as possible, inclusive of 5 portions of soluble fibre each day.
• However, eating more fibre, particularly insoluble fibre, leads to bloating and bowel frequency doesn’t improve. Insoluble fibres can cause increased bloating and may not improve slow transit constipation². On the other hand, it has been demonstrated that diets with soluble fibre can be associated with the improvement of the symptoms in chronic constipation without causing increased bloating³. Although Lucy has not been diagnosed with slow transit, her infrequent bowel movements suggest otherwise.

Digital rectal examination

• No pelvic floor descent, good strength and tone of the pelvic floor muscles, palpation of the anterior rectal wall suggested a rectocele, nil other to note.
• Balloon expulsion was carried out with an Ashley balloon catheter (See figure 1) and demonstrated a slight incoordination of pelvic floor and anal sphincter muscles but no straining.

Figure 1

Investigations

• A defaecating proctogram confirmed a moderate rectocele with trapping of stool. No perineal descent and nil other to note.

Psychological & Social wellbeing

• Faecal leakage has occurred during sexual intercourse, which has left her mortified and avoiding any intimacy with her partner. When a person experiences a traumatic event, their brain may process the event in a way that causes them to feel stuck in a state of hypervigilance or fear, even after the threat has passed. Trauma can also interfere with a person’s ability to form healthy attachments and relationships with others, which can further exacerbate feelings of anxiety and isolation. Lucy has developed a fear of faecal incontinence occurring again, creating anxiety around her relationship with her partner.
• Toilet-centred behaviour, avoids unfamiliar places and finds socialising difficult.

To summarise, Lucy has a moderate sized rectocele and feasibly slow transit constipation, as she is only having 2 bowel movements per week. Her most bothersome symptom is stool trapping in the rectocele, which has led to incontinence.

For further information on rectoceles please visit:

https://www.rcog.org.uk/for-the-public/browse-all-patient-information-leaflets/pelvic-organ-prolapse-patient-information-leaflet/

TREATMENT PLAN

Setting goals

• The treatment plan should be one of shared decision making, taking into account patient preferences⁴. This encourages active involvement and commitment to the proposed interventions⁵.

Lucy’s assessment identified her treatment goal using the MYMOP questionnaire (https://www.meaningfulmeasures.co.uk/). This is a problem specific individualised measure. It is quick and simple to use and captures which symptoms are most important to the patient and which activities of daily living they affect. Her goal was to improve rectal evacuation so that the number of toilet visits were reduced, and the risk of incontinence eliminated.

Treatment options for rectocele depend on the severity of symptoms. NICE (2022)⁶ recommend the following strategies:

Lifestyle modifications

• Lifestyle modifications such as weight loss and smoking cessation are frequently recommended as first line management strategies for bowel dysfunction, including rectocele⁶. Obesity and coughing can strain already weakened pelvic floor muscles. However, this is expert opinion since evidence for these is lacking⁴.

Since Lucy neither smokes nor was overweight these were not discussed.

Preventing or treating constipation

• Lucy was advised to slowly increase the amount of soluble fibre in her diet, to prevent bloating. She did not wish to pursue laxatives due to the unpredictable effects.

Oestrogen therapy

• Vaginal oestrogen should be considered for women with pelvic organ prolapse and signs of vaginal atrophy.

Lucy was having regular periods. There were no signs of vaginal atrophy.

Pelvic floor muscle training

• A tailored programme of pelvic floor muscle training has been shown to be effective for relieving symptoms of prolapse by strengthening the muscles and tissues that support the rectum and vagina, alleviating pressure and discomfort⁷.

Lucy had good strength and tone of her pelvic floor and was given a personalised programme to follow.

Rectocele support e.g., vaginal pessaries, splinting, digitation

• Physical support of the rectocele can aid evacuation.

Lucy was taught defaecation dynamics to optimise positioning on the toilet. However, she did not wish to digitate and was embarrassed to continue splinting, stating she wanted ‘a solution for her problems’.

Due to the significant impact on her day-to-day life, a multi-modal approach was applied where Lucy would carry out the tailored pelvic floor exercises and employ rectal irrigation at the same time to enable more complete evacuation, relieving symptoms of post-defaecation seepage, tenesmus and sensation of pressure. Igualada-Martinez et al (2022)⁸ recommends early intervention of rectal irrigation (as an alternative to suppositories), before pelvic floor muscle training, potentially giving symptom relief whilst strengthening these muscles.

RECTAL IRRIGATION

Initiation

Rectal irrigation involves instilling warm tap water into the rectum via a cone or catheter. When this is removed, the water is expelled along with the contents of the rectum and descending colon. The degree of evacuation will depend on several factors including the amount of water that is used.

The wide range of equipment available can be confusing for health care professionals (HCPs). The decision guide is a consensus document based on current evidence and best practice. It guides the HCP through the process of starting a patient on rectal irrigation, including choosing high or low volume irrigation, catheter or cone, aspects to include during teaching and when to follow up.

The decision guide (step 2) recommends low volume irrigation for rectocele and high volume for constipation. In our clinical experience, presentation of bowel conditions as described, the choice of product would lean to high volume, as this will address all symptoms, especially when using the Qufora IrriSedo Flow system, therefore addressing both the constipation with the volume of water and the rectocele with a cone that has a shower effect. Also, bearing in mind that Lucy had good dexterity and no issues with sitting balance therefore a cone system is deemed appropriate.

However, low volume was initiated for several reasons. Lucy’s most bothersome symptom was difficult evacuation (low volume recommended) with symptoms of tenesmus and stool trapping leading to faecal incontinence. She also had a very busy lifestyle so was concerned how irrigation would fit into her routine. For these reasons low volume was chosen i.e. Qufora IrriSedo MiniGo, which looked quick, easy and discreet to use.

Follow up

2-week telephone review

• Procedure took 10 minutes in the morning after breakfast
• Irrigated 10 out of 14 days
• 4 great results, more comfortable and less toilet visits
• 6 days of continued previous symptoms
• Plan – to continue with low volume irrigation, as symptoms may improve

4-week telephone review

• Insufficient relief
• Tenesmus and frequent toilet visits persisted, there had been a few instances of post-defaecation seepage and she was still avoiding intimacy with her partner.
• Since adjusting to a rectal irrigation routine Lucy was aware that high volume would be the next step
• Transitioning to another cone-based product within the same range i.e. Qufora IrriSedo Flow, made teaching high volume straightforward. Lucy was already familiar with attaching the cone (which had the same lubricant, so she knew it was comfortable to insert and remove), the versatile water bag was convenient to use standing on the floor in her bathroom.
• To save another visit to clinic, a starter kit was delivered to her home, and this was taught virtually over a web call.
• Qufora IrriSedo Flow has been evaluated by HCPs as easy to teach, easy to learn and easy to use. This was reflected on the web call.

OUTCOMES

On speaking to Lucy at her 8-week review, it was evident from the tone of her voice that her confidence and self-esteem had improved. She was irrigating most days, using 500-600mls of water, and having very good results, passing dark brown water.  She felt that evacuation was complete, tenesmus and the sensation of pressure in her vagina had both disappeared. Episodes of post-defaecation seepage had stopped. She was happier and had been out shopping and for lunch with friends. She was looking forward to a date night with her partner.

CONCLUSION

This case study demonstrates the importance of identifying goals that matter to the patient. Holistic assessment identified that it was appropriate to start irrigation sooner in the treatment pathway, with a multi-modal approach. Transitioning from low to high volume can be straightforward, leading to successful irrigation and the best possible outcomes for the patient.

REFERENCES

1. Bharucha AE, Pemberton JH, Locke GR 3rd. American Gastroenterological Association technical review on constipation. Gastroenterology. 2013 Jan;144(1):218-38. doi: 10.1053/j.gastro.2012.10.028. PMID: 23261065; PMCID: PMC3531555

• Basilisco G, Coletta M. (2013) Chronic constipation: a critical review. Dig Liver Dis 2013; 45:886–93

• Suares NC, Ford AC. (2011) Prevalence of, and risk factors for, chronic idiopathic constipation in the community: systematic review and meta-analysis. Am J Gastroenterol 2011; 106:1582–91

• Assmann SL, Keszthelyi D, Kleijnen J et al (2022) Guideline for the diagnosis and treatment of Faecal Incontinence-A UEG/ESCP/ESNM/ESPCG collaboration. United European Gastroenterol J. 2022 Apr;10(3):251-286. doi: 10.1002/ueg2.12213. Epub 2022 Mar 18. Erratum in: United European Gastroenterol J. 2022 Jul;10(6):606-607. PMID: 35303758; PMCID: PMC9004250

• Booth J, Bliss D. Consensus statement on bladder training and bowel training.

Neuro-urology and Urodynamics. 2020;1–21.36

• NICE (2022) Urinary incontinence and pelvic organ prolapse in women: management (NG123)

• Hagen S, Stark D, Glazener C et al (2014) Individualised pelvic floor muscle training in women with pelvic organ prolapse (POPPY): a multicentre randomised controlled trial. The Lancet vol 383,9919 p796-806

• Igualada-Martinez P et al (2022): Physiotherapy Management of Anorectal Dysfunction. Seminars in Colon & Rectal Surgery (2022), doi: https://doi.org/10.1016/j.scrs.2022.100936

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Cutting out your baseplate can seem like a task. Making sure you haven’t left any gaps that expose your skin to output and creating a seal strong enough to protect from leakage can be stressful.

When you use a Convatec Mouldable Technology baseplate, you don’t have to worry about gaps and a secure seal. Let the patented technology in the baseplate take care of that.

But don’t just take our word for it. Keep reading to learn more about Glen Neilson’s stoma story and how Mouldable has helped him to live life on his own terms and carry on doing the things he loves most, like climbing mountains. Glen has had his ileostomy for 22 years due to Ulcerative Colitis, but has never let his stoma dictate what he can and can’t do.

“My stoma was my life-saver. I completely understand why not everyone shares this feeling. But that’s how I have come to think of my stoma. It saved my life – and completely transformed the way I live my life.

But it hasn’t always been that way. I woke up during surgery in intensive care staring down at it. That wasn’t the best introduction! And neither was catching MRSA in hospital and spending 8 long months recovering at home with a hole in my stomach.

My first stoma bag didn’t bring any joy either. It didn’t help that I had problems around my stoma because of my baseplate and creases – and the fact my bag felt more like a carrier bag! It actually fell off the first time I ever went swimming. It took me two years before I would ever visit a pool again.

It wasn’t until I took to Google and ended up stumbling across the Convatec Natura two-piece bag that things started clicking into place (and I’m not just talking about the baseplate!).

The new bag gave me confidence and the old me started coming back. I got into going to the gym again, walking, golf and wild swimming.

After using the 2-piece Convatec Natura for years, and although I was more than happy with it, I just thought I would see if any new products were available or if there was anything available I didn’t know about as I was training for Kilimanjaro at the time. I wanted something that may not need cutting or worrying about the size compared to the stoma so was even more comfortable while I hiked.

This is when I was introduced to Convatec Mouldable Technology, which honestly was life changing for me. It is just amazing and gives me the confidence to climb mountains do my daily job here in the UK as a firefighter without any worries whatsoever. I truly believe no other product available on the market can match the superiority of the mouldable system.

The best thing about Mouldable is that it’s so easy to apply and there’s no cutting required. You literally just roll the baseplate back with your thumbs, apply it and it then gently returns to its original shape to hug my stoma, giving me a nice snug fit.

Another great thing about Mouldable is that a layer of the baseplate can absorb liquid output, causing it to gently swell around my stoma for an even better fit. Perfect for when I’m climbing mountains or when out on a job as a firefighter!

I would recommend Mouldable to anyone, as it literally has been life changing for me.

Want to learn more? Find out what others had to say about Mouldable in the video below.

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Transanal irrigation (TAI) is a management option for people who suffer from constipation. Here, we look at best practice for those who are using TAI for constipation to make sure it is as safe, comfortable and effective as possible.  Remember, it is always best to discuss the issue and any treatment with your doctor.

How do I get the best results from transanal irrigation?

Before commencing irrigation, it is advisable to familiarise yourself with your irrigation system.
Following the provided instructions for use, assemble the product, fill with water and pump
through the system.

It can take a little time to get used to irrigating, and for the bowel to become accustomed to the
procedure. It may take 2–4 weeks to get into a well-practiced routine. It is important to irrigate at a
similar time each day and to allow yourself enough time to complete the procedure thoroughly.
The process takes approximately 20-35 minutes and should be performed regularly (usually every 24 or 48 hours) to achieve the best results.

For those with reduced, or no bowel/rectal sensation, it is advisable to stay close to the toilet
post-irrigation, until you have a routine that works well for you. It is a good idea to use a disposable absorbent pad immediately after performing irrigation.

You can repeat the irrigation process if required. If you are unable to feel the urge to open your bowels, then you can use measured of amounts of water to achieve the right volume for you. It is best that you speak to your clinician to discuss what is right for you.

As irrigation cleans the lower portion of the large intestine it can help to:

• Reduce the risk of constipation by preventing the build up of stools
• Reduce the risk of faecal incontinence and leakage in-between each evacuation
• Regain control over your bowel management
• Reduce the amount of time spent on your bowel care

This article is part of the Education Spotlight on Constipation, supported by Renew Medical. You can also read more about constipation in our information library here.

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Constipation is common, but there are management options that can help. Here we take a look at how transanal irrigation helped one teenager manage his condition.

Rugby-playing Joe, 14, suffers from idiopathic constipation, a type of constipation where the cause is unknown. An estimated 1 in 100 children and young people suffer from the condition. Symptoms include painful bowel movements and bowel movements that are hard, or difficult to pass . Sufferers may also soil their underwear, which is something Joe is particularly familiar with, experiencing ‘accidents’ between 8 and 12 times a day.

According to Michael, Joe’s father, Joe has struggled to control his bowel movements all his life. At primary school he had to take a nappy sack in with him, along with clean underwear to change into. It wasn’t until he was eight that he was diagnosed with idiopathic constipation, but even then, the process was long and often fraught. ‘It was overwhelming,’ Michael says, particularly as the initial treatment Joe was prescribed ‘made (the condition) a lot worse.’

While Joe – an otherwise typical teenager – has a laissez-faire attitude toward it all, describing these years as “a bit of a pain,” his father is more outspoken about the anxiety and stress it had on the family. “It’s been a weight on my mind,” he says. ‘I’ve been climbing the walls.’

Joe, too, admits that his insecurities growing up often prevented him doing the things he wanted to do, such as staying over at a friends house.

“He’s growing up and getting older now,” Michael says. “There’s a lot more self-consciousness and body shaming happening. He got self-­conscious that someone might pick up on an accident he wasn’t aware of.”

Help with managing constipation

Things changed around six months ago when Joe’s doctor suggested transanal irrigation (TAI).  TAI is a simple procedure in which body temperature water is passed through a soft silicone cone or a catheter into the rectum, to assist in the safe evacuation of stool from the lower section of the bowel.  

Though Joe was already familiar with using suppositories, he hadn’t used TAI before and he initially worried it might be uncomfortable or difficult to use. “I wasn’t sure about it at first,” he says. But to his surprise, he found the system soft and comfortable. “It doesn’t hurt at all,” he says.

Now, Joe uses an irrigation system every morning before school. It takes him between ten and twenty minutes, and he passes the time watching a show on his iPad. In the evening, he takes a laxative treatment.

“A dramatic change.”

Michael remembers the day he started his new regime. ”He came home from school and there was an actual swagger in the way he walked. That sense of relief, you know?”, he says. Joe says he feels a lot more sociable now. He’s also confident enough to enjoy rugby and other contact sports without the fear of an accident.

“His sport and social life have changed dramatically,” Michael says. “It’s really made a tremendous difference. It’s improved things vastly.”

“It really has helped,” Joe agrees. “I’m not worrying about anything now. It’s great!”

This article is part of the Education Spotlight on Constipation, supported by Renew Medical. You can also read more about constipation in our information library here.

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