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.

• Am I the only person who has a bladder or bowel issue?
• Who can I speak to about my bladder or bowel problem?
• Do children and young people experience bladder or bowel problems?
• Are continence products the only answer?
• Where can I get reliable help or advice?

At Bladder & Bowel UK we are contacted by people of different ages and stages of life with a wide range of questions and concerns regarding bladder and bowel difficulties. While our team of specialist nurses and product co-ordinator are happy to respond to individual enquiries, we felt it might be helpful to address some of the more common questions we are asked. 

So who is affected with bladder and/or bowel problems?

Bladder and bowel problems are very common and can affect anyone at any stage of life. Many people find it difficult to discuss their symptoms with anyone, including their healthcare professional. However it is important to know that much can be done to treat, manage and improve issues and it is important not to just put up with symptoms, as help is available.

Your GP, practice nurse or other healthcare professional will be used to having conversations about issues that you might find difficult and should respond to you sensitively and with practical suggestions. They will also be able to refer you to the right specialist service, if they feel this is needed.

What about children?

Many children and young people are affected by bladder and bowel issues. These do not always just get better with time. The most frequently occurring problems are difficulties with toilet training, wetting in the day or at night, constipation and/or soiling.

Sometimes it is assumed that wetting, soiling, or rushing to the toilet is due to naughtiness, laziness or an inevitable part of a disability. However this is very rarely the case. Therefore, all children and young people with a bladder/bowel problem, including those who have additional needs, should be offered an assessment, support, and appropriate treatment as the issues often do not simply get better as children get older.

Bladder & Bowel UK Top tips

Seek professional help if you have symptoms.

We would always encourage people to seek professional advice and help about any bladder and/or bowel problems. Much can be done that may cure or improve the issues. Your healthcare professional should be able to offer an assessment or refer you to a specialist service. This will then help indicate the underlying cause and the most appropriate treatment or management options.

Is it to do with my age?

Bladder problems can affect children, young people, men and women of any age. It is not an inevitable part of being young, getting older or having a disability or medical condition. Therefore, please do not put up with bladder and bowel incontinence or difficulties emptying your bladder or bowel.

How do I access help?

You could talk to your GP or other healthcare practitioner, eg. practice nurse, district nurse. For children you could also contact their school nurse or health visitor. If necessary they will refer you onto the right service to offer the right support.

There are specialist bladder and bowel services for adults in most places in the UK and many areas also have specialist services for children. You may need to be referred by your healthcare professional, although some may accept self-referrals.

Alternatively, complete the Bladder & Bowel UK webform (https://www.bbuk.org.uk/enquiries/) and we may be able to offer some initial advice and will help you get in touch with a professional, who will understand and be able to offer assessment and management.

What help can these services offer me?

Bladder and bowel services offer specialist advice, assessment, treatment, management and support to adults or children and young people experiencing bladder and bowel problems. 

Examples of the types of problems that bladder and bowel services may help with include  

• Urinary incontinence (leaking urine) or difficulty emptying the bladder.
• Waking up more than a couple of times in the night to pass urine or wetting the bed during sleep.
• Needing to go to the toilet more frequently or urgently than is usual.
• Pelvic floor disorders.
• Prostate problems.
• Toilet training issues.
• Constipation.
• Faecal incontinence (soiling) or difficulty controlling bowel movements.
• Difficulty emptying or fully emptying the bowel.
• Difficulty getting to the toilet due to disability or another health condition.

Where will I be seen?

Bladder and bowel services usually offer clinic appointments across their NHS areas. Home visits may be arranged for people who are housebound. Your doctor or health care professional will be able to put you in contact with your local service. You can also contact Bladder & Bowel UK for information about how to access your local service.  

What will happen when I am seen?

You will be offered an assessment, to help your professional understand the bladder and/or bowel problem. You may be asked to fill in bladder and or bowel diaries before the assessment, as they will help to identify what is happening. In some cases further tests may be required. The outcome of the assessment will explained to you and the healthcare professional will then discuss the options for treatment or management with you. 

What options are there if I am not able to be fully continent?

Many continence problems are treatable, or can at least be improved. However, it is not always possible to fully treat or cure incontinence. Therefore, it may be that following a full assessment from a specialist healthcare professional, it is agreed that alternative solutions for managing incontinence are the best option in the circumstances. 

A wide range of products, devices and appliances is available. No single one will suit everyone’s needs and it is not uncommon for people to use a combination of products eg. containment pads along with aids to assist with toileting. 

Examples of the types of products available include:

• Bedding and chair protection.
• Bowel irrigation devices.
• Bowel/faecal leakage management devices.
• Catheters, which may be used with drainage bags.
• Urinary sheaths and body worn appliances for boys and men.
• Pelvic floor equipment.
• Swimwear.
• Toilets and Commodes.
• Urinals (male and female).
• Disposable and washable pads and pants.

It is important to remember that there are a number of options that may help cure or at least improve bladder and bowel symptoms. Therefore Bladder & Bowel UK would always recommend discussing any issues with your healthcare professional (GP, practice nurse, or health visitor or school nurse for children).   

Bladder & Bowel UK may be able to provide initial help, advice, support and information as well as signposting to services and other organisations.

We can be contacted via our web form at https://www.bbuk.org.uk/enquiries/

Find more Bladder & Bowel UK resources here: Information library for adults – Bladder & Bowel UK (bbuk.org.uk)

The post Common Questions and Concerns regarding Bladder and Bowel Health Issues appeared first on Bladder & Bowel UK.

General suggestions:

Contact the travel company, airline, coach or train operator to discuss your individual needs before booking and travelling. If luggage or body searches are worry as exposure of your continence products is a possibility there might be a private area where this can be done.

Think about what you need to carry with you, such as medicines and spare products. You may need to have a letter from your doctor to be allowed to carry them through security. 

You may want to ask the operator if you can board early, to ensure you have time to get settled with anything you may need during the journey.

Disposable continence pads:

• Disposable pads can take up a lot of space. Consider taking pads that are more absorbent than the ones you usually use, so that you need to take fewer of them. Or you could try smaller pads that take up less space.
• Make sure you get the products you’re going to need well ahead of your travel date.
• A vacuum pack bag can help to reduce the amount of space pads take up in your luggage.
• Consider using other products eg. men could consider using a sheath instead. 
• Would you be able to manage washable products while away? These take up less space.
• Ask your product provider whether they are able to deliver direct to your holiday destination, or send a supply beforehand. But make sure you have a backup your luggage just in case there is a problem and they do not arrive.
• Make sure you have some spare products in your hand luggage in case your main luggage is lost or delayed. You could also divide your pads between your luggage and that of a travelling companion if you’re happy to do so.
• Contact the travel provider to see if there are any luggage restrictions or if continence products are exempt.
• If you are worried about leakage, consider having a chair protector for the journey.
• Consider the climate you are travelling too. Dampness can affect the absorbency of pads and heat can affect the adhesive tapes, for example on sheaths.
• Remember you will have less to bring home with you, as most of the pads will have been used.

Managing Catheters on long journeys:

• Consider having a urinal, such as a uribag, to empty catheter bags into. A travelling companion can then take it to the toilet to empty this for you.
• Make sure that you carry spare catheters, bags and any other equipment you may need with you.
• Ensure you have some spares, in case of delays or cancellations.
• Divide your catheters and supplies between your hand and hold luggage and consider giving some to a travelling companion, in case of luggage delay or loss.
• Have hand sanitizer and wet wipes in case access to a sink and soap is limited.
• You can get a medical validation or travel certificate from your catheter provider. It will explain in different languages why you are carrying catheters and also has a section urging officials to be discrete.
• Consider using ready-to-use hydrophilic catheters if you are travelling in countries with poor water quality.

Accessing the toilet:

• Try to book a seat near the toilet and on an aisle.
• Consider using a pad inside close fitting underwear, in case you cannot get to the toilet quickly enough.
• Think about taking a small bag with wet wipes and spares with you that is easily accessible throughout the flight.
• Be aware that some people find that they are more likely to leak larger amounts of urine when the plane starts to descend. Consider planning a toilet visit just before then.
• If you’re not sure what the toilet facilities are like at your arrival destination, consider a toilet visit before decent begins.

Clothing:

• Wear clothing that is comfortable and easy to rearrange when accessing the toilet.
• Dark coloured clothing makes leaks less visible.
• Loose fitting clothing is easier to remove. 
• Consider having a spare set of clothing and a plastic bag in your hand luggage in case of leaks.

Fluid intake:

• Make sure that you drink enough. Plenty of water will prevent dehydration, help to protect against urinary tract infections and ensure that urine remains dilute. Concentrated urine can irritate the lining of the bladder and increase wetting.
• Avoid tea, coffee, hot chocolate and alcohol as all of these increase urine production.  
• Avoid fizzy drinks as these can irritate the bladder lining.

Bowel issues:

• Try to stick to your usual diet routines when travelling to avoid feeling bloated, nauseous or uncomfortable. Digestion and body clocks can be upset by crossing time zones.
• Try to move as much as you can, particularly on long flights. This will help with both circulation and digestion.
• Discuss with your health care professional whether an enema or suppository a few hours before the flight would be an appropriate way for you to try and avoid a bowel motion during the flight.

Find more Bladder & Bowel UK resources here: Information library for adults – Bladder & Bowel UK (bbuk.org.uk)

Find NHS advice here: https://www.nhs.uk/conditions/urinary-incontinence/

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Definition of sustainability: using resources responsibly so they are available for future generations, while doing as little harm to the environment as possible.

Urinary incontinence is a common problem, thought by the NHS to affect millions of people. If you or someone you care for has a continence problem, it’s important to see a medical professional as there are lots of options which can improve or eliminate the problem. However, this isn’t always possible, so whether we’re talking about the short or long term, using the correct products for incontinence management is vital for physical health, independence, and quality of life. 

So how can we combine greater awareness of sustainability with proper management of the condition?

Disposable products are the norm

‘Sustainable healthcare is a major goal both worldwide and for the NHS, where single-use products are a key contributor to plastic waste.”

Sustainable Development Unit, 2020 (UK Government Body)

Making incontinence products more sustainable

A more sustainable approach to incontinence management includes reducing the amount of single-use products, recycling, and finding longer lasting, multi-use alternatives.  Thankfully, there is innovation happening within this area.

Multi-use options include: 

•  Washable incontinence underwear: these can be washed and re-worn multiple times. 
•  Female bladder support devices: they are inserted into the vagina to support the bladder neck and can reused.  
•  Male urethral control devices: these are wrapped around the penile shaft to restrict urine flow.  
•  Male body worn urinal: they have an inner receptacle lining that drains urine from the penis and direct-connect leg collection bag. 

These options are more sustainable because they result in fewer products being thrown away and fewer products being produced in the first place. They can also be more cost-effective than the disposable products.  

Hygiene, comfort, and quality of life 

For people with continence difficulties, hygiene, comfort and quality of life are the priorities.

Appropriate use of the right product for the right person reduces the likelihood of skin irritation, dermatitis, rashes, skin infections and moisture lesions. It is also important to consider effective containment, lifestyle, maximising independence and personal preference.

Pros & cons of disposable pads 

• Disposable, single-use pads usually need to be changed several times during the day, when the pad reaches its absorbency capacity (some have a wetness indicator to guide changing), or is soiled.  This has a time and cost implication.  

• Disposable pads are often designed to reduce odour and lock urine and moisture away from the skin. Some new generation products have devices that alert an app when the product needs to be changed.  

• They come in many sizes and designs, meaning that there should be a product available for all levels of incontinence and different body shapes.  

• They are widely available.

• They are non-recyclable for hygiene reasons and are often made with non-biodegradable materials. 

Pros & cons of washable products  

• Washable products usually require a larger initial financial outlay.   

• They require individuals to have access to a washing machine, and appropriate facilities to dry them, such as a tumble drier, well-ventilated house, or access to outside drying.  This can be time consuming for the individual or their carers. 

• They have a reduced carbon footprint thanks to their multi-use nature: less production, and less waste. 

• New innovation means that a wider range of washable products are available. Like disposables they come in a range of sizes, designs and absorbencies which are discrete and effective.

• Washable products may be worn throughout the day and night, like disposable products. 

Most washable products are made from soft natural fibres, so are comfortable. 

Support to make the right decision

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. 

There are lots of things to consider when deciding on the best option for anyone managing a continence issue. It is important to be aware that treatment is possible for many conditions.  Where this is not an option, or is not immediately possible, it is helpful to know that there are other products than just the disposable pad that has been available for many years. Happily, research and development continues to explore innovative and increasingly sustainable alternatives. 

Your healthcare professional can provide more advice, information and support

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

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Because urinary incontinence (UI) is rarely talked about openly, there is a lot of misunderstanding around the issue. Therefore, whether someone is dealing with short term, long term or permanent incontinence, they might experience difficulties socially and psychologically. This article discusses the experience of stigma amongst people suffering from urinary incontinence, to create greater understanding and empathy around this common medical condition.

Stigma and UI: the basics

Definition of stigma: feelings of disapproval that people have about particular illnesses or ways of behaving.

Men, women and children can experience urinary incontinence and associated stigmas. Causes in adults can include stroke, some cancers, neurological conditions, dementia, obesity, presence of lower urinary tract symptoms and decreased mobility. Women are generally reported as having a higher prevalence of urinary incontinence, due to different anatomies and causes of urinary incontinence, and additional causes can include childbirth and menopause. It is also common for men to experience urinary incontinence following a prostatectomy, with rates increasing from 5% to 60% prevalence among this group.

Stigmatisation is a process of exclusion. When an issue, such as incontinence, is stigmatised, this leads to two groups existing: those who do have the trait, and those who don’t. Stigma can have a big impact on a person’s self-identity, and it is now well understood to have a serious negative effect on physical and mental health.

Why might UI be stigmatised more than other conditions?

We are brought up to understand from an early age that passing urine and faeces (wee and poo) should be done in private, and in a tidy way. Incontinence can rupture this social norm. Many people affected by urinary incontinence fear associations of uncleanliness, sexual impotence, or being ‘an outsider’ socially. They may fear being perceived – or may perceive themselves – as weak, dependent, or doddery. They may be embarrassed or ashamed.

Research has shown that the stigma of urinary symptoms is tied to how far the problem is perceptible – whether visually (such as marks on clothing or visible products), due to odour (such as the smell of urine in the home or on somebody themselves), or behaviourally (such as avoiding activities, or needing to make frequent trips to the bathroom). If someone has an ‘accident’ or is not able to contain their incontinence, they may be distraught and worried about what others might be thinking. This is an understandable response, but it’s important to bear in mind that urinary incontinence is a medial condition that should be treated with empathy.

The stigma of incontinence is a serious issue. Stigma creates stress, and then worsens people’s ability to deal with the stressful situation. It can lead people to stop living their normal lives, leaving the house, and going about their day-to-day activities, causing them to become isolated and withdrawn. This might mean they are less active, in turn causing greater physical and mental health issues. It can also remove people from their social support networks, cutting them off from people who can help.

Crucially, the shame felt as a result of bladder and bowel health problems, including urinary incontinence, can be a barrier to treatment. People might deny or conceal their condition, and put off seeing a doctor, especially if the matter is concealed from even close family and friends. This delays timely treatment which might lead to a cure. Remember, there are lots of management and treatment options out there. Without medical advice and help, a potentially resolvable problem can stay untreated.

Stigma has a strong link to mental health concerns, such as reduced self-esteem, increased anxiety and depression, and can affect relationships, employment and overall life stability. Many people with incontinence symptoms report feelings of powerlessness, and feel a lack of agency over their own body. If you are struggling with your mental health as a result of urinary incontinence, it is important to speak to your doctor, or reach out to a mental health organisation, such as a local NHS service, or Mind.

“Crucially, the shame felt as a result of bladder and bowel health problems, including urinary incontinence, can be a barrier to treatment.”

What can be done to reduce people’s exposure to stigma?

New treatment and management options have been developed to provide a broader range of choices to people. These can lead to rehabilitation or better management of incontinence, meaning reduced exposure to stigma, and improved quality of life. Urinary incontinence is common but every patient’s position is unique. The good news is that product innovation continues, leading to a wider range of available products to help people best manage their particular condition.

Just as stigma can cause an obstacle to treatment and management, effective treatment and management can help people regain feelings of agency, and get their self-identity back. This is why seeking help from medical professionals and experts in incontinence products is important.

Ultimately, people dealing with continence issues do not need to suffer in silence. All health concerns deserve to be treated with respect, and the right to comfort and dignity are human rights.  There are a greater number people who are affected by incontinence than you would think, and there are organisations and professionals who can provide support and guidance for improved quality of life.

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

The post Understanding the stigma of urinary incontinence appeared first on Bladder & Bowel UK.

Stress urinary incontinence is when you leak from your bladder when coughing, sneezing, laughing, running or jumping, for example. Usually only a small amount of urine is passed. It occurs when the pelvic floor muscles around your bladder and anus (back passage) become weak or stretched.

What causes stress incontinence?

Stress urinary incontinence can happen at any age. It is caused by a weak sphincter (a muscle at the bladder outlet), or by poor support to the bladder outlet from the pelvic floor muscles and ligaments.

This usually happens because the muscles of the pelvic floor are weak or damaged. Pelvic floor muscles may become weakened by pregnancy, childbirth, and delivery, straining to empty the bowel, repeated heavy lifting, menopausal changes, long term coughing, constipation and being overweight, lack of general fitness and high impact sports.

What are the pelvic floor muscles?

The pelvic floor is made up of layers of muscles, stretching like a hammock from your pubic bone to the bottom of your backbone. These muscles help to hold your bladder and bowel in position, as well as the uterus (womb) in women. They prevent leakage from your bladder and bowel, only relaxing when your bladder or bowel is emptying.

What can I do myself to help with stress urinary incontinence?

You can help yourself by making some lifestyle changes in order to reduce pressure on your bladder and pelvic floor muscles.

• Exercise regularly, including pelvic floor muscle exercises. Avoid exercises that increase the pressure on your abdomen such as high impact aerobics, jogging/running.
• Avoid smoking, which can aggravate bladder weakness through coughing.
• Avoid gaining excess weight. If you are overweight, a weight loss diet might help your incontinence.
• Drinking plenty of fluid each day, typically 1.5-2 litres (6 – 8 large cups or glasses, unless otherwise medically directed ). Drinks containing alcohol or caffeine, for example tea, coffee, or sugary fizzy and energy drinks may irritate your bladder and should be avoided. You can have drinks that do not contain caffeine, such as decaffeinated tea or coffee.
• Limit the amount of caffeine and alcohol you drink to prevent bladder irritation and avoid increased urine production.
• Trying not to become constipated by eating a healthy diet with plenty of fruit and vegetables
• Doing pelvic floor exercises. These can improve your muscle tone (strength), your continence and quality of life. Your health care professional will explain these exercises.
• Seeking medical advice if you have a long-term cough

All of these can also be discussed when you attend your consultation with the doctor, physiotherapist or nurse specialist. They will be able to advise and support you make these changes.

When should I seek further treatment for stress incontinence?

Although you may feel embarrassed talking to someone about your symptoms, we would encourage you to have a chat with your GP if you have any type of urinary incontinence. They are used to having these conversations and you should be encouraged to know that this can be the first step towards finding a way to effectively manage the problem.

Many people wrongly think that incontinence is a normal part of ageing, or that it cannot be treated. We would recommend seeking further advice who can assess and guide on treatment and management.

Will I need any tests?

These are some initial tests that you may have as part of your assessment:

• Urinalysis: This test usesa sample of urine to find out if there is any infection or any blood in the urine.
• Bladder diary: You will be given a chart (bladder diary) so that you can keep a record of the amount of fluid you drink and the amount of urine you pass, for a 3 day period. You can also record other information on the chart such as incontinence. ( link to our diary )
• Bladder scan: This is to find out if there is any urine left in your bladder after you have passed urine. The nurse will check the residual urine using an ultrasound machine to scan the bladder.
•  Physical examination: Your health care professional may need to undertake a physical examination to make a further assessment, for example a pelvic/vaginal, rectal or prostate examination.

Some further tests may be required if the cause of your urinary incontinence is not clear. Your health care professional will usually start treating you first and may suggest these tests if treatment is not effective.

Pelvic floor exercises

These are exercises that improve and strengthen the pelvic floor muscles. It is important that you are shown how to do these correctly and you will be referred to the physiotherapist or specialist nurse for this treatment. They will assess your pelvic floor muscle strength and then advise an individual programme of exercises for you to follow.

Are there any other treatments?

If pelvic floor exercises and conservative options do not help, your health care professional will discuss further treatments, for example, you may benefit from a referral to a Bladder and Bowel specialist nurse, physiotherapist or a doctor who specialises in urinary incontinence.

Further treatments can include medication (tablets), nerve stimulation, physiotherapy or surgery.

Download this information as a leaflet (PDF)

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

The post What you need to know about stress incontinence appeared first on Bladder & Bowel UK.

Other blogs published this week have provided information on lifestyle changes that may help, the treatment that is available, why bedwetting should be treated, the myths and facts surrounding the condition, information for teenagers and adults and tips to help you manage. 

This blog is about the support you can get from your healthcare professional

GP’s, School Nurses and Health Visitors are part of the team of health professionals called universal services. They are your initial support for bedwetting. They should  complete an assessment and provide some advice and  discuss treatment options.

Bedwetting is considered a medical condition from the age of five. It is a common in younger children and while some do get better with time, not all will. Children who are wet most nights are least likely to get better without treatment and, what is less well known, is that bedwetting can continue into adulthood or start again after a time of being dry.

Therefore, you should see your healthcare professional if bedwetting is happening more than two nights a week, if it has started after being dry at night for six months or more, if you are a teenager or adult, or if it is worrying or upsetting.

What does an assessment involve?

You (or your child, if they have bedwetting) may be asked to keep records of wet nights and of bowel actions (poos) for a week or two. The healthcare professional may also want a bladder diary. The bladder diary is a record of which fluids and how much have been drunk over two or three days. You will also need to write down when the toilet is used and how much urine is passed. Most children will need help to keep the bladder diary and it should be done over a weekend, or during school holidays.

The information you keep about wet nights, bowels, drinking and passing urine will allow the health professional to see how well the bowel and bladder are working. There is a bladder diary, with instructions on how to complete it on the Bladder & Bowel UK website – www.bbuk.org.uk/wp-content/uploads/2022/11/Baseline-Bladder-Diary-paediatric-Bladder-Bowel-UK.pdf – or your healthcare professional may provide one.

It is likely that your healthcare professional will ask questions about how long the bedwetting has been happening, about general health, and medical history. For children you may be asked about toilet training. it is important to also tell the health professional about any problems with toileting during the day, including damp, wet or soiled underwear, having to get to the toilet quickly, or going more often than usual: most people need to pass urine (wee) 5-7 times a day.

Your healthcare professional should explain to you what they think might be causing the bedwetting and should be able to suggest ways to help. This may include treatment for constipation if that is present, good drinking and toileting routines, as this can help the bladder to work more effectively. Good routines include having a water-based drink about every two hours, avoiding fizzy and caffeinated drinks (tea, coffee, hot chocolate, cola and many energy drinks contain caffeine) and stopping drinks an hour before bed. They may also suggest medication as this is helpful for some.

Dependent on the bedwetting symptoms and any progress that is made with following advice they give, your health care professional may, after discussion with you, be able to refer to a local specialist bladder and bowel service or bedwetting service for further assessment and support. There are specialist bladder and bowel services for adults throughout the UK and there are specialist children’s services in many areas. Where there is no children’s service, your child may be referred to a paediatrician.

Therefore, this World Bedwetting Week if you, or your child is affected by bedwetting, ask the GP for advice and support. If it is your child that is affected, you could speak to their school nurse or Health Visitor.

Where can I get more help?

You can find more information about bedwetting and other bladder and bowel conditions on the Bladder & Bowel UK website. Information for adults is at www.bbuk.org.uk/adults/adults-resources. Information for children is at www.bbuk.org.uk/children-young-people/resources-for-children. You can contact the Bladder & Bowel UK helpline for free confidential advice – www.bbuk.org.uk/enquiries.

There is also information – www.stopbedwetting.org – and – www.worldbedwettingweek.org.

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Bedwetting is a medical condition. It is not caused by anything you, or your child are doing wrong. It is not the result of laziness or naughtiness. If you are finding it difficult to deal with bedwetting speak to your healthcare professional and ask for advice and support to make it easier to cope.

What can I do to make the bedwetting less likely to happen?

• Encourage your child to drink six to eight cups or glasses of water-based drinks a day, spread evenly throughout the day, from waking up until an hour before bed.
• Avoid letting your child have fizzy drinks, except as an occasional treat.
• Avoid drinks with caffeine in them: tea, coffee, hot chocolate, cola and many energy drinks contain caffeine.
• Avoid your child having anything to drink in the hour before bed.
• Avoid your child having any food in the hour before bed, particularly food that is high in salt or protein.
• Make sure your child goes to the toilet just before they go to sleep.
• Try to stick to a good bedtime routine. Avoid computer games, television and other screens in the hour before bed.
• Try to make sure your child’s bedroom is dark.
• Try to make sure that your child can get to the toilet easily if they wake up during the night: you could try a potty or bucket in their room, leaving a light on in the bathroom, or giving them a torch to have by their bed.

How can I protect the bed?

There are lots of options available for mattress protectors. These are sold online and in shops that sell bedding. Some cover the whole mattress; others are smaller and are usually called bed pads. Bed pads sit on top of the sheet, and some have wings to tuck under the mattress to hold them in place. They are designed to absorb fluids and can be washed in the washing machine.

Disposable bed pads are also an option and can be thrown away when wet. 

Some people chose to use washable or disposable pants or nappies. These are all designed to contain the urine and help keep the bed dry.

How can we manage trips away from home?

Many families worry about sleeping away from home if their child wets the bed. However, there are things you can do to help:

• Take a waterproof mattress cover with you to protect the bed.
• Use washable or disposable bed mats.
• Use disposable pull ups or a nappy while away from home.
• Take extra bedding and pyjamas with you.
• If you are using sleeping bags, you could take a waterproof sleeping bag liner.
• Ask your healthcare professional about a trial of medication (Desmopressin) to help reduce the amount of urine produced at night.  Desmopressin needs to be prescribed and should be tried before the trip away, if possible.

For overnight trips with school or other groups, you could consider:

• Discussing options for discretely managing the wetting with the leader of the group.  They may suggest that your child is woken earlier than the others, to give them a chance to remove any wet clothing and shower in private. They may also be able to make sure that there is a bin in the toilet for disposal of used products.
• Putting a disposable nappy or pants inside your child’s sleeping bag, so that they can pull these on when in their sleeping bag. They can also take them off in the sleeping bag and leave them there, if only away for one night.
• Putting a disposable nappy or pants into a large washbag. When it is time for bed your child can ask to go and do their teeth and put on the nappy or pants in the privacy of the toilet.
• Make sure your child takes a water bottle with them.  If their night clothes are wet, they can pretend they have spilled the drink.

Where can I get more help?

Your healthcare professional should be able to provide some initial advice and support. They will also be able to refer you onto a specialist for treatment, if needed.

Bedwetting is a common medical condition in childhood and can be treated from the age of five years old. However, it can affect people of any age. There is more than one cause for bedwetting and these are outlined in other information on the Bladder and Bowel UK website. For adults information is here – www.bbuk.org.uk/adults/adults-resources. For children it is here – www.bbuk.org.uk/children-young-people/resources-for-children.

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Nocturnal enuresis is a medical condition where the bladder empties during sleep. It is more common in women, older adults, and people with Down syndrome. It happens when the bladder needs to empty during sleep, but the brain is unable to wake the person to the bladder signals. The wet bed is outside the person’s control, but still may cause embarrassment, shame, frustration, and disturbed sleep. It can also affect intimate relationships.

What causes nocturnal enuresis in teenagers and adults?

There are different reasons why the bladder may need to empty at night:

• Normally the kidneys produce less urine at night than they do during the day. If the individual is not able to produce enough of a hormone that reduces urine production at night, the kidneys will continue to produce daytime amounts of urine and the bladder will not be able to hold it all.  
• If the bladder is smaller than it should be, or if the muscles in the bladder are tightening during bladder filling (they should be relaxed during bladder filling) the bladder will not be able to hold onto the urine and will empty. 

If either or both these problems are present, along with an inability to wake to the bladder signals the bladder will empty into the bed.

Are there any other causes for enuresis in teenagers and adults?

• Urinary tract infections can cause nocturnal enuresis. This is because they are associated with an increased need to pass urine.
• Fizzy drinks and drinks with caffeine in them (tea, coffee, cola, hot chocolate and many energy drinks contain caffeine) may irritate the bladder and cause wetting. Caffeine also has a diuretic effect (it encourages the kidneys to make more urine).
• Alcohol has a diuretic effect, and it has an impact on sleep. It may make it more difficult to wake to bladder signals.
• Constipation can result in difficulty emptying the lower bowel. The retained stools then put pressure on the bladder, which is in turn cannot hold as much urine as usual, resulting in wetting.  If the constipation is very severe, it can partially block the urethra (the pipe that connects the bladder to the outside), so the individual is not able to fully empty their bladder.
• Sleep apnoea (stopping breathing for a short time when asleep) and snoring have been linked to nocturnal enuresis. Treatment for this may help.
• Smoking, being overweight, high blood pressure and not taking much physical exercise have been linked to nocturnal enuresis in women.
• If there is a blockage in the bladder or water pipe (urethra), then nocturnal enuresis can happen. Blockages can be caused by stones in the bladder or urethra, or an enlarged prostate in men.
• Type I and type II diabetes (sugar diabetes) can cause nocturnal enuresis, particularly if poorly controlled. This is because high blood sugar levels result in increased urine production.
• Some medications, including diuretics (medicines that increase urine production), medicines used to improve sleep and some that are used for mental health conditions have been linked to nocturnal enuresis. If you think that your medicine may be causing the condition, speak to your healthcare professional before stopping your medication.

For many teenagers and adults there may be more than one cause for the nocturnal enuresis.

Can anything be done to help the nocturnal enuresis?

There are different treatments for nocturnal enuresis. If you have had treatment before that has not worked, it does not necessarily mean that there are no options for you now. The treatment you are offered will vary according to what your healthcare professional thinks is causing the problem. Some people need more than one treatment, and some may need to be referred for further investigations or to a specialist service for support.

Is there anything I can do to help myself with nocturnal enuresis?

Sometimes simple changes to lifestyle can be helpful. These include:

• Drink plenty of water-based rinks during the day.
• Avoid all drinks in the last two hours before bed.
• Avoid drinks that contain caffeine or alcohol and fizzy drinks.
• If you are overweight, try to lose some weight.
• If you are taking medication, discuss this with your healthcare professional.
• Try to avoid constipation, by ensuring you are drinking enough water-based drinks and that you have sufficient fruit, vegetables and fibre in your diet. If constipation is a problem, talk about the options with a pharmacist or your healthcare professional.

What other options are there to treat nocturnal enuresis?

If the measures above do not work, then treatments that target the underlying cause of the nocturnal enuresis may be an option. 

If your kidneys are making too much urine at night, a medication called Desmopressin may be suitable, if you are under 65 years old. For older adults Noqdirna may be an option. Both must be prescribed by a healthcare professional. They are not suitable for everyone, and older adults may need blood tests before and after starting treatment.

If your bladder is not storing urine as effectively as it should, then medication for this may be helpful. There are some medicines (called anticholinergics) that help the bladder wall muscle to stay relaxed while the bladder is filling and so help it to store urine more effectively.

If the nocturnal enuresis is caused by another problem, such as diabetes, a blockage in the urinary system, sleep apnoea or a side effect of medication you are taking, your healthcare professional may be able to suggest options or refer you to a specialist service.

Where can I get more support and information?

If you have nocturnal enuresis, do not suffer in silence, but speak to your healthcare professional. They may be able to offer an assessment and recommend treatment or refer you to a specialist.

It is important not to ignore any new bladder and/or bowel symptoms as these may suggest a different underlying condition that can and should be treated.

You can find more information on the Bladder & Bowel UK website – www.bbuk.org.uk/adults/adults-resources – or contact the Bladder & Bowel UK helpline for free confidential advice – www.bbuk.org.uk/enquiries/. 

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