Fiona Le Ber, Queen’s Nurse,Education & Development Coordinator, Family Nursing & Home Care, Jersey, introduces the event.

Fiona Le Ber, Queen’s Nurse, Education & Development Coordinator, Family Nursing & Home Care, Jersey, began the day with the Chair’s opening remarks. She was thrilled to welcome the keynote speaker, Jacqueline Emkes, patient advocate who shared her personal experiences and her national involvement in raising awareness of bladder problems, to improve service provision.

The morning lectures continued with Anna Hancock, Clinical Nurse Specialist for Continence Care at Coventry and Warwickshire Partnership NHS Trust. Anna delivered an engaging and interactive session, testing delegates knowledge on essentials of continence assessment.

Janice Reid, Lecturer in Nursing, School of Nursing, University of Ulster, delivered
an interesting lecture on initial management of continence, including continence disorders and individualised management plans and discussion of first line conservative therapies for common problems affecting both bladder and bowel in adults. Janice explored the need for setting realistic treatment goals within the framework of shared decision making and person-centered care.

The morning session concluded with an insightful update on resources to support continence care, delivered by Nikki Cotterill, Professor of Nursing in Continence Care at the University of the West of England and North Bristol NHS Trust. Nikki highlighted the importance of remembering that each encounter is an opportunity to promote continence, that individuals do not need to be continence experts but need to have the confidence and language to initiate discussions. Nikki explained that enabling disclosure is a priority and signposted to some resources with suggestions about what to do next including:

• The CONfidence app which enables people with bladder or bowel issues to gain information about the causes of bladder and bowel issues, self-help, treatments, products, practical tips and support services. There are additional sections for carers, partners and young people. (www.confidenceapp.uk)

• Continence Product Advisor containment product selection for adults with urinary and/or faecal incontinence. It includes practical considerations for males and females, providing impartial and evidence-based information. (www.continenceproductadvisor.org)

• The bladder & bowel service map highlights the location of adult and children’s services in England by region. The contact and website details for all services are listed. (www.bladderandbowelservicesmap.com)

From the voluntary sector, Nikki highlighted the charities:

• Bladder & Bowel UK (www.bbuk.org.uk)

• Bladder Health UK (www.bladderhealthuk.org)

• ERIC – Children’s bowel and bladder charity (www.eric.org.uk)

Afternoon workshops were delivered and facilitated by committee members with delegates being able to attend all the sessions in small groups.

Karen Irwin, Bladder & Bowel UK, running the puzzle by products workshops.

Karen Irwin, Service Manager / Specialist Nurse, Bladder & Bowel UK, led the ‘Puzzle by Products’ workshops where delegates discussed how introduction of containment products and other resources may help improve quality of life for those experiencing bladder and bowel health issues. They also considered potential challenges faced in selecting appropriate products, including a wide range of toileting aids and equipment that has been designed to enhance incontinence management or assist with toileting. Jenny McCarthy, Clinical Nurse Specialist for the Emerald Nursing Team at B. Braun led a workshop on ‘Demystifying Laxatives’ and Victoria Coghlan, Nurse Consultant Bladder and Bowel, Aneurin Bevan University Health Board led the ‘Catheter Troubleshooting’ workshop

The event received very positive feedback. Delegates were directed to the numerous resources available on the RCN Bladder and Bowel Forum website, including free webinars, informational content, and support materials, accessible here.

The forum also has a closed Facebook page that members can join.

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

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

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

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

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

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

The length and diameter of the catheter.

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

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

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

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

Handle of the catheter

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

Integrated drainage bag

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

Coating

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

Discreet packaging

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

Easy to open packaging

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

Further information

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

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

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

Download as a PDF

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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Parents may also have to explain their child’s condition and associated care to school, extended family and others who look after their child, such as out-of-school clubs or nurseries.

What is often forgotten is that a bladder or bowel condition in one child can affect other children in the household as well. It is not easy to invite friends to play or to sleep over if you are worried about any lingering smells at home due to episodes of incontinence, or how others may react to a brother or sister’s toileting routine. There may be anxiety that if friends find out that a sibling has a bladder or bowel issue, they may tease or bully both the affected child and their sibling. Many children will also be conscious of the additional pressure that managing the bladder or bowel issue causes for their parents.

Difficulties managing journeys and finding appropriate places to clean and change a child who has experienced urinary or faecal incontinence, and any associated embarrassment or perceived stigma, may limit the activities that a family feel confident to do. This may result in all the children missing out on holidays, day trips, visits to wider family and friends’ homes or other outings that their peers take for granted.

Children who have bladder and/or bowel issues are more likely to struggle with self-confidence and self-esteem, and there may be psychological impacts from the issue, but these may also affect the child’s brothers or sisters. They may become upset when they realise that their brother or sister should be clean and dry, or if they perceive others are responding negatively to them due to the wetting or soiling. Parental attention may be focussed on the child with the problem: on the practicalities of managing, attending appointments and undertaking recommended treatments. This may result in parents having a reduced capacity to provide support and attention to other children in the family.

Different rules about what is acceptable for different children within a family may be difficult for young people to understand. Differing boundaries may give rise to disharmony and feelings of neglect or resentment and may induce anxiety in other children. Occasionally, younger siblings of the affected child may respond by regressing in their own toileting.

The way that families approach managing bladder and bowel symptoms can help all the children in the family. When families understand that children do not wet or soil to be naughty or because they are lazy, but because they have an underlying problem, then the first steps can be made to work on a solution.

Talking to all the children about the issue, what is thought to be causing it and things that can be done to help, will reduce any feelings of isolation that the affected child has and allow their brothers and sisters to offer support, encouragement and to feel involved. This positive response may also eventually help to reduce the taboo in society on discussing bladder and bowel health issues.

Healthy eating, drinking and toileting habits are often recommended as first-line interventions for both bladder and bowel issues. All children in the family can be involved in these and in offering support and encouragement. Positive role modelling and motivators for all the children to exhibit desired behaviours can create a sense of solidarity and involvement.

Other children in the family should not have to provide direct care to the child with the issue, but some may want to be involved and offer practical, as well as moral support. They may also be able to give different perspectives about how the child is managing when away from home e.g. in school or when with wider family members.

Every child and family are different. Therefore, how bladder and/or bowel symptoms in one child affect the other members of the family will be unique. Some basic principles that can help other children in the household feel included and helpful are:

• Ensuring that all the immediate family know how the bladder and bowel work and how to promote bladder and bowel health.
• Provide opportunities for children to ask questions, to be involved and to help support a sibling who is affected by a bladder and/or bowel condition.
• Seek support from your child’s school nurse, health visitor or other healthcare professional who can help you support all your children when one of them has a bladder and/or bowel issue.

For more information about bladder and bowel conditions in children and how they may be managed please visit the Bladder & Bowel UK website.

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Prevalence of Incontinence  

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

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

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

 Sustainability

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

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

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

Environmental sustainability

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

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

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

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

Introducing Washables Incontinence Underwear

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

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

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

Initial Preparation & Washing:

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

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

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

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The NHS estimates that 14 million people of all ages are living with bladder problems, and one in 10 of the population is affected by faecal incontinence. This new campaign aims to raise awareness of the role individuals play in supporting loved ones who experience the problem and the kind of support they need in turn.

The new campaign will engage with those people who are supporting friends and family members – listening to their voices and gathering their experiences through original research. It will introduce a new series of resources to provide help on topics such as ‘How to have difficult conversations: talking to a family member about incontinence’ and ‘Signs a family member may need help with incontinence.’

The campaign also seeks to emphasise that families and support networks often struggle to deal with incontinence and remind policymakers that the burden of care often falls unjustly and disproportionately on family members who need more specialist support.

Resources

The informative resources, produced by Bladder & Bowel UK’s team of specialist nurses, are available from the campaign hub. Topics covered include:

• Supporting someone with incontinence: Shining a light on the impact on families.
• Signs a family member may need help with incontinence.
• How to talk to a family member about incontinence.
• Who can help me if I am concerned about my child’s bladder and/or bowel health?

Survey

The campaign will ask audiences to share their experiences, explore how supporting someone with incontinence might have affected their own well-being, and affirm what kind of support they would benefit from. The impact of incontinence on families and support networks survey is now live on the campaign hub.

Alongside the survey, a submission portal is open. This allows people to share anonymously what they have learnt on their journey of supporting an individual with incontinence. The portal is available to offer advice to others in similar situations.

Karen Irwin, Specialist Nurse and Service Manager, Bladder and Bowel UK said:

“Many of us will find ourselves supporting a loved one with incontinence at some point. This is something that is rarely discussed – even within families. This campaign is about shining a light on the experiences of everyone involved and providing guidance and advice to people navigating this tricky terrain. We want everyone to get the help they need, and to do this we need to tackle the taboos. People should know that they’re not alone in this.”

Sarah Curtis, Managing Director – UK, Ireland & BeNeLux, Attends said: “We understand how much effective continence care improves wellbeing, not only of individuals but their families and friends as well. That’s why we are delighted to be supporting Bladder & Bowel UK’s vital new campaign. Taking a holistic view of what continence support is and working towards a better understanding of the often-forgotten impact of incontinence on support networks.”

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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.

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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. 

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