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.

The post Insights from the RCN Continence Care Conference appeared first on Bladder & Bowel UK.

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

The post Making an Informed Catheter Choice appeared first on Bladder & Bowel UK.

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

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

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

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

Nursery

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

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

Health visitors

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

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

School nurses

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

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

General Practitioners

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

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

School or collage

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

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

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

Specialist services

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

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

Further information

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

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

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

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

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

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

Conversation tips 

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

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

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

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

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

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

What is needed for a positive conversation? 

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

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

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

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

Next steps 

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

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

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

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

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

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

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

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

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

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

Signs to look out for in people of all ages

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

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

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

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

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

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

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

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

Incontinence in children

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

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

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

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

What to do next

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

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

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

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

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

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

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

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

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

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

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

Difficulties for caregivers 

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

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

Emotional impact of incontinence

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

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

Financial impact of incontinence 

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

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

Social isolation

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

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

Changes in daily routine

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

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

Communication challenges

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

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

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

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

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.

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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.

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Shackley et al (2017) writing for the British Medical Journal states that the use of urinary catheters is one of the highest treatment options within our healthcare system, with 1 in 5 patients in hospital and 1 in 14 in the community setting being catheterised. The risks of indwelling catheters are well documented and include catheter-associated urinary tract infections (CAUTIs), bacteraemia and increased and urosepsis.

In 2015 the National Institute for Health and Care Excellence (NICE) acknowledged Intermittent selfcatheterisation (ISC) as the gold standard in continence care and this is now the preferred method of bladder management. The reason for this is that not only does ISC put the user in control of their own bladder function and facilitate normal voiding, but it can also reduce the risk of infection and offers greater psychological and physical benefits to a traditional indwelling catheter. (Catheter Care, RCN Guidance, 2019)

What is Intermittent Self Catheterisation?

Intermittent self-catheterisation (ISC) is defined by Shah and Leach (1998, cited in Naish 2003), as ‘passing a catheter into the bladder to remove urine when the patient cannot pass urine normally’. The procedure may be repeated every few hours if necessary and is viewed as an alternative technique to an indwelling catheter as a means of managing urinary problems. ISC is an established intervention (Addison, 2001, cited in Naish 2003) and is recognised as a safe and effective procedure (Moore, 1995, cited in Naish 2003). For many, the thought of undertaking ISC can be daunting, there is for some the fear of undertaking something medical, for others a fear of pain or discomfort. For most patients undertaking ISC, it is an essential task in order to maintain bladder function.

Who can be taught ISC?

Any individual proven to have a significant residual volume of urine over a prolonged period would benefit from ISC. This is because retaining urine is a significant risk factor and cause of urinary tract infections. Patients who undertook ISC would need to have good cognitive function and suitable dexterity or the support of a carer or family member in order to have a successful outcome. It is also important to choose the correct type of catheter to meet their needs, therefore holistic assessment is essential.

Urinary Tract infections (UTIs)

Urinary tract infections are divided into upper or lower UTIs depending on which part of the urinary tract is affected. The urinary tract consists of the kidneys and the ureters, the bladder and the urethra.

Lower urinary tract infections are much more common than upper UTIs and include the bladder and urethra. Upper UTIs are potentially more serious as they can involve the kidneys. Whilst it might seem a bit daunting that you can get a UTI from using ISC, it is important to remember that the risk of getting a UTI is much higher if you don’t use intermittent self-catheterisation. In fact, one of the key reasons that ISC is often recommended is to reduce the chances of developing a urinary tract infection. However, that does not stop patients worry about them, A Coloplast survey in 2016 of ISC users in the community setting states that 45% of patients worry about getting UTI’s when they self-catheterise. And most expect to get a UTI at least 2-3 times a year which is demonstrated in this case study below.

Case presentation

Bob (pseudonym) is a 62-year-old man with a spinal cord injury. He is paralysed from the neck down and no longer has any natural bladder function. He uses a wheelchair during the day and cannot stand to pass urine. He has chosen to undertake ISC for the last year, instead of having an indwelling catheter, but has experienced several episodes of uro-sepsis and admission to hospital. His wife performs the ISC for him, 5 times a day into a jug.

When we met Bob, he was using a good standard catheter that was functionally adequate however he was keen to explore if there was anything we could suggest that might make his life easier, particularly for his wife, and also help reduce the number of hospital admissions in the future. Owing to recent research we were able to discuss how the friction force of catheters could effect urethral trauma and therefore potentially increase infection rates. By undertaking a detailed consultation and listening to Bob and his wife’s needs we were able to show him a couple of new catheters, one of which has a catheter bag attached and is known as a “set” catheter.

Bob has highlighted to us that he did not go out often – he had never catheterised away from the home, the experience of catheterising usually meant leakage of urine as his wife struggled to catheterise and hold a jug. We were able to show him how to use Speedicath Flex Set, a new catheter that had a bag attached – this bag would capture the urine as ISC is performed, negating the need to use the jug.

Additionally this catheter has a triple action coating technology applied to the catheter – this makes insertion smoother – less friction should mean less trauma to the urethra and therefore long term reduce the potential of urine infections that in the past have led to sepsis.

The detailed consultation also allowed time to explore hygiene aspects with ISC and as the catheter has a sleeve, explain how this reduces the likelihood of cross infection but also discuss with both Bob and his wife the importance of hand hygiene. Bob has been using the catheter for a while now and has not had any further admissions to hospital. Most importantly, Bob has found new freedom. Accompanied by his wife they have managed to get out and about a little. They no longer use a jug and rely on this system to support their needs.

What is Friction Force and Triple action coating?

Within the case study we referred to friction force. A catheter with insufficient hydration can cause friction and irritation to the urethra. On average, catheter users catheterise 5 times a day – which adds up to 1825 times a year, this is why it’s so important that every single insertion and withdrawal of the catheter is as smooth as possible to reduce discomfort and protect the urethra. (Stensballe J et al 2005). The coating on the Speedicath Flex Set catheter that was used in this case study has the triple action coating technology. To protect the mucosa from the risks of damage, complications,** and UTIs,*** it’s important to have a coating that stays bonded, stays smooth and stays hydrated.

All SpeediCath catheters come with a unique hydrophilic coating, featuring our Triple Action Coating
Technology. It consists of three strongly bonded elements, designed to protect the urethra in three ways: it stays bonded, stays smooth, and stays hydrated.

Stays bonded
SpeediCath’s unique hydrophilic coating stays bonded during insertion and
withdrawal due to a proprietary base-coat that is covalently bonded to the catheter
surface for an even coating without dry spots.

Stays smooth
SpeediCath’s unique hydrophilic coating stays smooth because the polymer top-coat
enables excellent water absorption for low friction, smooth insertion and reduced
discomfort compared to uncoated catheters.

Stays hydrated
SpeediCath’s unique hydrophilic coating stays hydrated with a special water-based
solution that swells the coating and makes it instantly ready to use.

Making life easier

It is cases like Bob’s that make us realise how important it is to choose the correct catheter when performing ISC. Using current data, such as friction force data, to help empower patient choice is highly important. ISC offers significant advantages to that of alternative bladder management solutions and when performed well and concordantly will reduce UTIs, improve quality of life and enable independence.

References
1)IC value proposition January 2016: Coloplast survey, CIC users in community setting n=2942 (PM-06287) – on file

1. Stensballe J, Looms D, Nielsen PN, et al. Hydrophilic-coated catheters for intermittent catheterisation reduce urethral micro trauma: a prospective,
   randomised, participant-blinded, crossover study of three different types of catheters. Sponsored by Coloplast. EurUrol 2005;48(6):978–83, n=49. **
   Urethral bleeding (hematuria) and strictures
   *** compared to uncoated catheters
   • Sharkey et al (2017) Variation in the prevalence of urinary catheters: a profile of National Health Service patients in England. Published in
   the British Medical Journal 2017; 7(6): e013842. Found online at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5577876/#:~:text=Our%20results%20
   indicate%20that%20urinary,more%20prevalent%20in%20males%20overall. (accessed 13th January 2021)
   • Vahr S, Cobussen-Boekhorst H, Eikenboom J, Geng V, Holroyd S, Lester M et al (2013) ‘Evidence-based guidelines for best practice in urological health care. Catheterisation; urethral intermittent in adults; dilatation, urethral intermittent in adults’. European Association of Urology Nurses (EAUN).
   • Naish, W (2003) Intermittent self-catheterisation for managing urinary problems
   • Catheter Care (2019), RCN Guidance For Healthcare Professionals, Pg 33
   • https://www.nhsemployers.org/pay-pensions-and-reward/nhs-terms-and-conditions-of-service—agenda-for-change/pay-scales (accessed
   10th January 2021)

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Enuresis, or bedwetting is a common condition in children and young people. However, it can be very distressing and frustrating for them and for their families. For many it causes, low self-esteem, can lead to sleep difficulties, and psychological issues and many worry about the possible embarrassment if others finding out.

What is bedwetting?

Bedwetting is a recognised medical condition that results in the bladder emptying during sleep.  It  is also known as enuresis or nocturnal enuresis.  Affected children and young people cannot help the problem. It is not caused by anything they or their family are doing wrong or are not doing.   It is not caused by laziness or naughtiness.

While bedwetting can be made worse by stress, it is not usually caused by this. Rarely it can be linked to other medical conditions. Therefore, if your child has suddenly started wetting after a period of being dry, you should ask their healthcare professional (GP or school nurse) for help and advice.

What causes bedwetting?

There are different causes for bedwetting.  If the  brain is not able to fully wake a child or young person up when the bladder signals that it needs to empty, then the bed will get wet. However, most children and young people can sleep through the night without needing to go to the toilet.

If the bladder is not working well enough to be able to hold all the urine that is made overnight, then it will need to empty during the hours of sleep. If the child or young person cannot wake, the bed will get wet.  Some children with bedwetting also have problems with bladder function when they are awake. These children may experience some urine leaking during the day: they may get damp or wet underwear. Some may go to the toilet more often than usual (frequency) or they may have to get there quickly than usual (urgency). This can appear to families as if they are leaving it to the last minute to go to the toilet, which is not usually the case: it is the bladder ‘twitching’ at any point during filling, which causes a sudden, strong and unexpected need to get to the toilet quickly.

Most children and young people can reduce urine production during the night,  so that the bladder is able to hold all that is produced while they are in bed. However, if the kidneys are making too much urine while the child or young person is asleep and they are not able to wake to the bladder signals, the bed will get very wet.

Is there anything that can be done to help with bedwetting?

Constipation can also cause bedwetting or make it worse. This is because the full bowel can put pressure on the bladder. Therefore, it is important to try to prevent constipation through a good fluid intake, and by encouraging your child or young person to eat a diet that includes plenty of fruit and vegetables. If you think they may be constipated, then speak to their healthcare professional. Constipation in children and young people does usually need to be treated with laxatives.

Drinking well during the day helps the bladder to work well. This in turn helps it to hold urine better during the day and at night. Most primary school age children should be drinking about 1.5litres of water-based drinks a day;  teenage girls should be having 1.5-2 litres and teenage boys 2 -2.5litres a day. Drinks should be divided up so that all children and young people are having a water-based drink about every two hours, or six to eight drinks a day.

Drinks that are fizzy and drinks that contain caffeine, such as tea, coffee, hot chocolate, cola and many energy drinks, should be avoided. This is because fizzy drinks and caffeine can irritate the bladder lining and increase the likelihood of being wet.  Milk is considered a food rather than a drink.

Children should have their last drink of the day about an hour before bedtime. Drinking late in the evening does not give the kidneys enough time to get rid of any excess fluid before sleep, so may make bedwetting worse. However, stopping drinks too early in younger children may make it more difficult for them to drink as well as they should during the day. Young people, who go to bed later, may stop drinks up to two hours before bedtime. 

Emptying the bladder just before settling to sleep is also important, particularly for children who play or read in bed.  Avoiding screens, such as TVs, electronic tablets, computers, phones etc,  just before sleep may also help as the type of light given out by the screens cause unsettled sleep patterns and trick the body into continuing to make wee at the daytime rate, rather than at the lower night time rate.  

A good bedtime routine may also be helpful. Some children and young people are more prone to wetting if they are very tired due to late nights, others are more prone to wetting if they go to bed early, as they are in bed for longer as their bladder may not be able to hold on for this extra time.

Are there any other treatments for bedwetting?

If the measures outlined above do not help, then medication or an alarm may be appropriate. There is a medication called Desmopressin that helps to tell the kidneys to make less urine overnight.  This is available on prescription from your healthcare professional and there is more information about it in the Bladder & Bowel UK leaflet at Understanding Desmopressin (Desmomelt) – for parents and carers.

Alarms are devices that make an intrusive noise when the child starts to wet. They can be attached to pyjamas (body-worn alarms) or have a mat that goes under the top sheet (bed mat alarms). The noise is designed to wake the child as their bladder starts to let go, so that they can get up and go to the toilet. They can take some time to be effective. While it is not clear exactly how they work, they do help some children to learn to wake to the bladder signals, others learn to hold on all night. There is more information about alarms at Using alarms as a treatment for bedwetting – for parents and carers

Some children may need other medication to help the bladder work well and some children need to have more than one treatment. Therefore, bedwetting in children over five years old should be assessed by a healthcare professional.

Why Christmas can be a good time to think about managing bedwetting?

Children and young people usually spend most of the Christmas holidays at home with their family.  Most children need support to establish good drinking and toileting patterns and this is easier when everyone has time at home.  Also, although there may be more sweets and chocolates around, traditional festive foods tend to include lots of fruit and vegetables. These can help to prevent constipation, which may make bedwetting worse.

The holidays can be a good time to start using a bedwetting alarm. The alarm will disturb you and your child or young person when they wet during the night. However, holiday times may allow you and them to catch up with lost sleep, by getting up a bit later in the morning if they do not have to go to school and you do not have to go to work.

If you have tried the initial adjustments to your child’s routine and the bedwetting is not improving and they are over five years old, then you can ask their healthcare professional for assessment and further treatment. 

Where can I find more information about bedwetting?

There is more information about bedwetting on the Bladder & Bowel UK website at https://www.bbuk.org.uk/children-young-people/resources-for-children/ and in other blogs on the Bladder & Bowel UK website at https://www.bbuk.org.uk/?s=bedwetting.  There is also information on the website at https://stopbedwetting.org/

Where can I get more advice and help?

Your child or young person’s GP, school nurse or health visitor should be able to provide more information and initial assessment. They may be able to refer your child to a local service for support.  You can also contact the Bladder & Bowel UK helpline for free confidential information and advice via the webform at https://www.bbuk.org.uk/helpline-enquiries/ or on the telephone at 0161 214 4591

For more information and resources for professionals working with bladder and bowel issues, visit our professionals’ section here. 

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