Last year as part of Continence Awareness Week, University Hospitals of Leicester NHS Trust’s (UHL) Adult Continence Team launched their ‘Taste the Difference Challenge’. The team worked collaboratively with ward staff and housekeepers in Leicester’s Hospitals, to promote and offer decaffeinated tea and coffee to inpatients across the Trust.  Educating staff and patients about the benefits of switching to decaffeinated tea and coffee for a healthy bladder was one of the campaign’s aims, and gathering patient feedback such as could patients taste the ‘decaf difference’ and whether they would make the switch to decaf once they knew the health benefits.

Why is switching to decaffeinated tea and coffee a good idea?

Apart from reducing overactive bladder symptoms such as urinary urgency, there are other health benefits including reduction in sleep disturbance and insomnia, reduction in tachycardia and palpitations and helping to prevent dehydration and headaches as well as reducing indigestion and lowering risk of osteoporosis as caffeine prevents absorption of calcium (NHS, 2021).

The UHL Continence Team launched the ‘Taste the Difference Challenge’ following a pilot project on an acute hospital ward, which was experiencing inpatient falls related to toileting. In UHL, falls associated with toileting equate to 1:4 (between 2020-2021) and research suggests a high correlation between falls and lower urinary tract symptoms in hospital (Roggeman et al. 2020).

What did the project involve?

The pilot considered thinking holistically about falls related to toileting and continence. After observations of care and talking to staff, it was identified that decaffeinated drinks were not routinely offered during ‘drinks rounds’.  Staff did not know the benefits of switching to decaffeinated tea and coffee, such as reducing urinary urgency and could potentially reduce a person’s risk of falls.

We asked housekeepers to proactively offer patients decaffeinated tea and coffee, and patient feedback indicated that most patients could not taste the difference. A resource pack was also developed for the ward which included coasters, posters and patient information leaflet to explain the benefits and promote decaffeinated tea and coffee.

What was found during the challenge?

During the challenge, the team collated nearly 700 pieces of patient feedback which included over 50% of patients saying they could not ‘taste the difference’ and over 76% patients reporting they would switch to decaffeinated once they knew the health benefits. A recommendation was made to the Trust’s Chief Nurse and Executive Board to consider making decaffeinated tea/coffee served as default with caffeinated tea and coffee remaining as an alternative option for patients. The Trust’s leadership team made a decision to support this initiative and we are in the process of rolling it out across our hospitals. Importantly, this means whilst we are promoting the health benefits of decaffeinated hot drinks as standard, the choice for our patients to choose caffeinated drinks will still be there.

The impact of the ‘Taste the Difference Challenge’, and roll-out of decaffeinated tea and coffee across the three hospitals will be measured through further patient feedback, and analysis of falls Datix incident reports, as to whether inpatient falls have reduced associated with toileting.

What’s next for the challenge?

The ‘Taste the Difference Challenge’ has since been trialled in another community hospital trust, and following their own ‘Taste the Difference Challenge’ in Memory Cafés for people living with Dementia, Age UK in Leicestershire now serve decaffeinated tea and coffee in their Memory Cafés.

The ‘Taste the Difference Challenge’ is a really simple, and fun way to promote decaffeinated tea and coffee, and can be transferred to any hospital, community group or residential care home setting. The potential benefits of switching to decaffeinated products in any environment could be significant and include improving a person’s health and potentially reducing falls, as well as improving patient dignity through lower continence pad usage. As part of the UHL Continence Team, I hope to share these benefits with other organisations or groups who might be interested and want to trial their own ‘challenge’ too.

If you are interested in delivering your own ‘Taste the Difference Challenge’, then Sarah Coombes, Continence Nurse Specialist at UHL, would love to hear from you.  Email: sarah.j.coombes@uhl-tr.nhs.uk, for further information and a resource pack to get you started.

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

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Not everyone gets excited about bladder and bowels, but I’ve loved this area of care since I completed my nursing training 37 years ago.

After living my whole childhood and teenage years in Lancashire, I decided to venture down south to undertake my training and found my way to the wonderful city of Canterbury. It seems like many years ago now, and I suppose it is – but what a great place to start my nursing career. Back then, our groups were only 10-15 students, with the nursing school having an intake every two months, during the year. I have many lovely memories and lifelong chums.

On qualifying, I came back home, missing the Lancashire Moors. I secured my first newly qualified staff nurse post, working in neurosurgery and neurosciences. I gained great experience there as a staff nurse, getting a good grounding post qualification. I later moved into community nursing, and soon after, qualified as a District Nurse. I even had the old navy-blue district nursing cap to keep my wavy locks under control.

At this point I gained a real passion for continence care. I was not only assigned my own team’s continence assessment visits, but the other teams would pass theirs over to me as well.

Through this work I came across a local, specialist nurse in a neighbouring trust. He was widely recognised as a national expert, so I boldly made contact, picking his brains, quietly gaining lots of remote continence experience to help me in my own clinical practice.

Developing skills in continence care

I decided that continence was the specialist area for me, and I was thrilled when an opportunity arose to join my remote mentor as a specialist nurse. While I was sad to leave district nursing, continence was my true calling.

I developed and set up a new clinical service within the residential home sector, and also provided education and training to the staff. The project was also nationally recognised, being highly commended for a national nursing award.

I was determined to further my knowledge over the next few years. I attended a few courses along the way, added in a degree, some health research and more, all for the greater good of broadening knowledge, improving practice and striving to always deliver the best patient care.

After some years in this role, a wonderful opportunity came up. The position was across two well-established continence services, working with patients with functional bowel issues, and developing and implementing care pathways around bowel issues. This was part of an important change in recognising that continence extends to bowel issues, as well as the bladder.

This project was nationally recognised, winning the Continence Foundation Award. On completing the project, I was appointment Lead Specialist Bowel Nurse and joined one of the teams, where we offered local and regional bowel and pelvic floor clinics for about 15 years. Happy days.

My work has been varied: I undertook a secondment to a medicines management network service for 18 months which was a very different role, supporting NHS, prisons services, local authorities and patients. This focussed on improving health through optimising the use of medicines, and I worked as member of a wider pharmaceutical team. On completing of the secondment, I returned to my clinical continence post.

My work in continence care today

I currently hold a dual role. I am Service Manager and Specialist Nurse at Bladder & Bowel UK, and I am a Specialist Nurse in a tertiary pelvic floor and functional bowel service clinic.

It’s great to be able to work across both roles. I am able to maintain my specialist clinical practice, while also working in a third sector area. These are very different yet complementary ways of working.

For many people Bladder & Bowel UK are the first point of contact. Often we are supporting people who have never before discussed their bladder and bowel issue. Perhaps we are advising someone who is struggling to manage their relative’s continence problems. or a parent who is struggling toileting their child.

We also offer support and advice to health care and other professionals who are seeking solutions to help them support their patients, through the helpline, training, consultancy and more.

So much has changed since I started nursing all those years ago, but I still absolutely love working in this speciality of care.

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

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The most important thing you can do to keep your bladder working well is to ensure that you are drinking plenty of water-based drinks each day. Most adults and teenagers should have between 1500 and 2000mls of fluid every twenty-four hours, with drinks being spread throughout the waking hours, until about an hour before sleep. Most school aged children should have about 1500mls per day. More than this may be needed if the weather is very hot and for those who are very active.

If you are drinking correctly then your bladder should empty about four to eight times a day. Urine should be pale or straw-coloured. Yellow or darker coloured urine may be an indication that there is a need to increase fluid intake.

Fluids that are good for the bladder

The committee are currently working on projects including:

• Water is the best option for the bladder and for general health
• Diluted cordial / squash drinks
• Diluted fruit juice
• Many fruit and herbal teas
• Red bush tea (a type of tea that is naturally caffeine free)

Fluids to avoid

• Alcoholic drinks
• Caffeinated drinks. These include tea, coffee hot chocolate, cola and many energy drinks. Decaffeinated tea and coffee are not totally caffeine free, but have only a small amount of caffeine in them, so are a good substitute to regular tea and coffee
• Fizzy drinks

Other advice to help promote bladder health

Try to avoid constipation.  Having a full bowel puts pressure on the bladder and can therefore cause problems with emptying, may make leakage more likely or worse and is associated with an increase in urinary tract infections (UTI).  Eating plenty of whole grains, fruit and vegetables, drinking sufficient water to keep the urine a pale colour, undertaking some physical activity every day and going to empty your bowels as soon as you feel the need will all help to prevent constipation.

Pass urine whenever you need to. If you are drinking well then you are likely to want to empty your bladder every two to three hours. Holding on too long when you need the toilet can make it more difficult for your bladder to empty fully and can increase the likelihood of developing a urinary tract infection.  Also try to avoid going ‘just in case’.  If you go too often when you do not need to pass urine, then the bladder can eventually become smaller and therefore hold less, increasing the need to go to the toilet more often.

Make sure you take long enough and are relaxed when you are at the toilet. This helps the bladder to empty fully.  Women should always sit down properly to pass urine. Hovering over the toilet encourages tightening of the pelvic floor and can prevent complete emptying.  Emptying the bladder completely helps to protect against urinary tract infections.

Do pelvic floor exercises. The pelvic floor is the muscle group that support the pelvic organs (the bladder and lower bowel in males and females as well as the uterus and vagina in females). As with all muscles, the pelvic floor works more effectively if exercised. A strong pelvic floor will help to protect against leaks, particularly when you cough, sneeze, laugh, lift something, or have a strong urge to pass urine. If you are unsure about how to do pelvic floor exercises, speak to your healthcare professional.

Wipe from front to back after using the toilet, particularly after a bowel movement.  This will help to prevent bacteria from entering the urethra, which can then cause a urinary tract infection.

If you are a smoker try to give up. Smoking is associated with bladder and kidney cancer, with irritation of the bladder lining which can make overactive bladder (a condition where there excess bladder contractions cause sudden and frequent strong urges to use the toilet and may be associated with urinary leakage) and a painful condition known as interstitial cystitis worse. Furthermore, smoking can cause coughing which may result in urinary leakage.

Try to keep your weight at the right level for your height and build.  Being overweight can cause stress incontinence (leakage when you cough, sneeze, laugh or lift something). Try to stay active, as not only will this help with weight control, but moderate activity may help with bladder control.

When and who to ask for help about bladder health

If you are worried about your bladder health or are experiencing any of the following, then talk to your GP or other healthcare professional.

• Pain or a burning sensation when passing urine
• Passing blood in your urine
• Passing urine more frequently or having an urge to pass urine that is stronger than usual
• It takes you longer to empty your bladder than usual, you find it difficult to pass urine, or you feel that you have not managed to fully empty when you go to the toilet
• Any leakage of urine during the day or at night
• If you are waking more than once a night to pass urine

Problems with bladder control and function are not typical at any stage of life, including in children who are toilet trained, after childbirth or in advancing years. They may occasionally be a symptom of a wider health problem, so should be assessed. Most bladder problems are treatable and, even for those bladder issues that cannot be cured there are many management options that may make living with a bladder condition easier.

If you have any concerns about your bladder health, then do talk to your healthcare professional.

Bladder & Bowel UK have information about a wide range of bladder and bowel conditions for children and for adults on our website. For free confidential advice and support then contact our helpline via the webform or on phone number 0161 214 4591.

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Karen is thrilled to be reappointed for a further term of office on the RCN Bladder and Bowel Forum.

Congratulations also to Fiona Le Ber, Clinical Nurse Specialist Community Continence and Stoma care, Queens Nurse, Jersey who will be taking up her new position of Chair of the forum.

• Other Bladder and Bowel Committee members are :-
  Suzanne Ryder, Professional Lead for South Manchester Bladder and Bowel Service, Professional Lead – Citywide Manchester Bladder and Bowel Services
• Vicky Coghlan, Advanced Nurse Practitioner Bladder & Bowel Service Aneurin Bevan UHB Bladder and Bowel Service
• Nikki Cotterill Associate Professor of Nursing in Continence Care, UWE and North Bristol NHS Trust
• Janice Reid Teaching Fellow, School of Nursing, University of Ulster

The forum is a group of nurses supporting each other and driving change to improve bladder and bowel care. We contribute to raising the profile of continence care nationally and supporting RCN members

Current projects of the Bladder and Bowel Forum

The committee are currently working on projects including:

• Revision of the RCN publication. Bowel care: management of lower bowel dysfunction, including digital rectal examination and digital removal of faeces (2019)
• Revision of the RCN publication. Catheter Care – Guidance for Health Care Professionals (2021)

For further information of how you can get involved, to join the forum, and to access information and online resources, tools and support, please visit the website.

The forum is also active on social media via Twitter and have a closed Facebook page, so please do come along and introduce yourself.

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

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All of these symptoms may cause embarrassment to the individual who is experiencing them and they may decide because of this not to invite family members to spend time at their home or may turn down an invitation to stay with relatives. However, Christmas is a special time and a time for families and friends to be together. We aim to support people to enjoy the holiday period regardless of their condition.

Some practical preparation and, if possible, some open communication will help you as individuals to spend time together and not allow your bladder and bowel condition to cause you to miss out or feel isolated.

Practical tips for preparing to travel with a bladder or bowel condition

• Ask for a bedroom that is closest to the toilet for convenience.
• If you have a bladder problem especially at night buy a urinal that you feel comfortable to use in the bedroom to save lots of trips to the bathroom to aid discretion.
• Ensure you have adequate protection in the form of continence pads, underwear and bed protection. It may be advisable to buy a more absorbent pad to aid your confidence when other people are around.
• Ensure you have plenty of skin wipes and disposable bags to aid your hygiene regime and discreet disposal of incontinence products.
• Speak to your GP prior to the Christmas period if you have any concerns regarding your bladder and bowel condition as medication may aid management of the issue.
• Do not reduce your fluid or dietary intake as this may make the problem worse. If you suffer with bladder urgency reduce the amount of caffeinated drinks you drink. Try decaffeinated tea or coffee, diluted cordials and fruit teas as this may help to alleviate some of the urgency.

Get in touch with us

If you do need help with the bladder and bowel symptoms you are experiencing please do not hesitate to contact the Bladder & Bowel UK Helpline. We are closed from Friday 24th December at 4.30pm and reopen Monday 3rd January 2021 at 9.00am.

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This post is promoted content by Contrelle.

Take it slowly

Having a baby is a momentous occasion. It changes everything, your body, your relationships, your priorities, and how you exercise. Getting back to training after having a baby will depend on your fitness level pre-baby but there is every reason that you can return to your pre-baby level of fitness. Exercise can help you recover after childbirth, make you stronger, improve your mood, relieve stress, and help prevent postnatal depression. The key thing is to progress slowly whether you are an elite athlete, an amateur runner or you aspire to do Couch to 5K.

If you had an uncomplicated birth, you can start gentle exercise as soon as you feel able, but it is recommended that you wait until after the 6-week GP postnatal check before starting any high-impact exercise such as aerobics or running. How soon you’re ready to start exercising depends on your circumstances. It will also depend on the type of birth you had. For example, if you had a caesarean section, your recovery time might be longer.

Education and awareness are key. Labour and birth can cause physical problems that include lower back pain, pelvic girdle pain, and urinary incontinence. Diastasis Recti – where your abdominal muscles weaken and separate to accommodate the growing baby is a common but treatable condition. Urinary incontinence is also common but not normal – despite the narrative that is pedalled in the mainstream media that ‘oops moments’ are normal and part of a woman’s life.

Getting the advice you need

If you are reading this article after having a baby and experiencing any leakage, please seek help from either your GP, your health visitor, midwife, or physiotherapist. There simply is no need to put up with leaking no matter how little. It is not just part of the motherload – which is hard enough in itself. Leaking should not be a barrier to your returning to exercise either – it may just mean that you need a specific exercise programme bespoke to you and your body.

Even if you have had an uncomplicated birth, it’s worthwhile speaking to your GP about getting a referral for postnatal physiotherapy. One such company that offers this is the Mummy MOT – a comprehensive one-hour check that assesses posture, functional movement (as mums need to lift, bend and squat), abdominal muscles to check for any separation, and a pelvic floor examination to assess for pelvic floor dysfunction. You will be given a detailed report of findings and be confident you have a roadmap to getting back to safe exercise.

Innovative products to help get women moving

Aside from physiotherapy, there are some amazing products out there to help women get back to exercise if they are suffering leaks when they laugh, cough, sneeze, jump, lift or run. Contrelle Activgard is one such femtech innovation and is an easy-to-use, soft bladder support that helps stop leaks before they happen. It gently lifts and supports the bladder neck and urethra to help stop annoying leaks. You can use one a day or just when exercising. Contrelle offers protection against bladder leaks and is also affordable. Contrelle comes in three different sizes as every woman is different. Once you find your perfect size, you can just get on with living your life. Buy the sizing kit here.

A person-centred approach

It’s encouraging that the spotlight is now on women’s health – but women’s health is about much more than reproductive health. For many years, medications have been designed around the male anatomy. We need a much more person-centered approach when it comes to treating women with issues such as incontinence and prolapse. It’s good that the NICE draft guidelines advise that a three-month programme of supervised pelvic floor muscle training to help prevent pelvic floor dysfunction should be offered to women from week 20 of pregnancy. Prevention is better than cure, but it is only a piece of the much wider jigsaw.

It’s up to every woman to keep the conversation going, it’s time to ditch cutesy marketing taglines that normalise women’s suffering. It’s just not acceptable. Change is happening, but it is up to every one of us to be accountable and to keep shouting from the rooftops. We need a more joined-up approach from our health service providers, collaboration is critical, or the wheels come off.

As Dr. Stacey Rosen puts so eloquently:

‘The health of women is not a women’s problem. It is a universal, societal problem. When women are healthier, communities are healthier, families are healthier, the world is healthier.’

This post is promoted content by Contrelle.

Get in touch with us

Bladder & Bowel UK have information about a wide range of bladder and bowel conditions for children and for adults on our website. For free confidential advice and support please contact our helpline via the webform or on phone number 0161 214 4591.

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That patients will adhere to their prescribed therapies is something that many healthcare professionals (HCPs) take for granted. Yet, the reality is that between a third and a half of all medicines prescribed for long‑term conditions are not taken as recommended in the UK. [1] Poor adherence to to prescribed therapy – whether medication or a device (e.g., transanal irrigation) – is linked with poor clinical outcomes. By compromising the effectiveness of the treatment, poor adherence also leads to increased demand for healthcare due to lack of improvement or deterioration of the condition. The World Health Organization (WHO) considers poor adherence to treatment of chronic disease ‘a worldwide problem of striking magnitude’[2] and improvements in this area could undeniably have a significant positive impact.

What causes poor adherence?

To address the issue, we must first understand the elements that influence adherence. These can be split into intentional and unintentional causes and include: the therapeutic alliance; perceived lack of control; risk of dependence on medications; stigma associated with medication use; and lack of knowledge, education and support. Successful adherence comes from providing support to the patient throughout the entire process, from assessment to establishing long-term use of the treatment.

This is particularly important for patients with bowel dysfunction who may be reluctant to discuss their symptoms and have a tendency to ‘self-help’ and delay seeking medical help. Symptoms are often intermittent for bowel conditions, and patients may be tempted to avoid the issue when symptoms temporarily abate. Furthermore, treatment for bowel conditions can include strong medications and invasive treatments, which can interfere with some aspects of daily life and therefore discourage patients from sticking to their regime. Yet, the longer patients wait to seek treatment, the more the condition can worsen, leading to extended treatment times. This is further exacerbated by current difficulties in accessing primary and secondary care,[3] and more recently by COVID-19’s impact on waiting times to see specialists.

Tackling non-adherence

   1. Communication, time and empathy 

Crucially, non-adherence should not be seen as the patient’s fault: adherence must be a partnership between patient and HCPs. Receiving adequate support from HCPs is vitally important, especially during those first few months of beginning a new treatment. HCPs should aim to help patients make informed decisions about their own treatment and should ensure that all information is accessible. It helps to provide clear and complete information about the benefits and adverse effects of available therapies or medical devices, including alternatives to the treatment or device that is chosen. Explaining the rationale behind the selection of a treatment – such as improved symptoms – is crucial, as well as setting expectations for side effects and speed of improvement. Finally, any adjustments that may be needed during treatment should be made clear to the patient from the onset, so that they are not taken by surprise.

    2.Treatment ownership

By providing this in-depth information, patients can have a sense of ownership of their treatment and feel more motivated to adhere. Having a motivation to adhere will make patient adherence more likely than if patients are merely passive recipients of advice. This investment of time is worthwhile since informed and empowered patients are more likely to stick to their medication regime or device treatment plan. Similarly, involving patients in prescribing decisions and adapting consultation style to the individual can help HCPs to establish how involved their patients would like to be in decision making. Patients may also require some support in implementing adherence strategies, for instance setting up reminder applications or alarms on their phones.

   3.Tailored interventions

Adopting an open, no-blame approach encourages patient engagement, enabling them to discuss their concerns about treatment. In turn, this helps HCPs to understand and anticipate any factors which could stop them taking their medicine. A strategy that works for one patient may not be so effective for another so assessing each case on an individual basis is a good approach. The more tailored interventions are to the patients and their specific difficulties, the better.

   4.Follow-ups 

After initial advice and prescription is delivered, regular follow-ups should be carried out. This can be carried out more easily through teleconsultation, particularly with patients accustomed to this format due to the COVID-19 pandemic. HCPs can recommend that patients keep a treatment diary where appropriate, in which they track their symptoms and any treatment side-effects. Catch-up sessions also provide patients with an opportunity to report back on their experience and HCPs to personalise the therapy if necessary.

With healthcare systems under increased pressure due to the pandemic, strengthening adherence to improve patient outcomes and prevent condition escalation should be given more attention. HCPs can play a greater role in optimising adherence for their patients. For the strategies outlined above to work, a joined-up approach is best – whereby patients receive coordinated support from healthcare professionals and organisations. The shift to integrated care systems in the NHS will help foster this consistency throughout the patient journey. Tackling non-adherence will require some investment of time and resources from HCPs and healthcare organisations, however, the widespread benefits that stem from improved adherence will make it worthwhile from both a patient quality of life and a health economics perspective.

For further information and resources for treating bowel dysfunction, please visit https://bowelinterestgroup.co.uk/resources/

References

[1] National Institute for Clinical Excellence (NICE), Medicines adherence: involving patients in decisions about prescribed medicines and supporting adherence, 28 January 2009

[2] World Health Organization, ADHERENCE TO LONG-TERM THERAPIES: Evidence for action, 2003

[3] The Patients Association, Pandemic Patient Experience II: From lockdown to vaccine roll-out

April 2021; The Times, A record 5.45m await routine hospital treatments, 12 August 2021

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GPs should be a first port of call for patients suffering with constipation; yet one in five are too embarrassed to talk to their GP

Highlighting the scale of stigma associated with constipation, an equal proportion said they would be embarrassed to discuss erectile dysfunction with their GP. As there is a lack of understanding about what constipation is, what is ‘normal’ when it comes to bowel health and how it should be treated, it is vital for sufferers to be able to speak comfortably to a medical professional as early on as possible.

Unfortunately, the stigma means that people are suffering in silence needlessly until the condition becomes too difficult to bear, necessitating more intensive treatment. In 2017/18, constipation was the cause of 71,430 hospital admissions, the equivalent of 196 people a day! Constipation is a treatable and manageable condition, so earlier and improved treatment would alleviate an unnecessary burden on the NHS: in the same year, the total cost for treating unplanned admissions due to constipation was £71 million.

Even more importantly, there is a long-term impact on wellbeing and quality of life. Chronic constipation can cause debilitating physical and psychological distress, especially as it can cause other issues, such as chronic pain and urinary tract infections (UTIs). For some patients with existing health conditions, such as multiple sclerosis, constipation is yet one more complication that can amplify anxiety and depression. In fact, 40% of patients with constipation experience an anxiety disorder.

The perception that constipation is a minor health issue that can be easily treated at home without professional support can lead to avoidable aggravation of the problem.

Bowel habits are an important indicator of our health and any complaints in this area should be given the same attention and care as other ailments. Patients suffering from constipation may simply require advice about improved diet, exercise and laxatives – of course, good bowel health starts at home – but those with long-term conditions or immobility may need more intensive treatment. Improved understanding about bowel health can therefore empower patients and help to prevent unnecessary suffering, while at the same time eliminating avoidable costs for the NHS.

Please find the full report here.

This post has been written by Dr Benjamin Disney, Consultant Gastroenterologist at University Hospitals Coventry and Warwickshire NHS Trust. 

If you would like to talk to someone please don’t hesitate to call the Bladder & Bowel UK helpline on 0161 214 4591. Or if you would prefer, you can email us at: bbuk@disabledliving.co.uk

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