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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

The post Buzzers for Bedwetters Project appeared first on Bladder & Bowel UK.

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

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

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

Resources

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

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

Survey

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

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

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

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

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

The post New campaign explores how people are affected by a loved one’s incontinence – and what support they need. appeared first on Bladder & Bowel UK.

We provided much of the information for the frequently asked questions. Therefore we are delighted that there are links to Bladder & Bowel UK’s children and families information library and to our website.

What is Bedwetting?

Bedwetting, sometimes called nocturnal enuresis, or simply enuresis, affects approximately 20% of 5-year-olds and 10% of 7-year-olds. It is considered to be a medical problem once children have passed their fifth birthday.

It used to be thought that children would grow out of the problem. However, without treatment many children will continue to wet the bed into late childhood, or their teens. It can sometimes last into adulthood which demonstrates the importance of effective treatment and management.

‘Supporting ALTURiX in the creation of the DreamDry® app from concept to release has been a rewarding process. The app provides helpful information for children and families as well as recording children’s progress and use of any prescribed medication or alarms. A positive development is the means to support open communication between parents and healthcare professionals, fostering a collaborative approach to managing bedwetting.’ – Davina Richardson, RGN/RSCN, Children’s Specialist Nurse.

Why DreamDry®?

This app has reliable information that may be helpful when tackling bedwetting – but also allows parents, guardians, and caregivers to quickly log the child’s wet and dry nights.

Additionally, DreamDry® facilitates record keeping and enables the healthcare professional to see a record of how well the child is managing to adhere to treatment and its effects.

The digital platform means the family do not have to keep track of bits of paper and will have the information safely stored on their device when they speak to the healthcare professional.

There is also a function which allows the user to export the information to CSV or PDF.

‘‘We are thrilled to have recently launched DreamDry® and are extremely grateful to Bladder & Bowel UK for providing their absolutely essential support with input on research and information that fuelled the six-month development journey. Working together, we hope we have created an App which makes a meaningful impact in the lives of parents and children.’ – Team ALTURiX

Our involvement

DreamDry® was funded by ALTURiX, and developed with support from Bladder & Bowel UK, and ERIC, The Children’s Bowel & Bladder Charity and is a free App published on the Apple App Store, and Google Play.

Download DreamDry®

The post DreamDry® – a free easy-to-use bedwetting support App appeared first on Bladder & Bowel UK.

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

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

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

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

The limits of lifestyle changes

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

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

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

Help with managing constipation

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

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

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

‘It’s really changed my life.’

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

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

Background

Functional bowel disorders (FBDs) are a group of medical conditions that affect the normal functioning of the gastrointestinal (GI) tract without any apparent structural or biochemical abnormalities. These disorders are common, affecting over 25% of UK adults¹. The term “functional” means that the disorder is primarily related to how the GI tract functions rather than any specific physical damage or disease.

Some common functional bowel disorders include:

• Irritable Bowel Syndrome (IBS) – IBS causes abdominal pain or discomfort, along with changes in bowel habits, such as diarrhoea (IBS-D) constipation (IBS-C) or alternating between the two (mixed IBS).
• Functional Constipation – infrequent bowel movements, difficulty passing stools, and a feeling of incomplete emptying.
• Functional Diarrhoea – frequent loose or watery stools without any identifiable cause.
• Evacuatory Dysfunction – difficulty in passing stools, often associated with excessive straining and a feeling of incomplete evacuation.
• Faecal incontinence – the accidental passage of stool from the rectum.

In clinical practice, symptom overlap is common among patients. They frequently speak of the considerable burden these conditions have on various aspects of their lives, including relationships, overall health, and ability to work. These insights led to the development of the PERSPECTIVE study.

The PERSPECTIVE study has explored the impact of the aforementioned FBDs on patient’s lifestyle, including their real-world experience of using transanal irrigation (TAI) to manage these symptoms. This study differs from previous studies as it has explored a wider range of FBDs. This article will discuss the results regarding TAI usage.

Method

A total of 4,794 individuals were invited to participate in the study from two existing cohorts of people, sourced from two existing databases:

1.  ContactME-IBS – a dedicated national registry (NHS owned) for individuals who self-identify as having any type of IBS. People sign up to receive information about research opportunities, without any obligation to participate. This provided access to over 4,000 individuals from both primary and secondary care.
2. Durham Transanal Irrigation database, which had over 200 TAI users, all seen in secondary care.

Data from 933 respondents were captured through a single online questionnaire. Among them, 183 (20%) had experience of using TAI, and 110 (60%) continue to use it.

Results

In the study, females were primarily irrigating for constipation-related symptoms (43, 44%), while males used it predominantly for diarrhoea or mixed-type symptoms (9, 82%).

Respondents often faced delays in starting TAI, with 48 (44%) reporting symptoms for 10 or more years before beginning treatment. This delay could be attributed to various factors such as the time it takes to access specialist services. There is a need to increase awareness around bowel dysfunction and the benefits of treatments to address this issue.

Respondents were asked to rate how effective TAI was for them at 3, 6, and 12 months using a scale of 0 (no benefit) to 10 (excellent). At 3 and 6 months there was a positive correlation, meaning that if TAI was effective at 3 months, it was likely to still be relieving symptoms at 6 months. In fact, the trend for effectiveness continued up to 12 months. So, TAI being effective at 3 months is a good indicator of longer-term effectiveness.

In fact, the findings suggest long -term effectiveness way beyond the 12- month period explored. The majority of respondents (58, 53%) had been irrigating for 3 or more years and 33 (30%) had been irrigating for even longer (5-10 years). Since TAI requires time and commitment, it is reasonable to conclude that patients will continue to use it if they are finding it beneficial in relieving their bowel symptoms. Hence, long -term use suggests long-term effectiveness.

TAI is an effective treatment for all types of FBDs. The 60% success rate in PERSPECTIVE is similar to that of other studies^3,4.

Interestingly, when we examined the data around those who continued irrigating and those who had stopped, we discovered that respondents with diarrhoea-related symptoms (IBS-D, functional diarrhoea, or faecal incontinence) were the highest proportion which continued using TAI (74%, 26). Among this group, a considerable percentage (77%) also reported faecal incontinence. Perhaps the burden of faecal incontinence contributes to the continued use of irrigation as a treatment option.

Implications for practice

The PERSPECTIVE results have significant implications for both patients and healthcare professionals:

• Patients with a wide range of FBDs can benefit from irrigation.
• Patients with IBS-D, diarrhoea, and faecal incontinence in particular, find irrigation beneficial.
• Reassurance for patients – that the therapeutic effects of TAI will not diminish over time, as observed with other treatments such as laxatives.
• Effective TAI can create clinical capacity – longer term efficacy means that healthcare professionals can confidently discharge patients back to GP care. Thereby freeing up valuable clinical resources and capacity, enabling more patients to be treated.
• Encourage patients to persevere with irrigation for up to 3 months, as per the follow up regime proposed by Emmanuel et al². After which time, if it’s beneficial continue, if not then stop.
• If irrigation does not give satisfactory results after the initial 3 month-period, refer back to the multidisciplinary team for further advice, aligning with the follow-up recommendations proposed by Emmanuel et al².
• These approaches streamline what is currently a convoluted journey for patients to access specialist treatment.

This post was written by Michelle Henderson, Clinical Education Manager, MacGregor Healthcare.

The post Insights from the PERSPECTIVE* Study: Using Transanal Irrigation for Functional Bowel Disorders – What are the Implications for Practice? appeared first on Bladder & Bowel UK.

INTRODUCTION

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

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

ASSESSMENT

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

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

Bowel symptoms

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

Medications

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

Diet

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

Digital rectal examination

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

Figure 1

Investigations

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

Psychological & Social wellbeing

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

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

For further information on rectoceles please visit:

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

TREATMENT PLAN

Setting goals

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

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

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

Lifestyle modifications

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

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

Preventing or treating constipation

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

Oestrogen therapy

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

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

Pelvic floor muscle training

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

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

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

• Physical support of the rectocele can aid evacuation.

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

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

RECTAL IRRIGATION

Initiation

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

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

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

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

Follow up

2-week telephone review

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

4-week telephone review

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

OUTCOMES

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

CONCLUSION

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

REFERENCES

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

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

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

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

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

Neuro-urology and Urodynamics. 2020;1–21.36

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

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

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

The post Rectocele and Incontinence: A Patient’s Journey to Improved Bowel Function appeared first on Bladder & Bowel UK.

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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At Convatec, ‘forever caring’ is our promise to give patients and healthcare providers the support they need as we bring to life our vision of pioneering trusted medical solutions to improve the lives we touch.

Existing complications of traditional coated hydrophilic Intermittent Catheters

Clean intermittent self-catheterisation (CISC), while straightforward for some, can be both difficult and painful for others.

• 40% of participants affirmed “I have pain (the catheterisation is painful)”.¹
• CISC can also cause trauma to the urethra and result in bleeding.²
• 31% of people using hydrophilic coated catheters had blood in their urine, potentially higher than in uncoated catheters.²

In a recent ‘Guide to intermittent catheterisation technology’ supplement published by the British Journal of Nursing, pharmaceutical science lecturers from Queen’s University Belfast stated:

“A significant problem, noted anecdotally and in the literature, is catheter-coating dry-out³.

Hydrophilic-coated catheters are normally provided in packaging containing a hydrating fluid or supplied with a hydrating pouch for use prior to insertion. Once fully hydrated, they remain wet and lubricious for a relatively short amount of time only (5–20 minutes). As hydration falls below 75%, the coating loses its lubricious properties and becomes adhesive, tending to stick to the urethral mucosa⁴. Correspondingly, the increased force and friction on catheter withdrawal has been reported to cause trauma⁵, microtrauma and urethrorrhagia⁶.

It has been reported that almost one third of patients using hydrophilic-coated catheters were found to have haematuria, while 40% reported pain associated with catheter use. Persistent urethral bleeding is common with ICs, occurring in 11–28% of users^6,7,8. Furthermore, the delicate epithelial lining of the urethra forms the first line of innate immune defence against pathogens, so any injury could increase the likelihood of urinary tract infection (UTI).

ICs have been associated with development of trauma-induced urinary strictures, known to increase a patient’s risk of developing a UTI^9,10.”

Innovative Catheter Technology

We have not seen any significant changes in catheter technology since the 1980s, when the first hydrophilic catheter was launched. Until now.

We would like to introduce you to FeelClean Technology, Convatec’s unique, patented catheter technology delivering a smooth, easy cathing experience with products that do not stick^10,11.

Our GentleCath Glide and new, compact GentleCath Air range of catheters incorporate this pioneering FeelClean Technology designed to make the task of CISC an easier and more comfortable experience.

90% of users rated GentleCath with FeelClean Technology better than their usual catheter for comfort during use.¹²

So what makes FeelClean Technology different? Unlike traditional coated hydrophilic catheters, we have integrated the water-loving, hydrophilic properties within the catheter material itself – so your patients can enjoy no sticking, reduced residue^10,11 and relief whenever they cath.

What do our customers think of GentleCath with FeelClean Technology catheters?

“The catheter is significantly better on removal. Pain is significantly reduced for patients who catheterise regularly.” Rachel Skews,Urology Nurse Practitioner, North Bristol NHS Trust

“I have tried several different catheters. With other catheters, the hydrophilic coating is sticky, and I found that when withdrawing those catheters, it left a residue in my urethra and I was getting UTIs.  When I discovered GentleCath catheters, I was so happy, I cried. I have been using GentleCath for 18 months now and my infections have significantly decreased.” Alison Hodgson, Ex Nurse & MS Patient, Wolverhampton

A seamless service for your patients with Amcare Group DAC

For over 30 years, the Amcare Group has provided support to people living with a variety of medical conditions. We pride ourselves on offering a first-class personalised delivery service.

As your prescription partner, we offer a reliable, convenient, and discreet service direct to your patient’s door.

Once you have prescribed GentleCath for your patients, register them with Amcare for an easy, seamless service. We will take care of everything and support your patients through the next steps of their journey with intermittent catheters.

Why choose us?

• We have a team of professionals available 8am-8pm Monday to Friday, and 9am-1pm on Saturday to answer your patients’ questions.
• We handle your patients’ prescription requests for them, so they don’t have to worry. We offer a no-fuss, personalised care plan and make sure we are delivering supplies on time, every time.
• If a user is unhappy with their catheter, our team of Product Specialist experts will offer advice or help you select alternative options from a huge variety of product choices.
• With the ‘Follow my Parcel’ app, our delivery partner DPD enables users to arrange the best possible discreet delivery experience.
• Amcare is currently rated 4.1 (Great) on Trustpilot by our customers.

Convatec. Healthcare is changing. So are we.

Find out more about GentleCath intermittent catheters, visit: www.gentlecath.com/uk

Find out more about Amcare Group, visit: www.amcaregroup.co.uk

© 2022 ConvaTec. /® are trademarks of the ConvaTec group of companies. AP-61414-GBR

References:

1. Roberson D, Newman DK, Ziemba JB, Wein A, Stambakio H, Hamilton RG, Callender L, Holderbaum L, King T, Jackson A, Tran T, Lin G, Smith AL. Results of the patient report of intermittent catheterisation experience (price) study. Neurourol Urodyn. 2021 Sep 13.Irwin NJ, McCoy CP, McCullough AR, Corbett DJ. Use of in vitro and haptic assessments in the characterisation of surface lubricity. J Engin Med. 2019;233(1):84–90.
2. Rognoni C, Tarricone R. Intermittent catheterisation with hydrophilic and non hydrophilic urinary catheters: systematic literature review and meta-analyses. BMC Urol. 2017 Jan 10;17(1):4.
3. Guldager PM, Fredskilde KW, Nalbandian MT. Intermittent urinary catheter. Google Patents; 2019.
4. Vaidyanathan S, Krishnan KR, Soni BM, Fraser MH. Unusual complications of intermittent self-catheterisation in spinal cord injury patients. Spinal Cord. 1996;34(12):745–7.
5. Humphreys O, Pickering M, O’Cearbhaill ED, Flanagan TC. A biomimetic urethral model to evaluate urinary catheter lubricity and epithelial micro-trauma. J Mech Behav Biomed Mater. 2020;108:103792.
6. Webb R, Lawson AL, Neal D. Clean intermittent self-catheterisation in 172 adults. Br J Urol. 1990;65(1):20–3.
7. Bakke A, Vollset SE, Høisæter PÅ, Irgens LM. Physical complications in patients treated with clean intermittent catheterization. Scand J Urol Nephrol. 1993;27(1):55–61
8. Santucci RA, Joyce GF Wise M. Male Urethral Stricture Disease. The Journal of Urology, Vol. 177, No. 5, 2007, pp. 1667-1674.
9. Krebs J, Wöllner J, Pannek J. Urethral strictures in men with neurogenic lower urinary tract dysfunction using intermittent catheterization for bladder evacuation. Spinal Cord. 2015;53(4):310–313.
10. WHRI6933 TA 1369 FeelClean Phase 1 Report.
11. WHRI7131 TA 1486 v2.
12. A Multi-Centre Clinical Investigation to Assess the Performance of GentleCath Glide Intermittent Catheters. Study U378 GentleCath Glide Final Report. July 2018. Data on File. ConvaTec Inc.

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