Introduction to toileting and incontinence
Going to the toilet is a routine daily task that most people don’t give much thought to. But the ability to control your bladder and bowels, known as continence, is a surprisingly complex skill that requires a combination of social, physical, cognitive, and biological factors (NHS, 2019). The medical profession uses the term ‘incontinence’ to describe the inability to achieve this. And for an increasingly large number of individuals in the UK, this is an issue that they struggle with. For example, it is thought that anywhere between 10 to 14 million people have some form of bladder difficulties. The precise number being difficult to assess, due to the stigma surrounding the condition (NHS, 2021). Losing bladder control, which is also referred to as urinary incontinence is described by the International Continence Society as ‘the complaint of any involuntary leakage of urine’ (ICS, 2002). In addition, many people experience difficulties with their bowels too, either alone or in combination with bladder problems. With bowel incontinence thought to affect 1 in 10 people in the UK (Click link here).
Incontinence: Impact and Stigma
Unfortunately, incontinence still carries a significant stigma, with many people feeling embarrassed and ashamed about their difficulties. A recent news story that reached the national press in the UK highlights some of the problems people may face (Click link here).
As a result, there is still a great deal of reluctance by individuals and society to discuss the issue openly, with widespread stereotyping of the condition as largely a problem of old age and those with cognitive difficulties. With the result that older people in hospital can often find themselves not being taken to the toilet or put in pads, even when they are continent, due to staff perceptions about elderly care (Dr Katie Featherstone report, click here).
And although the condition is more prevalent amongst women, it can affect young and old, men and women, apparently healthy people, and those living with a wide range of different health conditions and/or disabilities. It can also vary widely in its severity, with some people having comparatively mild problems, whilst others lose all control.
Irrespective of this, the impact on individuals can be significant, often effecting all aspects of their life, from worrying about what they are eating and drinking, concerns about travelling, impact on work and social life, increased living costs, relationship difficulties, and effects on sleep. With needing to know where the toilets are when out and about, and fear of having an ‘accident’, becoming a part of everyday life.
This can have a profound effect on an individual’s mental health, an issue that is sometimes overlooked, but which is often more of burden than the physical and practical aspects of the condition itself. With loss of confidence, low self-esteem, becoming socially isolated, increased risk of anxiety and depression, relationship difficulties and poor well-being, being just some of the difficulties reported. But again, being able to talk about these difficulties can really help, either with a close relative or friend you trust, or a healthcare worker. In addition, the charity Bladder Health UK has an excellent helpline that offers practical and emotional support to people living with bladder difficulties, including incontinence.
Incontinence: Seeking advice and help
Although it may feel embarrassing to approach a healthcare professional about this problem, it is very common and always advisable to seek medical advice, as incontinence can be a symptom of another condition, as well as a stand-alone issue. Help can be accessed through your local GP or health centre, district nurse service, and sometimes directly from the local NHS continence service. And there are numerous behavioral, dietary, exercise, pharmaceutical, and other treatment options available that may be able to help. And in many cases, people can regain control. But if difficulties remain, there are a wide range of different products and devices available that can help people manage the condition, with pads being one such example. Southampton University in collaboration with the ICS has a great website called ‘Continence Product Advisor’, which offers impartial advice about the different types of products available and can be accessed here. Another helpful organization is the charity Bladder and Bowel UK, which has a great website and helpline, and helps guide people through the different options. And with careful management, it is possible to live well with the condition, even if it is quite severe.
Incontinence: Breaking the taboo
In recent years there has also been a concerted effort to try and break the taboo around this very common condition. With for example, high profile campaigns by the NHS and health charities around pelvic floor exercises, aimed particularly at women following childbirth. In addition, numerous charities, individuals, and commercial companies have been raising awareness about the topic (Click link women, dignity, and Dorset for examples). Similar efforts have also been conducted for other stigmatized medical conditions, such as Mental Health Problems (Time to Change campaign) and Fertility problems. Whilst the health campaigner Deborah James also known as ‘Bowel Babe’, who sadly died recently, led a successful campaign highlighting bowel cancer, which unashamedly focused on issues around ‘poo’ and keeping an eye on your bowel habits.
Incontinence: Men can have problems too
Although women are more likely to be affected, it is still a big problem for men too. With a wide range of social, behavioral and health problems potentially leading to incontinence. And though men don’t have to deal with the added risk of pregnancy and childbirth, they do experience other difficulties that may impact on continence, such as prostate problems. Historically, women’s health including female incontinence has often been overlooked by the medical profession due to gender inequalities. And although things are now changing, with greater recognition of the impact of incontinence on women, the same is not true for men. Male incontinence being one of the few examples of where men seem to lag behind women in terms of recognition and support for a particular health condition. For example, in 2021 NHS England announced the roll out of pelvic floor clinics across the country, with the focus very much on women’s health. Leading to physiotherapists and a pelvic floor organization reminding people that ‘men have pelvic floors too’. In addition, men with incontinence often experience the added stigma of having a condition that is often seen as a ‘women’s health problem’. A situation not helped by all the TV adverts for continence pads aimed at women. Men may also struggle more with managing the condition, having little or no experience of pads, whereas most women will have grown up using menstrual products. Although it is fair to say that managing incontinence using pads is equally problematic for men and women due to the size and nature of the products themselves, as well as the stigma associated with them.
Living with Incontinence: The take home message
The key take-home messages here are that incontinence is very common, should not be something to be ashamed about, being open and talking about the condition can really help, and that there is a lot of advice and support available. And although there is still a stigma around the condition, things are slowly changing, and no one should have to suffer in silence.
