Continence

Incontinence is when you unintentionally pass urine or stools (poo) because you can’t control your bladder or bowel.

You may be able to get incontinence products on the NHS, such as incontinence pads or devices, for example, handheld urinals, but it depends on your local NHS organisation. To qualify for incontinence products, you may need to be assessed (which may involve keeping a diary of your bladder for 3 days) and start a treatment plan and meet criteria set out by your clinical commissioning group (CCG)

On your first visit, a continence adviser, usually a nurse who specialises in bowel and bladder problems, will assess you and explain your incontinence treatment options.

If you have incontinence, it’s important that you’re assessed by a healthcare professional. Depending on how severe it is, it may be possible to treat the cause of your incontinence, meaning you won’t need incontinence products.

Urinary incontinence may be treated with:

• bladder training – this involves increasing the length of time between feeling the need to urinate and passing urine
• pelvic floor muscle training – exercising weak or damaged pelvic floor muscles is often one of the first treatments recommended
• medication
• surgery

Bowel incontinence is often a symptom of another condition, such as constipation or diarrhoea, so treating the other condition may prevent the incontinence. For example, constipation or diarrhoea can be treated by changing your diet, taking medication or retraining your bowel.

NHS continence services

You can get advice about your condition from:

• an NHS continence service – which is staffed by specialist nurses, sometimes called continence advisers
• your GP – who may refer you to a continence adviser or your local district nurse
• You may be able to book an appointment at an NHS continence service without a referral from your GP.

Once you’ve been assessed, the healthcare professionals treating you will say which incontinence products are available on the NHS. Your local CCG may have criteria that you need to meet – for example, products may only be available for people with severe or long-term incontinence and you may be limited to a certain number of products per day.

If you request more incontinence products, you will be reassessed to check if this is necessary, and if so, more products should be offered.

NHS continence clinics have specialist teams providing support and medical advice for people with bowel or bladder incontinence. The clinics can be based in a hospital or in the community, such as in a health centre.

You can phone some continence clinics directly to make an appointment, but others will require you to be referred by your GP. To find out where your nearest NHS continence service is call your local hospital.

Urinal Sheath (Conveen)

A sheath is specially designed for men to provide a secure and discreet way to manage male urinary incontinence. It is a soft, flexible sleeve that looks like a regular condom and is rolled on to the penis in the same way. On the tip of the sheath there is an outlet that connects by tube to a urine collecting bag which is attached with straps to the leg.

Intermittent self-catheterisation (ISC)

(ISC) is used to treat bladders that do not empty fully.

You will be taught how to insert a urinary catheter into your bladder by a health professional – this can be done in a hospital, clinic or at home. Urinary catheters are inserted into the bladder at intervals throughout the day, or when you feel the need to go to the toilet. It is sometimes necessary to catheterise during the night as well. Once the urine has drained out, the catheter is removed.

Most people feel apprehensive about performing Intermittent Self Catheterisation. It can be a bit awkward to start with but with practice you will soon become confident, your local health care professional will offer you support until you feel able to manage alone.  Most people go on to say that they find it easy to self-catheterise after a time.

Suprapubic catheter

A suprapubic catheter is a hollow flexible tube that is used to drain urine from the bladder. It is inserted into the bladder through a cut in the tummy, a few inches below the navel (tummy button). This is done under a local anaesthetic or a light general anaesthetic.

Anyone who cannot empty their bladder may need a catheter. A suprapubic catheter may be chosen because it is more comfortable and less likely to give you an infection than indwelling urethral catheters.

Suprapubic catheters are sometimes used for the following reasons:

• People who require long-term catheterisation and are sexually active
• After some gynaecological operations e.g. surgery for prolapsed uterus or bladder, or surgery for stress incontinence
• Long-term catheterisation for incontinence. Although this is not recommended, sometimes medical staff feel it appropriate to avoid skin problems or other medical complications.

Some wheelchair users or people who can’t self-catheterise find this method simpler to manage

The doctor will insert your first suprapubic catheter during the initial operation. A small balloon at the tip of the catheter is inflated to prevent it falling out. A doctor or nurse can change the catheter in your home, or in their surgery or urology department. You, or a member of your family, may also be taught to change the catheter. You must not try to remove it without medical advice.

RADAR Key

A RADAR key (sometimes called an NKS Key) is a large, silver-coloured skeleton key that opens more than 10,000 locked, disabled toilets in the UK.

RADAR keys can be purchased at a large range of outlets including Disability Rights UK and the Blue Badge Company and if you are a disabled person you should be able to buy the key VAT free. Some local authorities provide RADAR keys free of charge.

Changing Places Toilets

Standard accessible toilets do not meet the needs of all people with a disability, Changing Places toilets are different to standard accessible toilets (or “disabled toilets”) and should be provided in addition to accessible toilets.

People with profound and multiple learning disabilities, as well people with other physical disabilities such as spinal injuries, muscular dystrophy and multiple sclerosis often need extra equipment and space to allow them to use the toilets safely and comfortably. These needs are met by Changing Places toilets.

Each Changing Places toilet provides:

• a height adjustable adult-sized changing bench
• a tracking hoist system, or mobile hoist if this is not possible.
• adequate space in the changing area for the disabled person and up to two carers
• a centrally placed toilet with room either side
• a screen or curtain to allow some privacy.
• wide tear off paper roll to cover the bench
• a large waste bin for disposable pads
• a non-slip floors.

You can see a map of where Changing Places toilets are located here.