Self-help guide on bladder and bowel problems

Tees, Hambleton and Richmondshire Continence Service

Introduction

Keeping a healthy bladder and bowel is very important but men and women of all ages and backgrounds can be affected with problems.

For some people, talking about bladder and bowel problems is not easy and they keep these problems hidden. Many people suffer alone and in silence because they are too embarrassed to seek help or do not know how to get help.

Bladder and bowel problems can affect not only the individual but also their family and friends, and can stop people from leading a full and active life.

This booklet aims to:

• Help you understand what is acceptable
• Help you keep your bladder and bowel healthy
• Enable you to identify and manage your bladder or bowel problems independently
• Help you understand when you need to seek help
• Tell you where you can go for help, advice, to discuss treatment options or just to talk in confidence

A healthy bladder

What is a healthy bladder pattern?

If your bladder is healthy, you will normally pass large amounts of light straw coloured urine between five and seven times in twenty-four hours.

You should not feel a strong urge to reach the toilet and should be able to hold on until you reach it. It is acceptable to go to the toilet once at night.

Bladder and bowel problems can affect not only the individual but also their family and friends, and can stop people from leading a full and active life.

Symptoms of an unhealthy bladder?

There are different types of bladder problems. In the medical world, these problems are called ‘urinary incontinence’. This is a complaint of involuntary loss of urine.

The most common problems are:

• Stress Incontinence
  Leaking, for example when you cough, laugh, sneeze or do exercise
• Urgency
  Urgency – the strong desire to pass urine which is difficult to put off
  Urge incontinence – not being able to get to the toilet in time before passing urine
• Frequency of micturition
  Passing urine more than ten times in a twenty-four hour period
• Retention of urine
  Not being able to empty your bladder. Symptoms include:
  – Hesitation on passing urine
  – Needing to push or strain to start
  – A weak or altered urine stream
  – Dribbling urine
  – Feeling that you have not completely emptied your bladder
• Functional Incontinence
  – Cognitive difficulties, for example; learning difficulties or dementia
  – Mobility problems
  – Difficulty in accessing a toilet, for example; upstairs or in a small space

How to keep your bladder healthy

Drink enough of the right type and amount of fluid:

• Do drink six to eight cups of fluid per day. (About three pints or 1500 ml)

• Do drink more water, fruit juice and squash with no added sugar

• Do drink decaffeinated tea and coffee as an alternative

• Do drink fruit and herbal teas but avoid nettle, dandelion and marshmallow as these herbs can irritate the bladder and bowel

• Limit drinks that contain lots of caffeine, for example tea, coffee, cola and energy drinks, as they may irritate your bladder and bowel

• Limit the amount of alcohol you drink. If you do drink alcohol, try to alternate between alcoholic and soft drinks to prevent bladder and bowel irritation

What can you do to help yourself

Try to avoid getting constipated

Constipation may cause your bowel to stretch and press against the bladder, making your symptoms worse. For advice on keeping your bowel healthy, see the information under the header ‘A Healthy Bowel’

Try to maintain a healthy weight

Being overweight can put pressure on your bladder. Contact your GP surgery for further advice.

Medication

Ask a health care professional or pharmacist whether your medication or medical condition can affect your bladder.

Stop smoking support

Smoking cessation advice and support is available through your pharmacist or GP. Contact details for smoking support services can be found within the useful contacts at the end of this leaflet.

Pelvic floor exercises

The diagrams show the pelvic floor muscles which stretch like a hammock from the pubic bone at the front to the bottom of the spine. These muscles support your bladder and bowel.

In men there are two openings through the pelvic floor muscles – the anus (back passage) and the urethra (bladder outlet). In women there is also a third opening for the vagina (birth canal).

The pelvic floor muscles support these openings, but if they are weakened they cannot support the openings effectively. This may mean that you leak some urine at times, for example with coughing, sneezing or laughing. This is called stress incontinence (SUI).

SUI is extremely common and can affect men and women of all ages, although it is more common among women.

Weakness of the pelvic floor can be caused by constipation or pelvic surgery but in women the most common cause is the strain and stretching involved in childbirth.

Finding your pelvic muscles

Tighten and pull up the muscles around the back passage – as if you are trying to stop yourself from passing wind. Now imagine that you are about to pass water and picture yourself trying to stop the flow of urine. You should be able to feel the movement of your pelvic floor muscle internally.

Slow pull-up

Slowly tighten and pull up the pelvic floor muscles, from the back towards the front as hard as you can – this is a slow pull-up. Hold the squeeze for as long as you can (up to ten seconds) and then relax the muscles. Relax for three or four seconds before trying another pull-up. Start with doing these five times and increase the number gradually (up to ten times).

Fast pull-up

Now pull the muscles quickly and tightly, and then relax them immediately. These are fast pull-ups. Again, start with doing these five times and increase the number gradually (up to ten times).

• Practice slow and fast pull up exercises regularly every day to make the muscles stronger – do not actually do the exercise while passing urine.
• Don’t hold your breath.
• Avoid tightening your buttocks, leg and upper tummy muscles whilst you are doing your exercise.
• Stop exercising if your muscles begin to ache – you have done enough. Take a break.

Bladder retraining

Retrain your bladder

Bladder retraining is a treatment for ‘urgency’ or ‘urge incontinence’. This is when you pass small amounts of urine very frequently and sometimes leak urine if you are unable to reach the toilet in time. The aim of bladder retraining is to help your bladder hold a normal amount of urine (500ml or one pint) and regain a normal pattern of passing urine.

There is a three-day bladder and fluid chart towards the end of this information. This will help you monitor your bladder pattern. Once you have filled the chart in, try to retrain your bladder using the advice below. Within a few weeks, you should see an improvement in your bladder pattern.

Bladder and fluid chart

• In the drinks column keep a record of what you drink in 24 hours. Measure and record the amount of all drinks in mls.
• In the urine column keep a record of each time you go to the toilet and how much urine you pass. Measure your urine output in mls.
• If you leak urine, record how often you are leaking in the urine column by writing wet.

Record using the chart – this can be found later in the leaflet.

Bladder retraining – What do I have to do?

• Using the bladder and fluid chart, monitor the times you pass urine, how much you drink and how often you leak urine over a period of at least three days
• If you leak urine record how often you are leaking in the urine column by writing wet
• Once you have your three-day chart, try to hold on for an extra five minutes each time you need to pass urine
• Once you are comfortable holding on for an extra five minutes try holding on for ten minutes
• Slowly increase the time you hold on for.

Tips for ‘holding on’

• When you first try holding on, sit on a hard surface, like a toilet lid, for a few minutes
• Recite a poem or song to keep your mind off your bladder
• Read a page of a book, magazine or newspaper
• Try and visualise your bladder stretching
• Try not to go to the toilet ‘just in case’
• Be positive
• Take each day at a time.
  Bladder retraining does work but it can take some time.

Getting help and treatment

There are a lot of treatments that can be tried, to help you manage your bladder problem. If you find yourself with any of the following symptoms, then you should seek help:

• Leaking urine
• Urgency to go to the toilet
• Going to the toilet often
• Not emptying your bladder properly
• A cognitive or severe physical impairment that prevents you getting to the toilet

Who can help

There are a number of people who can help you to obtain general help and advice:

• Your local continence service
• Your GP
• Your practice nurse
• Nurse practitioner
• Your district nurse
• Your physiotherapist or occupational therapist

A healthy bowel

What is a healthy bowel habit?

If your bowel pattern is healthy, you will pass faeces (poo) between three times per day and three times per week – both are normal. Your bowel pattern may be slightly different and this may be normal for you. Your faeces should be soft and passed easily without pain.

Symptoms of an unhealthy bowel

• Constipation
  Having bowel movements less than three times per week. Faeces are hard, there may be pain on passing faeces and you may feel the need to strain.
• Faecal Impaction
  If constipation is not treated, the bowel can become packed with hard faeces that you are unable to pass. You may experience a lot of tummy pain, feel sick and/or your appetite may decrease. This can be confused with diarrhoea because you may pass some liquid faeces.
• Diarrhoea
  Faeces are loose and watery and you may feel the need to go to the toilet frequently and urgently.
• Bleeding
  If you are bleeding from your back passage, seek medical advice.

Getting help and treatment

If you find yourself with any of the following symptoms, then you should seek help as soon as possible:

• Passing blood in your faeces
• Change in bowel habit
• Persistent unexplained diarrhoea
• Abdominal pain
• Passing runny mucus instead of faeces
• Pain when going to the toilet
• A lump in your abdomen
• Significant unexplained weight loss
• Passing loose faeces when you run, walk or are in bed

How to keep your bowel healthy

Eat healthily

A balanced diet will help prevent bowel problems and keep you healthy. People who have a diet that is low in fibre or ‘roughage’ may be more likely to have bowel problems. Foods high in fibre include fruit, vegetables, wholemeal bread and cereals.

You should:

• Eat five portions of fruit and vegetables per day
• Aim to eat two to three portions of oily fish per week
• Aim to eat two to three portions of dairy per day
• Reduce Fat
• Reduce Sugar
• Reduce Salt
• Eat at regular intervals, for example; breakfast, lunch and tea
• Aim to drink six to eight cups of fluid per day

Go to the toilet regularly

It is important to go to the toilet to open your bowels (have a poo) as soon as you feel the need. Give yourself plenty of uninterrupted time to sit on the toilet. You need to sit upright with your feet firmly on the floor. Use a step if needed. It is important not to strain too much but to allow the faeces to pass naturally.

Check whether your medication can affect your bowel

Some drugs can cause constipation, most commonly painkillers like codeine, morphine, anti-depressants, diuretics (water tablets) and iron pills. If you think that your constipation might be caused or affected by these drugs, talk to your healthcare professional or pharmacist about alternative medication or solutions to the constipation.

Be active

Regular activity can help to improve bowel movement. Adults should undertake at least 30 minutes of moderate physical activity on five or more days of the week. This could include activities such as:

• Walking to and around the shops
• Taking the dog for a walk
• Swimming
• Chair-based exercise

Bowel cancer screening

Bowel cancer is the third most common cancer in the UK. The NHS Bowel Cancer Screening Programme aims to detect bowel cancer at an early stage in people with no symptoms when treatment may be more effective. If you are aged 60-75 and are registered with a GP, you will be sent an invite initially to do the test in the privacy of your own home. The test will then be offered every two years .

Could you have functional incontinence?

[….] I struggle to walk to the toilet and sometimes have an accident

[….] I struggle to get my clothes up and down when I am at the toilet

[….] I am sometimes forgetful and forget to go to the toilet or forget where the toilet is
and then have an accident

[….] I struggle to get to the toilet because of its position in my home

[….] I find walking and/or getting out of the chair /or getting out of bed difficult

If you have answered YES to any of the questions above you may have functional incontinence. Please tick the functional incontinence box if you would like help with this. This can be found within the self assessment form at the end of this leaflet.

Home equipment

An occupational therapist can help with aspects of functional incontinence by seeing you in your own home environment and can suggest pieces of equipment. The following pages show some examples of what can be provided, the urinals are all available on prescription.

Examples of equipment we can provide

Useful contacts

Local continence services

Informal help, advice and practical solutions for people with bladder and bowel problems.

South Tees Continence Service

Telephone: 01642 944315
Email: [email protected]

Bladder and Bowel Community

• ‘Just can’t wait’ card available for a small donation.
• Advice, support and information leaflets available, for a small donation.

Email: [email protected]
Website: www.bladderandbowel.org

Disability rights UK

Their National Key Scheme (NKS) offers independent access to around 7,000 locked public toilets around the country. ‘Radar toilets’ can now be found in shopping centres, bus / train stations and other locations nationwide.

You can order from online shop visit website: www.disabilityrightsuk.org

To request a RADAR key at £4.50, or a region list at £3.50 contact:
Ground Floor, CAN Mezzanine, 49-51 East Road, London, N1 6HH

Telephone: 020 7250 8181
Website: www.radar.org.uk

Bladder and Bowel UK (Formerley Promocon)

A national service offering product information, advice and practical solutions for adults and children.

Burrows House, 10 Priestley Street, Wardley Industrial Estate, Worsley, M28 2LY

Telephone: 0161 214 4591 (Opening Hours: Monday to Friday, 9am until 4.30pm)
Website: www.bbuk.org.uk

Stop Smoking Service

Telephone: 01642 727655 or 01642 727579
Website: www.stopsmokingsouthtees.co.uk

NHS Smoke Free Helpline

Telephone: 0300 1231044

Local NHS Bowel Cancer Screening Programme

Telephone: 0800 707 6060
Website: www.cancerscreening.nhs.uk

Prostate Cancer UK

Specialist nurses telephone: 0800 074 8383

Frequency volume chart

Day One

Please follow the instructions found under ‘Bladder and fluid chart‘ on how to complete the chart.

Day two

Day three

Self assessment form

Please complete the enclosed self assessment form send to your GP practice I have read through this book and still have the following problems: (please tick)
[….] Bladder
[….] Leaking urine
[….] Urgency to go to the toilet
[….] Going to the toilet often
[….] Not emptying the bladder properly
[….] Bowel
[….] Passing blood in faeces
[….] Changed bowel habits
[….] Persistent unexplained diarrhoea
[….] Abdominal pain
[….] Passing runny mucus instead of faeces
[….] Pain when going to the toilet
[….] A lump in the abdomen
[….] Significant unexplained weight loss
[….] Passing loose faeces when running, walking or in bed
[….] Constipation
[….] Functional incontinence

I would like to make an appointment to discuss this further. My details are:

Patient experience

South Tees Hospitals NHS Foundation Trust would like your feedback. If you wish to share your experience about your care and treatment or on behalf of a patient, please contact The Patient Experience Department who will advise you on how best to do this.

This service is based at The James Cook University Hospital but also covers the Friarage Hospital in Northallerton, our community hospitals and community health services.

To ensure we meet your communication needs please inform the Patient Experience Department of any special requirements, for example; braille or large print.

T: 01642 835964
E: [email protected]

The James Cook University Hospital, Marton Road, Middlesbrough, TS4 3BW.
Telephone: 01642 850850

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