People with bladder and bowel problems

Patient voices: She always liked to feel useful

This video looks at care for frail elderly people especially if there are continence issues. Watch the video here.

People of all ages suffer from bladder and bowel problems (which you may hear described as ‘continence’ problems), and you’re likely to encounter affected individuals wherever you work in health care.

If you ask them how they feel about their problem, they’ll almost invariably tell you that the hardest part is the humiliation they feel about the loss of dignity it brings.

Bladder and bowel problems can be caused by many things, such as infections, injuries, immobility, poor diet and sometimes very serious conditions like cancer. People can be supported to manage their problem best by discovering the underlying cause and treating it. A thorough assessment needs to be carried out by people trained and knowledgeable about bladder and bowel problems: often, this results in the underlying cause being identified and treated successfully and the problem disappearing. If the problem remains, recognising the cause means that methods of prevention and management can be selected to meet the person’s specific needs.

There are many ways that you as a health care assistant will be caring for people with bladder and bowel problems. You will be part of a team working to an agreed plan of care that aims to help the person prevent and manage the problem. Ongoing assessment is central to this: assessment starts on first contact with the person and continues thereafter.

Contributions you can make to assessment may include listening to the person speaking about the impact of the problem on his or her life, finding out about anything that brings it on or makes it worse (for some people, cold weather or even simple acts like coughing, sneezing or laughing hard can create problems), testing the urine or stools for abnormalities, finding out about the person’s normal eating and drinking (including alcohol) habits, assessing how well the person can manage to get to and use the toilet, and supporting him or her to keep a bladder/bowel ‘diary’. You may be involved in monitoring the effects of any medication prescribed to address the problem, or in helping the person to choose and use garments and appliances designed to ease the effects.

In addition, you’ll be helping patients/clients to look after their personal hygiene, care for catheters (a tube that is inserted into the person’s bladder and which drains urine into a bag that can either be strapped to the person’s leg or held on a stand) if being used, and remove and dispose of soiled clothes and continence garments.

As you can imagine, bladder and bowel problems have the potential to be enormously embarrassing for the patient/client. Always, and at all times, you will be acting to preserve the person’s dignity and supporting him or her through what can be a very devastating experience emotionally, socially and physically. Your approach will go a long way to either helping the person to feel at ease or making him or her feel even worse.

You should:

  • be positive in your approach, showing willingness to help
  • never show any signs that you find the task unpleasant
  • involve the person in the care: don’t just take over and ‘get the job done’ – remember that the principles discussed in the Person-centred care section apply here just as they do in all other situations
  • work speedily and efficiently, but don’t try to hurry the person – he or she will decide the pace at which you’ll work
  • leave the person comfortable and feeling valued, not rejected.

Bladder and bowel problems are very distressing for individuals and their families. You can make the situation better by adopting a positive, professional attitude that maintains the person’s dignity and raises his or her self-esteem. You may be able to access a continence or specialist urology nurse through your organisation who will be able to advise you on issues around bladder and bowel problems.

The RCN has a number of resources that will help you understand more about how bladder and bowel problems can be identified, treated and managed. See: Continence Care Forum and The management of diarrhoea in adults.

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