The Continence Challenge Podcast – Functional Incontinence and Bowel Management

This episode discusses functional incontinence and good bowel management. Specifically what it is, how it presents, who may be affected by it and what advice there is which can help to make a difference to you on your continence journey. It is supported by evidence based knowledge and guidance from the Northern Trust Continence Service staff.

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Website resources mentioned in this episode:

Bristol Stool Chart - Bristol Stool Chart
Beambridge Medical - Beambridge Medical | England U.K.Incontinence products for sale.Adult Incontinence products 

What is The Continence Challenge Podcast – Helping You Regain Control?

A podcast from the Continence Service in the Northern Trust, providing listeners with a greater understanding of bladder and bowel dysfunction and education of what may be contributing to the problem and supportive measures which could be implemented to improve bladder and bowel difficulties. The series will give an introduction to the Continence Service and discuss common types of bladder and bowel incontinence difficulties, such as overactive bladder, stress urinary incontinence and functional incontinence. It will also look at how good bowel management can help with incontinence overall. The series will also feature service user stories and learn about the lived experience of someone with a bladder and/or bowel dysfunction.

continence challenge podcast - ep3 - functional incontinence
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Hello and welcome back to the Continence Challenge podcast, helping you regain control. Brought to you by the Continence Advisory Service staff of the Northern Health and Social Care Trust. My name is Deirdre O'Brien. I am the Continence Nurse Coordinator for Adult Services. Today, I'm joined by two of my continence staff nurses, Pauline Scullion and Lisa McQuillan.

And we're going to talk to you about another type of incontinence, this one being functional incontinence. And at the end of the podcast, we will discuss some good bowel management tips and advice. Thanks So, I'll start first of all and just give the listener a definition of what we consider functional incontinence.

So functional incontinence is slightly different to all the other types of incontinence because with functional incontinence there's not necessarily any particular bladder or bowel dysfunction. Because of other circumstances, the patient or service user will find that they have episodes of incontinence.

So, That could really be because they aren't able to get up and go, maybe there's a physical mobility issue, or that they don't recognize where the bathroom is, maybe they cannot find the bathroom. Or sometimes with cognitive decline, the bladder may be working perfectly normal and sending the normal signals that it would send, but because of the cognitive decline, it's not The, the brain is unable to recognize what's the natural process and what it should be doing.

So they, they can present with maybe not finding the toilet or not recognizing that need to go. So, first of all, I'll talk to you, Lisa, and what kind of patients would you generally see with functional incontinence, or can you describe to the listener who might be normally affected with this type of incontinence?

Yeah, um, so hi, my name is Lisa. So, um, yeah, sometimes we get patients in clinic obviously, um, with cognitive impairments such as like patients with dementia and Alzheimer's that, um, maybe they just are unsure and forget where the toilet's at. And other people we would get in as well, it'd be maybe just mobility issues, so people with mobility issues, that there are different maybe things in their way that are preventing them from getting to the toilet on time, such as like the environment, maybe is their chair too low, maybe like is there a mat that's making them slip from getting up, is their shoes not fitting, is there When we take clothing like, like, so a man maybe wears like proper trousers, braces, for a woman maybe just wear like, you know, the, some people would wear like maybe girdles and things like that there that just prevents them getting the clothes down in time.

So there'll be a lot of people we get in that there's just things there that just makes it a lot harder for them to get to the toilet in time. Yeah, to undo their clothes and actually get their, or make it from one place to the other. Yeah, maybe instead of like having like buttons and things, have like joggers, sometimes just up and down.

A lot handier, and make sure even their shoes, if they're like maybe like flip flops or their feet are sliding out of it, some more secure fitting shoes for them, that just makes them a lot easier for them to get to the toilet in time. Yeah, and it prevents them maybe falling on the way. Yeah. And then there's also those that.

aren't able to get up and go that, you know, where their mobility is at. Where they are totally relying on assistance, so they can't get up. They're waiting on the carers coming each time to go to the toilet and things like that. They're maybe more reliant on pads and things like that, that they're not able to get up.

Or family members having to come and prompt them every so often for the toilet. And I think too, you know, whilst this functional incontinence is definitely more prevalent in older people, because of maybe comorbidities that they have or, you know, conditions, maybe the likes of advanced arthritis or dementia as you've mentioned there, Lisa, or the likes of Parkinson's disease, where being able to move quickly is more prevalent in the older people, but functional incontinence can also happen to younger people if they have for some reason that inability to get up and go, and that could happen to somebody, you know, maybe a spinal injury or even just having a temporary issue, maybe if somebody has a younger person, maybe.

Breaking their leg and having that inability to get up and manage to get there and crutches quick enough. It's important that whenever we're dealing with functional incontinence, we look at what is contributing and seeing what we can do to help manage. So Lisa had talked there about, um, those patients with the mobility issues and the cognitive decline and Pauline, I'm going to ask you then, do you want to talk about, you know, Things that, other conservative measures that we could encourage that person with functional incontinence to adapt into their life, to try and help make things a wee bit better for them.

Hi, my name's Pauline, and whenever I do an assessment within the clinic, and the patient who comes to us as Lisa has already said that it's because of dementia, the Alzheimer's patients, that we would see a family member is normally always present. So we also give the advice to them as well because they're going to be there with them, whether the son, daughter, or pass on information into the carers.

So it's very important. Um, we advise is. to prompt, prompt the patient to the toilet, because obviously they're, with their memory loss and everything, you know, it's up to, um, for prompting. And we do, uh, like to set out like a toileting program every like two to two and a half hours. So a reminder again for the, the relatives and, and carers to, to prompt the patient every, every two to two and a half hours.

Other advice? What we speak about is um, the flu's intakes. It's very important. If people aren't drinking their normal amount, we recommend a litre and a half, two litres per day. Spreading it evenly throughout the day and in their toilet and program every, every two to two and a half hours. Another recommendation is decaffeinated tea, um, the reason being is caffeine is an irritant to the bladder and we do recommend that they, they pull that out of their, their fluid intake and change to, to decaf tea, as I say.

Because obviously that will give them that caffeine, being an irritant can cause an urgency. Yes. And which, you know, when you can't get up and go or you don't recognise the need to go, you don't want to add to the problem. Of course. But again, the fluids. It's, you know, by maintaining a good fluid intake, um, of the, you know, 1, 500 to mils to 2 litres will reduce that concentration of the urine and therefore they will not have that urgency, but it also helps ensure that they have a good, healthy bladder and nipple.

And reducing the risk of urinary tract infections as well, it's very important for your, for your fluid intake as well, um, for, for a man, for instance. So, for most patients with premobility, we recommend to sit on the toilet, to pee. We also advise our patients on bladder emptying techniques which is a good way for men and for a women.

For men, the norm is to stand, to pee. But, we as a part of our service, recommend for men to sit on the toilet. Rock on themselves from side to side, bringing their elbows to their knees. It's called, um, this is a bladder and emptying techniques. You're shaking and you're tilting your bladder to make sure you fully emptied your bladder when you made the effort to go to the toilet.

That's very important, Pauline, because as we get older, we are more, um, susceptible to, um, urinary tract infections. It's women more particular than men, but also women and men as they get older are more prone to that incomplete bladder emptying. Maybe retention issues in men maybe because of prostate enlargement and in women maybe because of, you know, advancing prolapses and the bladder has slipped out of its natural alignment.

Therefore, it's harder to get it completely emptied. And whenever somebody doesn't get their bladder well emptied, they are at that increased risk of those urinary tract infections. What you said is really important about your good fluid intake and for those, um, who have, you know, their incontinence is maybe worse, worse overnight, we'd recommend that you stop fluids two hours prior to bedtime and, um, double voiding is very important as well before going to bed.

Just trying your best to get your bladder emptied as much as possible. Um, to prevent that, um, increased incontinence overnight. And Lisa, can you think about, you know, these patients that have functional incontinence? We talked there about mobility and about the, looking at the environment and maybe the clothing you'd mentioned, you know, more suitable clothing that's easier adjusted.

Is there any other people that, you know, that we would signpost patients to, to help with that? Yeah, with a functional incompetence. Yep, um, so obviously maybe people with mobility issues, maybe would need an aid to help them get to the toilet. Sometimes maybe, is there no carers in place as well? So we'd always make sure, um, that there's the proper referrals done to the likes of maybe social services, um, to get a social worker input.

Um, maybe OT just to even get, um, a raised toilet seat to get them off the toilet a wee bit better. Um, maybe like a cushion for their chair or a recliner or things to get off the chair that bit easier. Yep. Um, owner, um, um, maybe a handrail, um, their front and back door. Just even or like, let's say a handrail in their bathroom.

Um, let's your physiologist come in maybe and to see if, um, will they benefit walking in? Maybe their furniture walking, maybe need like a walking stick or a Summer frame or a relator or something like that, just to make things a wee bit easier for them. Mm hmm. And I think it's important, you know, for patients listening to this podcast or carers of patients, if you think that maybe an input from the likes of a physio or social services is something that you need, whilst you're waiting for your continence appointment, it is okay to approach your, your GP or that to be signposted to those services, to maybe put something in place early rather than late.

So Pauline, do you want to tell us about how we can help those service users that can't get up and go to the toilet, how we can maybe help them out with like some toilet aids or, or what we can do to help them in that, in that matter? Yeah, so um, a part of our, our service, um, we can refer on to other services like District Nursing.

If I feel that a patient is struggling to get, you know, if the toilet seat is maybe too low, we could get them referred for a raised toilet seat. Also available is, um, for men at night time. It's called Beambridge bottles. We can do a script to the, our GP, do a letter, and they can get that supplied for you.

It just makes it easier for men with poor mobility that they don't have to walk to the bathroom at night time and they have the bottle available beside their bed. Also. We can get commodes as another thing for people for night time as well, even for during the day as well. They can be moved about from room to room.

And even, um, you mentioned Beambridge, um, those are Beambridge Medical Company and they have a range of products available that are available on prescription. You know, if you want to look up their website yourself and ask the GP for products, that's well and good. Or likewise, when you see us at clinic, if we thought that you would benefit from one of their products, we would refer you.

Sometimes in elderly men, the spray of The flow can go a bit adrift rather than staying, um, in a steady stream, so they have things like, um, funnels that can help because sometimes maybe if that man is standing to pee and the spray is going outside of the toilet bowl, the floor's getting wet and it's increasing that risk of falls.

Things like that are useful, or even, you mentioned men with the, the bottle, and sometimes those bottles have like a tap on the end of them where you can attach a drainage bag. So even somebody that's sitting in Even if they're sitting in a chair, a long time during between care calls could have a bottle at the side of their chair, you know, and it could be draining.

You know, if they have to pee a lot, they, they don't even have to get up to empty it. As such, it could drain into a bag so that when the carer comes in, that they could empty that for them. There's something else that's available for men is um, is the sheath. And um, they, they connect them to, to a drainage bag.

And it just leaves it then that, um, that can be fitted at night time and removed again in the morning. And it means then that there's not having, you don't have to get up at all then, then overnight, because your urine just drains away into this bag and the product's removed in the morning. And you use a new one every, every night.

They're, they're, they're not reusable. With functional incontinence, particularly in those with cognitive decline, it can progress from just urinary incontinence to actually urinary and faecal incontinence. As we said, bladder and bowel are working normally, but that awareness, that awareness, The signals that the bladder and bowel is sending to the brain, the brain is not processing the natural processes that you need to go through.

So, quite often, um, functional incontinence in those patients. It's really the reason why they end up maybe going into residential or nursing home care because, um, families find it really difficult to cope with that. And as we've talked about modifying your fluids for overnight and the likes of urine bottles and things and commodes that we can use for urinary functional incontinence.

From a faecal point of view, um, To help manage faecal functional incontinence, it's really about the importance of paying attention to that person and completing that bowel diary and seeing what their pattern is and looking at their diet and promoting a healthy diet. Um, and, looking at what that stool type is and trying to manipulate it.

So Lisa, if you want to just talk about the Bristol stool score there and just let the listener know what those types are, what advice we would offer to them. Yeah, so the Bristol stool chart is like a chart that we go by for anybody that's having sort of maybe bowel issues. So it goes from, it starts at number one and goes to number seven.

So one would be like anybody that's very constipated. Ideally we're aiming for a number four. On the chart, and then 6 and 7 is more your loose stool motion, so it's more, um, runny or diarrhoea, so 4 ideally would be the one we'd be aiming for. So if you're sort of at the number 1, which is sort of like tiny balls, you'll be more constipated, maybe means you need to add, um, a lot more fibre into your diet, especially even at your fluid intake, as long as, fluid intake as well, and a lot of fibre.

Water intake means your bowel can be quite dry, so it's important obviously to take water. But just looking at your diet, if they're very constipated, what is their diet like? Are they maybe not eating enough? Um, they maybe need to be taking regular meals if, if they're able to. Um, just having a look, even like the bowel diary, just to see what they are eating and what can be tweaked in terms of that.

Obviously, fibre, um, helps, helps the bowel go more regular. So it's very important to do that as well. And so if they're not having hard, um, hard, lumpy stills or hard constipated stills, but they're more having faecal incontinence that is just like pure water or loose and runny, that, that gets really, that's very difficult for families to cope with.

So, What sort of advice would you give them to try and manipulate that stool into something that is a wee bit more where the, that the person could maybe hold on to? Because obviously when you, when your bowel needs to move and it's just pure water, that urgency comes on so quick and it's very difficult to make it to the bathroom in time.

So what advice would you give them to maybe make that a wee bit more, um, It's very manageable to, whilst your fibre is great for preventing constipation as well. You know. Yeah, um, so anybody that really would be um, sort of at that end of the stool chart, more runny stools, more diarrhea, you'd be actually still looking at your diet and seeing is there something they're having every day that's triggering this?

So um, are they having too much fibre? Are they eating too much fruit and veg and things that is making it more runny? That doesn't help. There is obviously stool bulking agents that we can use as well and like medications like fibrogel sashes and things to bulk it up So it is more regular. It doesn't come as runny And sometimes in elderly patients and it's not necessarily the fibre that's making them loose and runny And sometimes it can be that like sugar content in their diet, or maybe there's additives in food.

So looking at the additives in food like sorbitol and high sugar content, especially in the elderly, it can cause them to be more prone to diarrhea. I think the other thing too is gravy. I don't know why, but gravy and sauces in the elderly population do make their, their bowels looser, you know, so avoiding that.

Recommendations do bind the bowel up. You know, we discussed like sort of your white bread, your rice. Believe it or not, marshmallows is really, really good for binding the bowel. And, um, bananas. Bananas are fantastic as well for binding the bowel. And as you say, Lisa, the GP could recommend a loperamide if needed.

Yeah, and good fibre. You know, whilst fruit and vegetables is great, sometimes overdoing it with the fruit, the sugar content in the fruit and that can cause, you know, yes, you're getting plenty of fibre from the fruit and all, but you're sometimes that over high sugar content in the fruit can cause that loose stool.

So modifying that and. You know, taking a good selection of fruit and fibre. Colleen, do you want to talk then about, um, how else you can help regulate the bowel pattern, whether that be yourself or whether you are trying to help regulate it as a carer for the, for the person, what can they do? Um, so previously discussed there is this definitely recommend that keeping an eye on their diet and also then after meals, making sure that they, the patient is tolerated immediately, straight, straight after a meal.

Um, and keeping a, keeping a diary on when their bowels do move. Is there a certain time of the day that their, their bowel, maybe when they find them, maybe they are soiled. So that's the time then when you're making your diary, that's the time you should be toileting, toileting your, your mother or father.

And we also recommend as well, if you find that, um, you're constipated, we would recommend a stool. Putting your, you know, your feet on a, on a stool to, to lift, to raise your legs up a bit more to help rather than straining, because you don't want to develop piles. Thanks. Um, and that, uh, that by lifting your, getting your feet up on a stool, um, which enables your knees to be a wee bit higher than your hips.

Mm-Hmm, . What that does is it, it opens out the angle, um, the, the angle in the, in the bowel, and it allows the stool to passage. Um. to, to move much smoother, um, whenever they're going to the bathroom rather than straining, which is really useful. And Pauline mentioned there about going to the bathroom after meals.

That is, that's really good if you could get into the habit of, you know, making sure that they do get to the bathroom or that you go yourself after meals. Because Whilst what's considered normal bowel activity is that somebody has either up to three motions per day or up to three times per week. If you are not going as frequently as that to try and enable yourself to go, make the best of your, of your time.

Your normal peristaltic movements that we have which is where your bowel moves in big waves and Normally, we have about two or three good peristaltic movements per day and they do tend to happen after meals because of Gastrocolic reflex that we have as soon as we eat food There's a reflex triggered within our stomach that sends messages to the bowel to start movement.

So that's why 10 15 minutes after a meal, it's good to go and sit on the toilet, and see if the bowel will move, so that for somebody that maybe has lost that awareness themselves, if you prompt them or take them, that may enable you to help them achieve a regular bowel habit where they're not being incontinent on the chair or in the house, but they're actually managing to make it to the bathroom.

Yeah, so no, we have talked about different things that obviously can help people, um, or the patient, sorry, with, um, the functional incontinence, but we do recognize the need to part of our service that we do supply containment products to people that do need them. So we would, we have different types of pads and absorbencies in them, but, We would advise, obviously, people who don't need the products not to wear them.

Take all the advice on board first before just going straight into a pad. Because sometimes that just, yes, it might give you the confidence that's there, but it can make you maybe just think that you maybe are going to become incontinent with a pad on. So we, um, would definitely, we supply the pads in all as well.

There's smaller pads and bigger pads and we would just, during our assessment, We would work out which one would meet their needs better. If they're only having a small bit of incontinence, they don't need to go straight into the highest absorbency pad. But it is very important that whilst they're wearing a pad, it's not to double pad, because obviously when you're needing a pad.

Your skin then, there's a risk of skin breakdown just due to the increased moisture and everything and obviously just of the incontinence. So it's important just to not double pad where a pad is appropriate for them with appropriate absorbency. So any of the patients that um, are requiring a barrier cream for their skin, um, just to prevent this.

breakdown of skin, it's just important that you just put on a thin layer of it because too much cream actually prevents the pad from working properly. It blocks actually the pad absorbency. And if you do need products, we will assess you and trial you with different products to ensure that we can find the right product for you.

In the meantime, whilst you're purchasing in the supermarket or online or whatever, if a pad doesn't, Um, work for you is like, I would say check the size, you know, measure, measure the person, um, or measure your waist, measure your hips to see are you, are you actually buying the right size. And if it's maybe that again, it is the right size, but it's not working for you, try a different style because one style does not suit everybody.

Um, and that's what we find definitely is, you know, using, giving out samples and, and getting patients to try different products. Is the way that we can find the best one to suit, suit you as an individual. So your choice might be limited in the corner shop or in the supermarket, but there is plenty to choose from online.

Um, and hopefully you won't be waiting very long until you're seen by our service and be assessed. And if, you know, if we find that you need products, we do provide a home delivery service where you 12 week supply delivered to your door and then you can reorder them every day. 12 weeks. So, so our, our aim is at the, the Continence Service is, is to help, to help you all build your confidence.

I know a lot of people that do come to me at the clinic have, the only time that they've been out of the house in months is to come, to come and see me because their confidence has, has dropped. Um, they just feel that they just can't live a, lead a normal life because of their incontinence. So our aim is, is to help build your confidence and, and get your, get the best quality of life possible and be able to leave the home.

And get out to the shops and go for small walks. So I hope that all the information that was provided here today, that, um, you all find it very, very useful and that it helps your confidence and changes your quality of life. There will be other episodes within this podcast series, and I would encourage you to listen to them too because, again, we find that patients very different seldom fit into one particular box.

So I would think that you would find the other episode useful too. So thank you very much for listening. Please provide feedback on our podcast, which can be found on the podcast summary or the Northern Trust website. Thank you.