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Continence - a nurse's perspective

People always say make your passion your profession, so I did, I became a fitness instructor… But I had a very different career prior to that; I spent 17 years in nursing.

Very early on in my new career it became clear that there was a ubiquitous problem of women leaking urine during exercise. Some women are very vocal about this in class! Others, not so much. But whether they were talking about it or not it, it was clear that it was a major issue. I really wanted to help and make sure the exercise I did with them was appropriate. Therefore, I spent a lot of time on CPD courses learning as much as I could about the issue, so I could improve awareness and avoid exacerbating symptoms. Most recently, I became an Adore Your Pelvic Floor Coach.

Finding out more, and thinking about the prevalence of this issue, made me reflect on my years of nursing and the huge numbers of people that I cared for with incontinence. The NHS estimates that 14 million men, women, young people and children of all ages are living with bladder problems and around 34% of women are living with urinary incontinence. 6.5 million adults in the UK suffer with some form of bowel problem with over half a million adults suffering from faecal incontinence, with a negative impact on their lives.

None of these statistics came as a shock to me, I almost feel that the true figure may even be even higher. I vividly remember shifts looking after elderly patients, where, almost every single patient was incontinent. In fact, finding a fully continent lady over 85 was a pretty rare thing, in my experience.

The cost of all this incontinence to the NHS seems pretty hard to pin down, with its ramifications so wide and varied. NHS England published ‘Excellence in Continence Care’ in June 2018. This document highlights some of the areas where incontinence is impacting on costs such as: contributing to pressure ulcers, falls, emergency hospital admissions for UTI's and admission to residential care settings for continence management. Not forgetting the obvious cost of containment equipment such as pads and catheters etc.

However, all of this is nowhere near the true cost because, as highlighted by Elaine Miller, what about the costs when people stop exercising and start living sedentary lifestyles to manage their continence? Similarly, what about the huge emotional cost to all of those women (and men), the negative effects on their mental health and well-being.

But what struck me, because of my years at the coalface, was that the cost of nursing does not appear to have been factored in to this. Nursing staff provide continence care around the clock in acute, residential and primary care settings. This isn’t referred to, specifically, at all. This figure would be enormous. Nurses are the second biggest workforce group within the NHS. When you start to consider that nurses and HCA's, on all wards of all settings and Trusts up and down the country, spend significant proportions of their shifts washing and changing patients who have been incontinent. Thousands of nursing hours every single day spent treating the symptoms of incontinence. I can remember so many shifts where I spent most of my 12.5 hour day, going from one elderly patient to the next (and back again!) changing their pads/beds and cleaning them up because they had wet or soiled themselves. (Interestingly, I never remember any of us being surprised by or questioning the number of patients who were incontinent. Incontinence was, most definitely, the norm to us.)

But as well as that financial cost, consider what else those nurses could have been doing, how much better their time could be spent. Difficult choices are being made by nurses every single day. They have to prioritise care and choose between important tasks. I can’t even begin to express how difficult and heart breaking that can be, it is one of the reasons I left the profession. Taking some of the continence care away could mean a nurse has more time to feed patients who aren’t able to feed themselves or spend time with dying patients and their relatives.

Fortunately, we have the means to do something about this. Some time and money spent on educating people on good pelvic floor, bladder and bowel health could save so much money across the board within the NHS and really improve people’s quality of life. Pelvic floor exercises can be taught to people of all ages as studies are proving that age is not a barrier to improving function. There is such a fantastic opportunity for change and I am so excited to be part of it.

Lisa Allen

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