Narrator 0:00
The information provided in this podcast is not a substitute for professional medical advice or treatment. If you’re concerned about your health in any way, we encourage you to consult your GP.

Hannah Paterson 0:12
People don't like talking about it, but incontinence can affect anyone. You may have a friend or relative who lives with it every day, or maybe you're worried about your own incontinence. Incontinence Talks is here to make us all feel more confident about continence, hosted by former Olympian Rower and Coloplast Ambassador Pete Reed. On today's episode, Pete is joined by urology specialist nurses, Michelle Hogan-Tricks and Emma Russell from Coloplast to talk about all things bladder and bowel.

Pete Reed 0:41
Today, I'm really excited. I'm joined by two friends, Michelle Hogan-Tricks and Emma Russell, welcome back from episode one. It's lovely to see you both again. I will leave your credentials up to you. I know you're both registered nurses. I know that you are medical experts, but we are going to do a deep dive into all things bladder and bowel, but please can I ask you to introduce yourself, Michelle?

Michelle Hogan-Tricks 1:03
Yes, thank you, Pete. I work for Coloplast now. I have been a specialist nurse for longer than I care to remember, 23 years. And I kind of really focus on all things bladder and bowel. All things wee and poo. I like to talk about wee and poo. And my kind of subspecialism, if you want to call it that, is kind of anybody who's got a neurological or a spinal condition, so for example, MS or spinal cord injury and how that would impact on your bladder and bowel.

Pete Reed 1:34
Emma.

Emma Russell 1:35
Thank you for having me back. For those who might not have listened to the first one, I'm Emma. I'm the Education Manager here at Coloplast. I have 24 years experience being a registered nurse. Nearly 18 of those were in urology as urology specialist nurse. So lots of bladder and a little bit more bowel now that I'm here.

Pete Reed 1:56
And professional education. So you teach the urology nurses in hospitals. What exactly?

Emma Russell 2:03
So part of my role is to help with the education, sort of all the online offerings, the face-to-face events, the ISC competency studies, bowel care competency days now that we give it delivered to healthcare professionals that can include doctors, nurses, physios, OT's.

Pete Reed 2:21
So you won't want to hear this, but four decades of experience between the two of you in all things.

Emma Russell 2:26
Thanks for that Pete.

Pete Reed 2:26
Sorry. All things bladder, bowel, wee and poo devices, innovations, pitfalls, successes, hope, all of these things.

Michelle Hogan-Tricks 2:37
It's a glamorous job.

Pete Reed 2:38
It's a glamorous job. So why aren't we talking about it? We are today. But why haven't we been?

Michelle Hogan-Tricks 2:43
Well, that is the big question, isn't it? We've been kind of – I've been involved quite a bit of research recently, I've had the privilege of doing. We did in collaboration with the multiple sclerosis trust, and the research came out, we asked 1,200 people with MS whether they would disclose if they were experiencing issues with their bladder, and sadly only 8% said that they would tell a family member or a friend, only 8%. And just over half said they would disclose it to their healthcare professional, only just over half. And the MS trust say that when they have their forums and their blogs, people are very, very open about cognitive issues, about fatigue, pain, but if anybody starts to talk about wee and poo, it doesn't get any traction at all. So it's definitely something that thank you for talking so openly about, but people are definitely frightened or embarrassed. I don't know what the word is really to speak about it openly.

Pete Reed 3:50
But that leads to suffering in silence? Absolutely. And unnecessarily maybe thinking that it's normal or not, but for whatever reason, not going to their GP, but it's really alarming that 8% is just not speaking to a friend or family.

Michelle Hogan-Tricks 4:05
If you think about bowel, if you think about words that we use around bowel, one beginning with you know, that is beginning with an S and ending in the T, it's always negative. So if you think about anything to do with bowelss and poo, we use that terminology in our language in a very negative way.

Pete Reed 4:26
Yeah, it works so just normal, speech, not medical stuff. Exactly, yeah. All that. Yeah, negative connotations. Yeah.

Michelle Hogan-Tricks 4:32
You know, the S word ending in T. I don't want to swear.

Pete Reed 4:36
Keep describing it.

Michelle Hogan-Tricks 4:38
It might have an I and H in it and replace the I with a 1.

Pete Reed 4:41
Yeah. But your right, negative connotations and it's come up in the podcast in previous episodes, but the more we talk about it, the more we normalize it, the less taboo it becomes. The same with anything, any subject, anywhere. So this is a small part of the solution, Emma finds the same thing, especially with so on the wee side, rather than the poo side.

Emma Russell 5:05
Most definitely, you know, the amount of men that I saw who had come to me with chronic retention because they had thought that this overflow incontinence, basically, where they weren't emptying properly and they were then leaking, was just them getting old, but actually what they'd done over time was increase their bladder capacity and be able to hold more, but then losing that bladder control and then not being able to pass water and then having chronic retention.

Pete Reed 5:30
It's much more normal than we might think as well to have small injuries. So Michelle, you're an expert in spinal cord injuries and urology, those kind of so well, I found, I'm an expert in my own spinal cord injury in my own body because you have to be when you're going through that process and learning and learning to reintegrate. But not every spinal cord injury presents, like you might think on TV with a wheelchair or breathing apparatus. Some spinal cord injuries are very small and very minor, but can have big effects on urology and the bladder and bowel. It might be the first thing that gets a bit of a knock and nobody's immune from a bruise after falling off a bike in the wrong place, or very, very normal things a slipping the bath through fall out of a tree, and it can cause a little bit of a scuff on the spinal cord, which can affect urology, which can affect the way you wee and poo.

Michelle Hogan-Tricks 6:28
Absolutely. There's a condition called Cord Equina syndrome, for example, which is, can be very much sort of what you're talking about there. You can end up with a Cauda Equina injury and the only things that are affected are your bladder and/or bowel and sexual function. It's then hidden, isn't it? And unfortunately, I've done another piece of research on this, actually, and it showed that with Cauda Equina syndrome, bladder bowel and sexual dysfunction are kind of the three big ticket items, the three things that people can often and do often experience dysfunction in, but yet in hospital, they're not always told. In fact, many of them are not told that to look out for that, it can be an issue, and then if you're on a busy surgical ward where you've had an operation and then you're you can be discharged very quickly because, of course, there's lots of patients waiting to come in with a head injury, or with a big spinal injury, and so often it gets missed and people are not aware that they have an issue and they're making other excuses for why, you know, for example, if it's a lady, you might think, "Oh, I've had issues because I'm perimenopausal or because I've had a baby." That happens a lot in MS, by the way. So there's a lack of general understanding, and we don't talk about it then because everyone's embarrassed to talk about wee and poo. And then also within clinicians, healthcare providers, it's sometimes missed. These are patients in that will often go on to have recurrent urine infections, real bad constipation, which can then create even more urine infections, and so it continues.

Pete Reed 8:09
Missing out those bladder bowel sexual function red flags, it might be a little bit of embarrassment, even from the healthcare professional where they just don't want to raise it. And it's easy and perhaps not too, because then there's a bed free and there's pressure and stresses that we all know about. So if those hidden symptoms aren't discussed, are presenting in people who otherwise appear able bodied, do you think it's easier for them to be discharged and sent home? Where, so in my case, there's something very visibly wrong, and actually I've found it much easier to talk about these, this is still hard for me to talk about. Yeah, I'm sure. Because it's very personal. But it's easier for me to talk about because there's something clearly wrong. I've got a wheelchair, so there must be some other things, and I'm very happy to talk about it. That must be a hundred times harder for somebody where you are outwardly able bodied looking. Why would you suddenly launch an offer in that?

Michelle Hogan-Tricks 9:09
If I'm honest, I don't think it's on purpose that clinicians miss it. I don't think that they feel like, oh, we've got this bed, so let's not talk about it. I think actually there's just we need to do better as experts in the field at educating clinicians around the area is what I would say. And many of these patients are discharged very quickly for whatever the reason often what it is is they might get asked, oh, have you had a wee? And they might say yes, of course, we know if you've got issues with the nerves that supply your bladder and your bowel, that you might have a very quick wee, a very small wee, and you've left lots behind, or you might have such a full bladder that you get some overflow incontinence that Emma was just talking about. So it's not a comprehensive assessment always. Then they go home, and of course, why would you think, I think many people wouldn't think, oh, well, I've had a problem with my back, and therefore these issues that I now have with your infections are because of my back. I think many people just wouldn't put that in there. Or now I've got really bad constipation, or all of a sudden I'm kind of leaking, and then it all gets worse because if you have constipation and then you leak that's often people think then they've got diarrhea, but they don't have diarrhea. It's what we call overflow incontinence. It's the liquid bit of your poo that kind of slips past this big impacted constipation, and then you're swinging backwards and forwards because again, you may go to a primary care health care provider that doesn't quite understand the nuances of all of this. And if you've not been given the right information to get the information yourself, i.e., you know, third-sector charities, for example, and your primary care provider doesn't quite understand it, you can see, and then we don't want to talk about it because it's embarrassing. We just pop along to the supermarket and get some pads, but that's perhaps not always the answer to this if you're not completely emptying your bladder, or if you're soiling yourself, we can definitely, for many of these patients, you know, give a better, better quality of life.

Pete Reed 11:27
Yes, so they might just feel dirty, ashamed, a bit of a burden. My story on this one, I think, listening to you, I think I got really lucky the day that I had my spinal cord injury. It was a spinal stroke, and I was amongst a group of soldiers going on a military course. And I remember feeling pins and needles in my legs and numbness, and I just thought it was a trapped nerve or something. I thought I'd sleep it off, and I woke up in the morning, swung my legs out and my legs collapsed from underneath me. I could just about get myself to my feet and had a shower, and the first thing in the morning, I went to the loo to have a morning pee and couldn't pee. And I just thought that's unusual. I could sort of feel like I needed to go, but just nothing, nothing a dribble or drip. And there was a medic on the course, pure luck. An army medic, so I went to speak to him, and he immediately said that's a red flag. We need to get you to hospital, which I'd never been to hospital before. I'd grown up in elite rowing, so I'd always had a doctor there that would deal with a stiff back. I'd never been to GPs and suddenly I found myself from this one world straight into another world, just because of pure luck that someone said that's a red flag. Brilliant. Luck, right? So thank you to that medic. But it got me to A&E quickly, and then into that secondary healthcare I needed from hospital, and I had mostly good experiences. But Emma, what would you say to anybody, listening that's hearing this account from Michelle, that might have experienced something similar? Is there advice from medical experts?

Emma Russell 13:06
So I was just I was just thinking, to be honest, you're talking about sort of that neurogenic side, but actually the functional side, those patients who have got that chronic those chronic UTIs, and they're not being investigated, or they've got that sort of constipation where the lactulose and the figs, syrup, and the high fibre, all those sort of conservative measures aren't working if they're not being listened to, and they go to A&E with issues, and then they get sort of fobbed off, and it's going back and forth to GPs. It's just do your search, keep asking for medical assistance and help.

Pete Reed 13:44
So this can be part of their research, listening to this, hopefully they found us.

Michelle Hogan-Tricks 13:48
I'm not sure what the word is, but how long do you think it takes on average for people to get the right, the right bowel treatment for them in this country? How long do you reckon?

Pete Reed 14:00
Is this going to break my heart?

Emma Russell 14:01
Like those numbers we said on how many UTIs you might get, if you're a,

Pete Reed 14:05
From first presenting to a GP.

Michelle Hogan-Tricks 14:08
From you, well, from a person feeling that there might not be something quite right their bowels to getting the right treatment, getting onto the right treatment plan.

Pete Reed 14:19
Four weeks.

Michelle Hogan-Tricks 14:20
Four weeks.

Pete Reed 14:22
More?

Michelle Hogan-Tricks 14:23
Try level up.

Pete Reed
Emma’s pointing up.

Michelle Hogan-Tricks 14:26
Six months?

Pete Reed 14:27
Really? No. Wow, God.

Michelle Hogan-Tricks 14:29
Yeah? No. No.

Pete Reed 14:32
So, tell me.

Michelle Hogan-Tricks 14:33
Five point six years.

Pete Reed 14:35
Really?

Michelle Hogan-Tricks 14:36
Yeah.

Pete Reed 14:36
And that's an awareness bit, an education bit, a stigma bit as well, I guess.

Michelle Hogan-Tricks 14:42
All of the above, I would say, I think also, yeah, education, massive for the public also for clinicians. What's super interesting is, if you speak to most clinicians, they'll say, yes, constipation is an issue. It's, it's a real issue, but then I'm not sure we take it as seriously as we could. Well, I'd argue we don't, if it's taking us five point six years, on average to get the right treatment.

Pete Reed 15:08
Michelle, you mentioned pads. So people, they would nip to the chemist, get a pad and try and just patch up this embarrassing thing that they're going through. Yeah. But so I'm not poo pooing paths. No, absolutely. Sorry. So they serve a purpose, but we're here to talk about options. So, how can we turn five plus years into what would be considered appropriate in your eyes, and what would be considered appropriate, like to getting diagnosis and the equipment for people to manage their own bladder and bowels effectively. What do you reckon is about right as soon as possible? It's all there, right?

Michelle Hogan-Tricks 15:49
Goodness. I mean, it's really interesting that you say four weeks, you know, and how far away that is from the reality is really interesting. And when I always start about, if we do bowel education days, I often I'll always start it with that and I get, and they're all nurses or clinicians, I should say in the room, and I make everybody stand up, and I say, right, sit down if you think it's three months, I never even go with four weeks. And as we go longer and longer and longer, you know, there's kind of like two or three people left standing. So even clinicians don't realise it's taking so long.

Pete Reed 16:22
It breaks my heart, the people suffering inside of me trhough.

Michelle Hogan-Tricks 16:25
So I think there's, it's so okay, it's really multifactorial. So the studies show that for the first, from one to eleven months, actually, people don't tend to present anywhere, they tend to try and manage themself, as you've just said. Go to the supe… you don't even need to go to a chemist, supermarkets to get pads, you know, it's simple over the counter-laxatives. And for many people, that's actually where, for many people, the solution isn't something fancy, some fancy equipment that they need. But for many people, it's actually just getting, you know, good quality, basic lifestyle and simple medication advice. The defecation dynamics is the posh word, how to sit on the loo, what muscles we should be using, all of those lovely things, fiber, whether you're having too much or too little, we talk a lot about more fiber, but for some people, that can be an issue as well. People don't tend to come off that rung though. So if that's not the right solution for you, or if you haven't had, you know, good advice, just, oh, have another laxative, let's add another laxative in, that's often not the answer. So moving up to that next level, which can sometimes involve, you know, a product like you're talking about, could be something like Transanal Irrigation, for example, or like a low-volume version of that, which is a bit less, it's just some, essentially it's just some warm water from the tap that you irrigate your bowels with. How long should it take was the question though. We totally digressed, didn't we? Well, I did. That's good, we're all learning. Yeah. You see, I start talking about poo and that's it. I'm off.

Emma Russell 18:04
but I think it's awareness, isn't it? It's awareness. You said to education and that's what we try to do anyway in our job is to educate the healthcare professionals, educating patients and consumers that, you know, there's things out there that, you know, just ask for help.

Pete Reed 18:23
There's a spectrum as well, isn't there?

Emma Russell 18:24
Yeah. I was just going to say, and I was just going to plug loo taboo again. Break the loo taboo.

Pete Reed
Yeah. Break the loo taboo.

Michelle Hogan-Tricks 18:30
And why is it taking people a year to go and speak about it, to their GPs or whoever it is, you know, that's,

Emma Russell 18:36
And I found with on the bladder side as well, you know, it would be the fact that maybe they've actually spoken to somebody, they've actually had that courage and said, do you know what, I'm really having issues with this. I'm going up five times at night or I'm leaking when I cough or I'm leaking when I walk, and then people go, do you know those things they can do? Yeah. You know that it's okay to have these issues, and it's usually only when they know that someone else has go it, that they'll go and seek help or the wife who doesn't want them getting out of bed at five times at night.

Pete Reed 19:08
Yeah, they don’t have to.

Michelle Hogan-Tricks 19:09
And again, you know, as you said about pads, it's absolutely they have absolutely they have a place for bladder and bowel dysfunction, but I think often it's very easy, isn't it to pop along to the supermarket while you get your self managed your bread and you soup and whatever else you get from the supermarket, pick up shampoo and pick up some pads, and then you don't have to talk about it. You can just kind of ignore and hide it, but it can get to a point if that's not the right answer. Because you're not completely empty in your bladder, for example, that, you know, gets to a point where people have an accident, they have an accident at the wrong time, you only have to have one or two of those bladder or bowel, I'd say I'd argue it's possibly worse with bowel because of the smell and it's maybe slightly less acceptable than it is to have a bladder accident. And that's it. You've lost somebody, you know, you again a lot of the research that I've done and it has been around Cauda Equina patients and multiple sclerosis, but we put free text so people could talk and it's so sad. The comments are just overwhelmingly sad, you know, you have an accident like that when you're out in the pub with your friends, are you going to want to do that again?

Pete Reed 20:22
Yeah, there's trauma.

Michelle Hogan-Tricks 20:23
Absolutely. You have an accident at work, do you quit your job, possibly, you know, so then even if we take it away, we kind of build it up to the wider community, it's our responsibility to get people into work, feel safe and comfortable at work, out socialising, otherwise it, that creates more issues for that person and society.

Pete Reed 20:47
Personally I don't use pads, but they're still sold, they're still bought. Sometimes it's appropriate under what circumstances is, is that the right direction for people?

Michelle Hogan-Tricks 20:58
Yeah, that is a really good question because pads are sometimes appropriate for people right and people often use them for reassurance, you know, lots of ladies, safety measures, safety measures, women have a bit of stress incontinence, but what I would say though is look, if you are going into the supermarket, you've never had an assessment and you think this is just normal because I've had some children or I'm perimenopausal all then if this is just what happens to women, please please do go and get yourself checked because actually there's pelvic floor exercises, there are apps you can find to help with that. In fact, if you are kind of 45-plus and you are experiencing that you've got more leakage now or you're having urine infections, it might mean that top up of estrogen could really, really help. There are lots of things that can improve that and sometimes pads are, you know, something that you may want to use as an adjunct for your lifestyle, but don't just go and pick them up is what I would say and just think, oh, this is normal, go talk to somebody about it.

Hannah Paterson 22:02
On our next episode, Pete chats, to Michelle and Emma, about the different treat and options available for people suffering with retention and constipation. There are lots of amazing charities that can provide focus support depending on your particular need, as well as lots of information at coloplast.co.uk. Thank you for listening to Incontinence talks. and remember to consult your GP if you have any worries about your own continence.