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. Today, Pete chats to Michelle Hogan-Tricks and Emma Russell about the different treatment options available for people suffering with retention and constipation.

Pete Reed 0:41
We've said a lot in this series as well that everybody's different. So there's a massive spectrum from somebody who's had a catastrophic spinal cord injury, someone that might have had a big operation after a cancer diagnosis, uh, MS, Cauda Equina and the other end of the spectrum of people that need to change the way they sit on the loo and change their diet, and nobody likes to feel like a burden. So everyone would probably want to assume that they're okay. Can we myth bust a bit to make sure people feel seen and validated, especially if they're a bit scared and nervous, because we're about to go into seeking help from the GP. Don't suffer in silence and the options available, because unique cases there are ways to help have a healthier more confident life where, and I've had a spinal cord injury, I haven't once had a spill and I could leak a leak which is great, but that's purely down to what I use and what my daily routine is. It'll happen one day and I'm not looking forward to it, but I'm one of the lucky ones where there's something clearly wrong, so I got all the education I needed early in the process and especially with maybe a degenerative condition like MS, it might happen a little bit slowly, the person that it's happening to might be scared that this is going in a direction, they might not want to seek help early enough. Can you reassure people and talk through what some of the options are for both bowel and bladder, actually?

Emma Russell 2:12
So yeah, I mean it really does depend on the condition, it depends on what you're diagnosed with, but you know, for emptying your bladder, there are intermittent catheters, there are indwelling catheters, super pubic catheters which go through the tummy, but we obviously know that ISC is the gold standard for bladder drainage, it's just something that we're taught as nurses, healthcare professionals, so ideally that's the best way because hopefully it’ll reduce your risk of UTIs, the now rather having an indwelling in. There are other options, but as I said, it really does depend on the condition and the patient and what's going to suit their lifestyle because I think you've really got to fit that management option in with their life, it's got to fit with them, it's got to fit their lifestyle, their quality.

Michelle Hogan-Tricks 3:02
And what I would add is absolutely that Emma, but I would just urge people if you are having issues, in particular if you have another condition as well, in particular if it's a neurological condition or a spinal issue, please, please just go and seek help if you think it's because you've had a baby or you think it's because you're getting a bit older and your prostate, it's enlarged a wee bit or don't self-diagnose with this, please just go and speak to somebody about it because it could be, we just want to get to a place where we're helping people regain control of all of this and it makes me really sad when I speak to people who have been experiencing issues for five, six years and really quite significant issues. And actually, myself or Emma will think, my goodness, there's actually a really simple solution here and you've been suffering for all that time and then retrospectively they'll say, oh my god, I wish I would wish if I had a pound for the amount of people that they find in the right person, Yes, find in the right person, pursuing, if you don't feel that it's being managed correctly at primary care level, pursuing, asking to speak to a specialist, you know, a specialist consonant service for example, Pete, you're lucky that you had such a great journey with your rehabilitation and your bladder and bowel included in that but I'd just like to add as well that for spinal cord injury, actually only the latest figures show that only 20% of patients get to a specialist spinal cord injury unit, only 20%. Yes, it used to be 33% in 2020, they might go to a rehab service that's not, not neuro specialist, so perhaps they won't quite understand the nuances as well as a specialist service and I just want to say there's many that are excellent as well, I just want to caveat that but you know, some might just go home, you're right, some might go to a community physio for example, who we've not quite picked up, that they've got bladder and bowel dysfunction. So yeah, people are kind of going to lots of other places apart from expert services.

Pete Reed 5:20
And spinal cord injuries are all a bit different, so where they are on the spine, how bad the injuries are, what they're presenting with, but so the listeners have a bit of context. There are 11 specialist spinal units in the UK dotted around, they're always stretched for beds. What I found was, it's not so much a physio place, it's more of an education centre, I went there to really learn from the spinal cord injury nurses on the key things were bladder's, bowel, skin care, sexual function, and then a reintegrating back to home, this sort of getting you ready for being at home and being independent, so the aim is you learn as much as you can so you don't go back there quickly or don't end up in hospital again, and I had really good experiences, especially with bowel care with the nurses there, because it was their bread and butter, it was just normal, they could teach me, show me that wasn't quite the case in secondary care in the initial hospital where they're doing everything and juggling everything. That's not their speciality. No, there's no blame or thing the point is no, I know I got really lucky.

Emma Russell 6:32
It must have been music for your ears,

Michelle Hogan-Tricks 6:33
Yes, that's music to my ears, I love those happy stories.

Pete Reed 6:38
It was a happy story, despite what was going on, there's something I've been meaning to ask you, Emma, so you mentioned intermittent self-catheterisation, you mentioned indwelling catheters, and you mentioned super pubic, which we've covered throughout the podcast, but we can cover in this episode as well, but when I was researching for this episode, I came across a word that I hadn't seen before, I'm going to read it now in butch of the pronunciation, but Mitrofanoff? Mitrofanoff. So what is that?

Emma Russell 7:08
That is the easiest way to describe it is a whole, basically, that goes into the bladder.

Pete Reed 7:16
How is that different from super pubic then?

Emma Russell 7:18
Because it can be, you can put the catheters in and out, so rather than the catheter sitting there all the time, balloon in the bladder, draining into a bag, you can actually use intermittent catheters into it.

Pete Reed 7:31
So while I've got you on the subject, and I know we've gone through this a little bit before, but please can you explain the mechanics for anyone that doesn't catheterise or need to, but maybe they're interested or maybe they're a patient advocate. Those four different processes. So where are you putting the catheter? Yeah, I'll leave that explanation to you as well. Okay.

Emma Russell 7:54
So when you're doing intermittent catheterisation, that is self-intermittent catheterisation, you're putting the hollow, thin, hollow tube into your bladder via your urethra, which just male or female, you're passing it through up to the bladder and emptying the bladder that way. So you're doing that intermittently, as and when you need to, depending on the regime, you, some people only have to do it once or twice a day, some people have to do it three, four times a day and some people up to six times a day. Then you've got the indwelling catheter, which is the catheter, again, it's a hollow tube, has a balloon at the end, which gets inflated once it's inserted into the bladder, and it has, you can either have it on continually draining. So you have a leg bag on your leg, or you can have it on a valve, depending on your condition, so that allows you to be able to sort of almost feel like you can actually go for a wee over a toilet without having a bag attached to your leg. And you can have that exactly the same with a super pubic, except it goes directly into your tummy, into your bladder, same, you can have it on a bag or a valve. The Mitrofanoff or urinary diversion type operations are really sort of the end of their journey, really, when all else is failed or there's nothing they can do to obviously help, but they will have to just empty their bladder through that or they can have urostomy, which is the diversion, which is when they have a little stoma.

Pete Reed 9:25
So the people that don't do any of this, this will sound like it will sound scary to them. So, to reassure, I guess people or people that do use these devices to pee, I use these devices, I self-catheterise, but five times a day or whatever it ends up being, make sure I watch the clock to see when I need to go, because I can't feel it. And it's perfectly, I mean, five times a day for the last five years, you can do the maths, I've done it a lot, and I just wheel up to a loo and catheterise and pee, it doesn't take much longer than before. It's obviously a bit different, but I apart from UTIs, I don't have a problem with the process of peeing, it feels it's normal now.

Emma Russell 10:08
But how long does it take you to get that normal process? How long in your journey did that become your normal?

Pete Reed 10:15
Okay, so actually very quickly, but then this is part of me saying that I feel lucky, because I had a spinal cord injury, so in the course of 20 minutes, you go from being able bodied to not being able to walk, so my life was this explosion of everything going wrong and losing a lot of things. Bladder function was one of those things, so I had an indwelling catheter, so actually when I was being taught by very, very good urology nurses about the process of self-catheterisation, I know that's not normal for everybody, but it was a relief for me because it was part of claiming back my independence, so right from the start, it's not normal pushing a pipe up your pee hole. But it's finding that new normal though. Yeah, so it's finding a new normal, and I found that quite quickly because of all the other things going on.

Michelle Hogan-Tricks 11:08
And gaining, as you just said, it's something that actually when you are going through such a catastrophic event, gaining control of your bladder and bowel function is wonderful. It’s starting to give you control back, but what I wanted to ask is, so for many people, thery might come into clinic, there might be taught how to intermittently catheterise in half an hour, an hour, depending on the clinic, and then off they pop, whereas you had lots of support, I suspect, within the unit that you've had.

Pete Reed 11:38
Yeah, I had time and support, and the conversation, wee and poo, wasn't taboo, because…

Michelle Hogan-Tricks 11:44
Wee and poo wasn't taboo. Well I like that. Yeah, I've got a new hashtag there.

Pete Reed 11:46
And it was the normal topic of conversation in the bass on the spinal ward, because everyone would be having their bowel routines at the same time. Yeah, see what I'm known. So everyone would say, "Do you go all right this morning? What are you learning?" There you go. So the big difference is, if someone's going in to see their GP and walking out with news of, "You might need to self-catheterise, these are the options. Go to the chemist, then they are losing something and getting a downgrade, that in their perception, where, when I was learning about self-catheterisation, I was getting an upgrade, because it was going from indwelling in hospital bed, paralyzed, not moving to, okay, you can get your life back in this very personal area.

Michelle Hogan-Tricks 12:27
And that's really interesting, again, some of the research that I've done, when we look at, on the whole, and obviously there's outliers, but when you look at the spinal injury group, that's exactly it, right. You have your injury for many people, and this is what I'm left with, and I have to somehow pick up the pieces, get on, learn all of this new thing, which is mind-blowing, devastating, difficult, but you are where you are, whereas when you look at some degenerative conditions, whatever that is, the research I've done is with MS, it's often, for some people, it's exactly what you've said, you're getting a downgrade, it's admitting that things are getting worse, but I would say to anyone listening, "Please don't look at it like that," go in and seek in help, get in the right management, is you gaining control back, it's you gaining control of your condition, it's you saying, "Actually, I am going to go out with my friends tonight. I am going to go to Oxford Street, shopping instead of a shopping mall because there might be less toilets. You know, people tend to start to to toilet map, we call it, they'll only go where they know there’s toilets. Exactly.

Emma Russell 13:36
Download the app, and everything. Download the app, which is great, by the way. Yeah, I think there's a toilet finder app, there's a wheel-mate app. I can't remember the names off top of my head, but if you go to your play store, Google store, I'm sure there's different toilet finding apps, and they can really help people when they're trying to travel, you know, just to think by getting the right treatment, you're going to gain control back.

Pete Reed 13:57
Yeah, that's so true. So, it's an upgrade for them as well, it's a reclaiming of identity. I love that, it's an upgrade. Yeah, it is an upgrade.

Emma Russell 14:06
I mean this, you know, simple things like this, these can regain someone's quality of life, you know, someone can actually get a good night's sleep and be able to function the next day. You know, continence during the day can be achieved, and that's where good teaching and good support, and you know, that advocacy from the nursing team, or from whatever health care professional they seek help from is really, really imperative that that's patient-centered. So, you're looking at the patient, what's important to them, and finding the right fit for them, and finding the right treatment.

Pete Reed 14:41
Is that the same, Michelle, with bowel care? So, the options, as far as I'm concerned, I think it's irrigation or a stoma, but I don't know. So, I use an irrigation system, and there's a lot of plumbing, it works for me, it's not ideal. It's not like pre-injury of just nipping to the loo, sitting down, easy, swift, clean, but this new process gives me independence, gives me confidence, I'm cleaner than most people, I know I am, because there's, well, I won't go into mechanics too much, but you're all washed out, so I have confidence going about my day. The big problem for me is making sure that I know where I'm going to have a private loo place. But what are the options, sorry.

Michelle Hogan-Tricks 15:33
Yes, I think with both actually bladder and bowel, as you say, look, would you rather be able to, pop along to a toilet, have a pee, have a poo without needing to use devices to help? Yes, I'm sure most people would prefer that. But I think the thing is, as Emma has said, it's the right treatment, whether it is bladder or bowel, for you, and that, you know, for some people that might be pads, for some people that might be medication, for some people that might be intermittent catheterising or intermittently catheterising. For some people, it might be botulinum toxin, which you may know one of the brands, and there are many others, as Botox. And it's the same for bowel, really, so I can't really stress enough, if you're having any sort of accidents or, you know, real constipation or anything like that, please, please just go and speak to your doctor about it, or, you know, your GP practice. And if you don't feel that you're getting that right treatment, then do pursue to try and speak to a specialist. So in regard to bowel, it's maybe easy to describe. We have something called the treatment pyramid. I don't know if you've seen it before or not, but essentially it's a piece of work that was done by some international clinicians. And it has three kind of rungs on it. And the bottom rungs, the bottom part of the triangle, if you imagine, a triangle is wider at the bottom, and then it's smaller at the top. So the bottom rung of that triangle is very much this kind of general lifestyle advice that we spoke about earlier, exercise, whatever that is for many people, that's not running. So for example, for you, Pete, your exercise might look quite different to me or a wheelchair user who's not an, you know, an, an Olympiad, whatever that looks like for, for, you know, each person, and understanding, you know, really good, simple advice is often the answer for many people. However, what we know is people get stuck there. So once you start to need to use over the counter medication, so Senacot, an example that many people might know, or, or lactulose, or,

Pete Reed 17:53
And their laxatives.

Michelle Hogan-Tricks 17:54
These are all laxatives that you can pop along to one of your, your local chemist and you can buy. Once you start to use these kind of things and, and it's not, you know, it's still not quite right for you. You really need to be sort of raising this and, and a good friend, and one of our colleagues always says two then review. So if you have put yourself on more than two of these, or a clinician has, you know, need to sort of rewind and start again. Then there are the kind of medications that you might use. People might know them as suppositories. Some of these you can buy over the counter, or a little microlette enemas, so these are the small little enemas that you would stick in your bottom and squeeze something out. Or there's larger ones. Once you, these are sort of all on that bottom rung, but these are things that generally a clinician might advise you to use.

Pete Reed 18:45
Can you explain what suppositories do, because I, as far as I'm aware, they sort of stimulate the rectum.

Michelle Hogan-Tricks 18:51
Yes, so that's an example of one. There's various different suppositories that do various different things, but the one that we would start with usually is this thing of stimulation. So another thing that, before you get to that level, what, if you do speak to a clinician, what they might ask you to do is just sort of stimulate around your bottom area. And you might naturally, what you naturally see actually with children, with babies when they're, kind of, if you look at babies who want to have a poo, they'll get themselves into the right position. They'll sort of do that crouching thing, and they'll touch around their bottom. And then we kind of say, oh, don't do that. That's dirty again, another negative. It's actually an inherent thing. What I mean is when babies do that, getting into the right position, toddlers, I should say, and touching around their bottom, that is an inherent thing that we have. Telling us that if you actually touch around the area, it does create stimulation. I think you, did you talk about peristalsis?

Pete Reed 19:48
We did. So what's the process, thank you, so what process is that touching or a suppository stimulator?

Michelle Hogan-Tricks 19:54
Yes, so that will stimulate a contraction. So for anyone who wants to rewind and remind themselves of GCSE biology or O level biology, depending on your age, we learn about peristalsis, which to keep it not very technical is when your gut needs to evacuate basically the way you get your stool around and out of your system is something called peristalsis kind of doing this to get around the plumbing system and it's… The muscle munching. The muscle munching out. The muscle munching out. Yes, the muscle munching the food all along.

Pete Reed 20:29
And then it comes out.

Michelle Hogan-Tricks 20:31
Exactly. So for some people, that's not working as effectively as it should, and in particular, neurological patients actually. Not only that. So if you touch around that area, you create those stimulations and a suppository glycerin is an example, we'll do exactly that. So you'd pop it in and you need to actually one thing, talking about that. One thing people don't realise is they just pop them in, but you do need to make sure it's touching against the wall of your rectum, otherwise it's just going to sit there and not do nothing. But it's sugar, basically, glycerin is sugar and it just causes your rectum to stimulate and that bottom bit of your plumbing, your rectum, is like a storage facility. So what should happen with a usual bowel is you should really, keeping it simple again. You should only really get stool collecting in there as you want to, you know, we would go to the toilet and empty our rectum and then it should be nice and clear. It should be empty. We've talked a lot about incomplete bladder emptying but actually it's the same for boughs, they may not always be completely empty and then you might get a spasm because your boughs might not be working, they might not be having as they should be. And then if you've got stool in your rectum, you might have an accident. So that's one of the examples of why people have accidents.

Pete Reed 21:48
You were talking about the pyramid.

Michelle Hogan-Tricks 21:50
I was talking about the pyramid back from track.

Pete Reed 21:52
Yeah, we're climbing up this pyramid, so we've gone

Michelle Hogan-Tricks 21:55
So that's kind of that bottom rung, and really almost the bottom one is almost splitting two. You've got the very simple piece, and then you get into these slightly more complicated medications like the suppositories and help me out. enemas, thank you, Emma, my mind went blank there, which really, you know, I would say if you're self-prescribing that stuff, please go and speak to somebody, just get some advice. Then you've got the middle rung of the pyramid, and this is where we go into things trans-anal irrigation, which we talked very briefly about earlier. And as you've just sort of talked about, it's an irrigation system that there are various different ones.

Pete Reed 22:34
I use Peristeen, by the way. Yeah. I don't mind mentioning it, it's an irrigation system by Coloplast.

Michelle Hogan-Tricks 22:40
Yeah, Peristeen is one of ours, and we're very proud to have lots of accreditation with NICE for Peristeen. So what will happen is you essentially just fill up the base of it. With water. Yeah, back of water, yeah. It's nice and tepid, it's got a nice little indicator to tell you it's the right temperature, which is great for people, again, who might have spinal injury, who may not feel, so you've got a nice little temperature there. And then you have a catheter, which is disposable. You put that in your rectum when you're sitting over the toilet. There's two different ways you can either have a balloon on it, so you don't have to hold it yourself, or you can have one with a cone that you do have to hold. It does sound a little bit complicated, but once you've got used to it, you know, you will say yourself, Pete, it's with the right support, which you absolutely should have. These are things that you need to get prescribed by clinicians. And essentially what that does is it irrigates your bowel. It helps with that stimulation, all the way up to your transverse colon, not wanting to get too technical with this. But like you just said, it gives you confidence that if you are someone with constipation, if you are someone who's having these strange spasms and accidents, actually, transanal irrigation will clear you out quite significantly, so you know that you can go about your business for the day. For some people, it's a whole day, for some people, it might be half a day, for some people, it's two days, three days. You get to know your bowel's right, but it just gives you confidence that actually I know, as you said, I'm cleaner than most people, that you know that you're not going to have, or you're going to significantly reduce the amount of accidents that you may have, or that might be, for some people, just very severe constipation, which also is incredibly uncomfortable and not very nice.

Pete Reed 24:40
So, I'm an athlete, so it means I'm really competitive, or I was an athlete. I'm desperate to know what the top of this pyramid is, because that's why I'm at the level that you've just described. Absolutely. What's the tippy top?

Michelle Hogan-Tricks 24:49
So, as I kind of said, as you're on the base, that's where most people should be, and then the kind of transanal irrigation is in the middle, and that's really the end of what we would call conservative management. So it's a great option for people, anyone who's kind of needing to do a bit of stimulation, whatever that stimulation might be, anyone who feels they're not completely empty in them, that they're, you know, they're bowels, they're having accidents, things like that, it's something that you can go and have a discussion with your healthcare professional about. The top is where we start to look at surgical intervention. So, most of the top, and we'll keep it simple, really, most people will have heard of an stoma, so this is where we get into the colostomy, colostomy bag, part of the bowel treatment there are various other things in there as well, but they're a little bit more technical. And so that's really that kind of tiny pointy bit. So the point is, the pointy bit, the point is, lots of points here, you know, that's kind of the least amount of people should be up there. And what you don't want is someone going from, oh well, I've tried lifestyle advice and it's really, really not working for me, I've tried a couple of suppositories, it's not really working straight to stoma. You know, you want to make sure you've got the right person on the right treatment plan at the right time. Technically, you don't always have to start at the bottom and work your way up. So, for example, if you had a very high level injury, somebody who couldn't unfortunately, you know, couldn't move their arms or their legs, you may opt for something like that, if they don't have carers and they don't have loved ones who can appropriately manage their bowels in another way, you may opt, and this is going to be a small, small, small group to go straight to stoma. For some spinal injury patients, you may also opt very quickly to go straight to transanal irrigation. So, you don't always have to start from the bottom.

Pete Reed 26:50
So Emma, with the bladder emptying options that are available, I'm wondering what appropriate, the pros and cons of each because I remember having an indwelling catheter very early on, so having a spinal stroke losing use of my legs and of my bladder, having that surgical procedure and lying in bed with a big pipe coming out into a bag. And that didn't last very long, and I remember the transition from indwelling to self-catheterisation. What are the pros and cons? When should they be used and when shouldn't they be used?

Emma Russell 27:26
So, it sounds like you were really lucky actually that you got transitioned from an indwelling to ISC quite quickly, but some people unfortunately get left with an indwelling for long periods of time.

Pete Reed 27:38
What's the problem with that?

Emma Russell 27:39
Which is not ideal because for every day that the catheter in, the catheter is in, they're increasing the risk of having a catheter associated urinary tract infection, which obviously people are aware that UTIs can really knock you back, it can really make you feel very unwell. You can have issues with the catheter's blocking, so there's a lot of risks when the catheter is in there. The damage to the urethra, skin damage if it's not attached properly.

Pete Reed 28:12
The people are discharged from hospital with an indwelling catheter, am I paraphrasing, but that's not ideal?

Emma Russell 28:18
It’s not ideal. The gold standard is intermittent self-cathetisation. That's what we would aim for, is that anybody that can't actually empty their bladder should be able to do ISC, but we know that that's not going to suit everybody, and that if people do need an indwelling catheter, then that's what they're going to have to have, then a super pubic is probably going to be one of the better ones. It has its risks as it is an infection risk, it's in the end of the day, it's an operation, there are risks of it being inserted, so it shouldn't be taken lightly, and that's why the options should be given.

Pete Reed 29:02
So we've mentioned it a couple of times, why is ISC the gold standard?

Emma Russell 29:08
ISC is a gold standard for bladder drainage because it's not keeping the catheter in there all the time, so it's reducing the risk of UTIs in that aspect. It's giving that patient the quality of life and the confidence and their life back, basically, they're able to do it themselves and keep their condition in control.

Pete Reed 29:28
Both of you have, you’re nurses, so you've done this before, you’re neurology nurses, you've catheterised people and normal, I don't even know what normal is, I've been catheterised by the way, by nurses, so I know what it's like, but how many, have you done more than 10?

Emma Russell 29:46
I mean, there's that greeting card, isn't there? I've seen more willies than a prostitute by being a urology nurse.

Pete Reed 29:56
More than a thousand?

Emma Russell 29:58
I’d say. Wow. I mean 20, 24 years.

Michelle Hogan-Tricks 29:59
I mean, I was a recovery sister for seven years. I mean, everyone, kind of turns up, throws all the covers off, and you know.

Emma Russell 30:07
I mean i think you get to a point where you have blood and bowel problems and you do just let loose, just be open about it, sometimes they are, especially when they come to healthcare professionals. And I had one chap who was coming for his catheter to be taken out, and yeah, there was a certain rise. Oh, go on. And yeah, it's something that you, as a healthcare professional, don't want to draw your eyes too.

Pete Reed 30:43
Can I, so I'm going to jump in a little bit there, that might not, sorry, you've raised it. Sorry, but that might not be a sexual thing, right? No, it's not a chap just thinking this is, I’m aroused, and it's like, I mean,

Emma Russell 30:58
The excitement of getting his catheter out, maybe?

Pete Reed 31:00
But is there, this is a thing that they would be mortified, and presumably not in any way aroused, and just thinking what on earth is going on here. What happened?

Emma Russell 31:11
Well, it's happened a couple of times, unfortunately, for the gents, but yeah, you just have to sort of put, you're nice about it, you don't make a song and dance about it, because it is. It's a natural thing. It's a natural thing for it to happen. You just have to carry on and do, keep doing what you're doing, and then just let them go with you.

Michelle Hogan-Tricks 31:35
Do you say I'm just going to hop outside for five minutes. Maybe get dressed?

Pete Reed 31:40
You both said there's nothing that we haven't seen. Nothing that we haven't done. Yeah, maybe it's 10,000 times then that you've catheterised.

Michelle Hogan-Tricks 31:54
I was just going to say, we did a tally chart now of how many lady in men bits we've seen.

Emma Russell 32:01
I mean, I sometimes forget last week. How am I supposed to remember 24 years?

Pete Reed 32:06
Can we talk about lady bits as well? Yes. Because I've got no experience of catheters with women, I've got loads on me, but is it important? I mean, there is as varied as the men, but more mechanically difficult, because not a handle. I don't know.

Michelle Hogan-Tricks 32:21
I think we would argue that it's harder as women than men to find.

Emma Russell 32:27
Definitely. You generally can find yours as males. They're quite easy to find your urethra. Women have a little bit more of an issue they can struggle to actually find the urethra. There's a lot of -- every woman is different.

Pete Reed 32:44
So hard to self-catheterise then?

Emma Russell 32:46
It is hard. Yeah. It's sometimes -- it's locating the It is hard. that the women find, she can't see, at least with a penis. Because we can't do that. No, because it's the purpose of the -- purpose of the earth.

Michelle Hogan-Tricks 33:01
You can't lift up. You can't lift up the ure. And see where you're going. We try to get women to feel, because that's the best way then. You don't have to rely on mirrors and things like that.

Pete Reed 33:11
But on the cleanliness, you need to be spotless and clean for this process. Male or female, because something's going up.

Michelle Hogan-Tricks 33:17
Something's going up.

Pete Reed 33:18
Yeah. And we’ve gone full circle.

Emma Russell 33:20
We have more layers -- layers of lips or labias, whatever you want to call them. So we've been a bit more rootaling around, to try to lean around a lot more. We do have to root around for -- but then there is a higher risk of not being able to find the hole.

Pete Reed 33:40
Have you catheterised yourself?

Emma Russell 33:42
I tried all the catheters, but when I was teaching, I tried all catheters that came on the market.

Pete Reed 33:48
I hadn't thought about this. Which is the best? Which was the best?

Emma Russell
Eve when I was there, but now it's --

Pete Reed
And so I don't want to delve too much into your medical history, but you're a healthy, you've got healthy bladder, right? So healthy people can

Emma Russell 34:05
I've got nurses, bladder. We've got quite a large one. But yeah, now I'm completely healthy, but I would try the catheters, so I know how they felt. For research purposes for my patients.

Pete Reed 34:13
Would you recommend healthy people using self-catheterisation?

Emma Russell 34:18
Not on a regular basis.

Pete Reed 34:19
But it's not going to do any harm. And was it -- so I can't feel anything when I do it, but can you?

Emma Russell 34:25
So, yeah.

Pete Reed 34:27
And how sore is it?

Emma Russell 34:28
So when I tried with a larger size, when I tried with a 12, it was a bit uncomfortable, and then I went down to a 10, it was more great -- it was -- it was -- it was fine. I think it also depends. It was a product too, yeah. But also, you know, you feel a bit restless, but most people do after that first attempt, but otherwise it was fine.

Pete Reed 34:49
That's amazing that you tried them all.

Emma Russell 34:51
And you get used to it. Yeah, you get used to it, but I thought I had to, to be the best teacher of ISC for my patient, I felt I had to tract, because I would undoubtedly get asked which one would you choose?

Pete Reed 35:04
Sorry, you said 10. I thought you meant 10 different types of catheters.

Emma Russell 35:07
No, the size 10. So the catheters come in Charrière sizes, so most women would probably use 8 to 10 or 12 size, and that's basically the thickness of the catheter.

Pete Reed 35:20
My question, to both of you, as we continue this last bit of sharing hope, it's about what should people do and where should they get their information. Because if they're a little bit worried, I think you could use a search engine on Dr. Google. Dr. Google. And you could put some stuff in, and it could take you all over the place with this subject area. So I'm putting you on the spot a little bit, but with your experience, I think you'd know, where can people, because we've talked about asking people to go and see their GP. We've also been saying that their GP don't always know, because it's a little bit taboo, the loo taboo thing. So how can people arm themselves with information, what sources are available, where would you send people, so that they can get appropriate information and ask the right questions to the right healthcare professionals?

Emma Russell 36:11
Well, there's so many charities about aren't there. There's the bladder health UK, bladder and bowel, the MS Trust. There's lots of different charities, ACP, yeah.

Pete Reed 36:22
So charities is the third sector, I think? Third sector. But always a safe space to go to for information, as opposed to just googling and coming across any old website.

Michelle Hogan-Tricks 36:31
So I think whatever your condition is, try to find the charity or third sector as we call them as well. That's responsible for that. So, for example, Spinal Injuries Association, cauda equina have CESCI, so C E S C I, Multiple Sclerosis Trust, there's also the MS Society. There's Prostate Cancer UK, all of these, you know you're going to get robust information of course. NHS as well. NHS. we, Coloplast, have a wonderful, I'm biased obviously, because Emma and I are very much involved within the education on our website, so it's absolutely wonderful.

Pete Reed 37:19
So, coloplast.co.uk and then I've seen lots of infographics that have been useful my education that I was shown by nurses five years ago, and people can go there as well for all incontinence issues, but are there incontinence charities if someone's just worried about this doesn't seem right or it wasn't like this a year ago?

Michelle Hogan-Tricks 37:41
Yes, so there's Bladder and Bowel UK. If it's children there's Eric, Eric is wonderful because so many children experience, in particular constipation, so it's not always, you don't always get the right information, so, Eric's wonderful.

Pete Reed 37:57
How do you spell Eric?

Michelle Hogan-Tricks 37:58
E R I C.

Pete Reed 37:59
Cool, great.

Emma Russell 38:00
Nice and simple, nice and simple, yeah. Yeah, Bladder and Bowel UK. But it's knowing that you're not alone, yes, and there is help out there in talking.

Pete Reed 38:10
Thank you both of you for coming in to share your, I'm sorry to say, again, decades of experience and this is, this is your, sorry, this is your world, so I'm saying it because we don't take it for granted. It's your world, so you speak about it very confidently, with extreme competence, you're the medical experts in this place, but, and I'm sure you've seen and done everything in your careers, we're really grateful that you've come into, speak to us, share that experience. You made it very, very easy to talk about and I've said before but a very difficult subject for me to talk about, so thank you for making it easy and sharing that with me.

Michelle Hogan-Tricks 38:49
Thank you for being so open.

Emma Russell 38:51
Yeah, thank you for having us. Thank you for doing this because I think a lot of people get a lot of, a lot of listening to.

Pete Reed 38:57
Well, wouldn't it be nice if we started seeing those five year numbers come down or started to see people progress through your pyramid a little bit quicker or, arm themselves, or feel a little less ashamed and accessing what they need to.

Michelle Hogan-Tricks 39:11
And I think that's, that's the thing and I know it's really easy for us to say this, but, you know, you said we talk about this a lot, we really, really do and just to, just to reassure people, I know it's difficult but, please, please, please do go and speak to your healthcare professionals because we talk about it all the time and we, you know, we'll have, I promise you whatever you say we will have heard it before so please just, yeah, pop along, speak to somebody and pursue it if you don't feel like you're getting, you know, the right advice.

Emma Russell 39:42
You might feel embarrassed but you won't embarrass us.

Michelle Hogan-Tricks 39:45
Yeah, we won’t be embarrassed.

Pete Reed 39:47
Michelle, Emma, thank you so much.

Emma Russell 39:48
Thank you for having us.

Michelle Hogan-Tricks
Thank you

Narrator 39:50
On our next episode, Pete is chatting to Coloplast Ambassador Jack and Hannah Gagen from Coloplast about continence care products. 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.