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.

In our last episode, Pete speaks with Jack and Hannah Gagan about innovation in continence health care.

Pete Reed 0:39
So I'm kind of excited about a product called Heylo that Coloplast are producing because, well, I don't use it. It's a product that's, uhm, is a ring, hence the name, that goes around a stoma and gives you some digital feedback onto an app on your phone about when you're leaking. And, that gave me a lot of confidence because when I'm thinking about the process of getting a stoma, whether or not it would work for me, part of my decision and it's, it's, it's informed, right? I, I don't, I don't know enough, so I need, I need to myth bust a little bit, uhm, but I wouldn't want to be sitting, ehm, uh, a black-tie mess dinner with, with the navel admiralty, in my, in my position as an honoree captain and then suddenly my white shirt goes brown and, and that was something I was worried about and then I was told about this, this product that you get an alert before that happens. Wow.

Hannah Gagen 1:36
I think in terms of like the innovation piece in stomas and stoma bags is that ultimately, I think the best product for that person will be the one that allows them to live the life that they want to live. And that can be in terms of innovation, so I think over the years we've seen all companies do so Coloplast back in. I mean, we've been working like since ‘78 in the UK, we actually, it was a nurse at Coloplast who created the world's first disposable stoma bag. Before they were big rubber bags with corsets, we were talking all the way back there, it's like in catheter care, I mean, casters were using like 3000 BC, right? So they're not new things, but the story's been going on for a long time and the innovations have been things that rather than just addressing the physical, so like the leaking, which is obviously incredibly embarrassing. Like, I think also it depends if you've got a colostomy or an ileostomy about the smell and things like that. But it's the fundamental checking. Like, I've probably forget how often I just check my tummy to make sure that it's not wet or that I'm not leaking.

Pete Reed 2:39
It's just habitual now.

Hannah Gagen 2:40
It's absolutely, absolutely habitual. And I think for some people, obviously, the active leaking in itself, you don't ever forget. And then I think that prevents many people from leaving the house. It prevents them from going to work. I mean, what, you know, things that you said about that idea of being able to just like self-manage, take back control. And that's what a stoma allowed me to do, is that I wasn't bound to the toilet. Now, what I have to think about is how many bottles of wine can I drink before I need to get to the bog sort of thing? You know, like, how many bowls of pasta is going to push me over the edge? It's that kind of thinking about, because I've got barely any short bowel. So everything I eat just kind of comes out straight away. So, I still need to be near toilets, but not like I used to.

Pete Reed 3:22
Well, you said you'd love your stoma.

Hannah Gagen 3:24
I love my stoma.

Pete Reed 3:25
Oh, my god.

So, so much passion in your eyes as well. Yeah. So, that's new to me. All of this subjects is I think is new to listeners. Can you explain why?

Hannah Gagen 3:34
Before I had zero control and I was on so much medication, and then in the end, when we fought to keep my internal pouch and it didn't work, we had another stoma formed. So, I had what was called a loop ileostomy, turned into an end end ileostomy. And then they gave me what was called a Barbie butt. So, when the Barbie film came out, I've got a nice photo of me in the cinema, like all in pink, the Barbie butt thing. The Barbie butt is where they removed the anal stomp, as we were talking about earlier. And you're sewn up, up your bum, nothing's there. I can't say what I've said in another podcast before because I edited it out, but it means your sexual preferences might be different if you're a man or woman, and it depends what you're into. So, but my fiancee and I spoke about it on the first day.

Pete Reed
We leave that in here.

Hannah Gagen
Yeah, I’m fine with it. But he was like, it was on those things, I was like, look, if you're into it, it's not going to happen. It's gone. So, that happens, and then I suppose everything else changes. But what it allows you to do, the reason why I love it, is because I've got my independence. I can control everything. And what I love in terms of the innovation piece that you're talking about is companies now don't just look after that physical bit about leaking, but they're thinking about your mental health with it. And I think that's where innovation has to go with Stoma Care as well, is because, you know, things like loads of companies thought about different coloured bags. And for me, that was a game changer when the first company did that because it was like, oh my god, it matches my underwear, it matches my bikini. I feel like, I just feel like less medical. And for me, innovation was always feeling about less medical. When you've got like 16 people at the bottom of the bed looking up bits and pieces, and all of a sudden you just don't feel like that. So, anything that moves you into that space, you're just feeling more human, more dignified, a little bit sexier. That's what innovation is for me in Stoma Care.

Pete Reed 5:18
Amazing, thank you for sharing.

Hannah Gagen 5:19
You're so welcome.

Pete Reed 5:20
Yeah, it's so important to have the conversation and it's not just about products, it's about feeling, dignity, awareness, conversations. What do you think is there a conversation to be had at the decision-makers level as well? Yeah, it's not just the companies, it's not just the users that need to be talking about this. I think a comfortable conversation in governments, how to fund this stuff, how to make sure people access the right equipment for them.

Hannah Gagen 5:47
Yeah, I think the, I mean, Jacq’s does a lot in this space as well. And we could probably talk about it for hours about what's going well and what's not. But I think the main thing is that bladder and bowel issues are actually technically not expensive to treat. But because we don't talk about them, because they're not raised up to the government agenda, because of the natural nature ofthe taboo of them, they don't really get onto the policy agenda, because we don't talk about them, because people don't really like to. So the more we talk about them, the better. And it opens up a space where people feel that they can talk about them. So we did something called the Catheter Challenge, where we built a loo in Parliament. That was cool. We've done things where we did a Stoma relay into government, where people all that we had like loads of people had stomas, and we handed over this policy baton and little Jess, who's amazing, got a stoma. She went over the finish line with her Stoma bear, and then we did some stuff in Parliament. And it was amazing. And that's the kind of thing where because it's a bit like 'Oh, it's poo and wee', you got to do something different. So I think we've had some really successful stories and talked about that stuff.

Pete Reed 6:49
So it's great that there's success in that area as well. I'm raising awareness at that level, because although some of the stuff is not expensive to treat, people with ostomy needs, catheter needs, what I understand is quite expensive is re-admissions to hospitals, for UTIs, bacteria as expensive, the AMR, that's costly in a different way. Very much so. And antimicrobial resistance, sorry. And where I found innovation that's helped enormously is reducing my reoccurring UTIs from the previous product I use. I've spoken about this throughout the series, is moving on to the Luja product that's enabled me to catheterise five times a day with more confidence that I'm lowering my risk of UTIs. And that's proved itself to be the case since I started using in Luja in August 2023. I've had a really good run, felt much better for it, felt like I'm contributing more to society. More like myself, I don't feel like a patient. I'm using fewer antibiotics, at just one other people to have experiences in their ostomy or continence world with products and innovations that work for them to give them the same feelings that I've had as a result of innovations.

Emkes 8:10
I think certainly at a government level it's about opportunity costs. If that's the right economic term that if you don't do this properly, then they add on that are going to be huge. So to do catheters, stomas properly will save you so much money. But it is, as you say, admissions to hospital. There was a fantastic, it started during COVID down in Cornwall. The catheter bus. Its like a pizza delivery service. And they unplugged catheters, they sorted out new catheters, they fixed people who had fallen down because they had a UTI, they fixed their antibiotics. And they had the most incredible success rate, something like 90% stay at home rate. So those are people who would have been in A&E. Now that is extraordinary, so it's not rocket science, it's not that complicated. Can we just make sure that the awareness is there, government allows us to spread the awareness, but actually at a much more simple level. I am aware that in general medical, well in all medical training, doctors nurses do not have mandatory bladder and bowel modules. Now that would make such a difference, we have asked through it, time and time again, but it is not a sexy subject, is it? Its not groovy to talk about. I think probably urologies are the probably surgeons who most people just don't want to be urologist. And the ones I know are so amazing. But why is there not training at a very elementary level in primary care? If I go to my GP, he hasn't got a clue, has no idea what I'm talking about. He says, you just tell me what you need. But maybe he could tell me what other catheters are there. Even if there was a cheaper product, fine, and if it's a worry for him, fine or her, fine. But then tell me, tell me why it's cheaper and could it be better? I'll give it a go, fine. But if I don't like it, I promise you, I won't use it. If I don't use it, I will end up in hospital.

Pete Reed 10:32
And that's a big swing as well. So the cost is not just somebody being in hospital and the cost of antibiotics and admissions and blocking a hospital bed. It's also that that person isn't a way, thriving, earning, contributing, helping other people. And when I was injured, because my injury was a spine cord injury and it was a spinal stroke, it was very rare. And I became with a small public profile. I became the spinal stroke guy. So people would reach out to me from all over. But since then, I've heard some real horror stories about people being a bit forgotten, a bit left at home, about reoccurring UTIs, about going back to hospital unnecessarily.

Hannah Gagen 11:12
You literally just said that they get it right. So something can stoma care. And I think it comes in other parts of the NHS is something called get it right first time, GIRFT, which is a very boring policy term. But in terms of stoma care, basically there should be a national GIRFT project, which is evidence-based, because what that would allow people to do is cut out those postcode lottery where some people are getting good care and others aren't. And the idea is in stoma care, right? Like one leak is too many. If you get it right first time, same as in ISC, is if you are unable to have shared decision making, which there's loads of literature on SDM shared decision making, if you're allowed to do that, which is where the clinician and the patient has a decent chat, they say, "This is my lifestyle, these are the kind of things I want, these kind of things I do." And the clinician says, "Well, that's all great, but here's what's clinically appropriate for you." Then that's really important and that's something. So when that's done with this kind of pathway, where everything's done right first time, in terms of cutting down those costs and readmissions and everything else, that's all part of it. So there's definitely stuff that can be done in that sense, yeah.

Pete Reed 12:17
We've been really personal, we've talked about bleeding, we've talked about sex, what we haven't covered yet is a bit about female anatomy, about periods. This is stuff I just don't know about, because although I catheterise five times a day, I've got a penis, I don't know the mechanics. So what don't I know? What would the female listeners like to hear when it comes to catheterisation and challenges of female anatomy?

Emkes 12:44
It’s quite interesting I've just been asked to, some of the work I've been doing is what you call a PPI patient, public involvement. That one.

Hannah Gagen 12:57
You just like saying pee all the time.

Emkes 12:59
On research projects. And to begin with, I just thought, I have nothing to say, these people are so clever, they are brilliant clinicians, academics, researchers. I haven't got a clue. But then you go on to the calls. Most of them are virtual. Thank you, COVID. So I can get to the loo quite quickly to have a pee. One of the projects I've just been talking to some women. So I tend to sort of host a group of patients who are a little bit embarrassed about talking about anything in front of a clinician, but somehow they don't seem to mind talking to me. And this particular group, there were 35 women on the call. Most of them were pre-menopausal. So that means that they are still having periods. Some of them are having very heavy periods. Some of them having what they call interval periods. And some of them are having what we call more normal periods. And my only question to the clinicians was, well, how do we know which one we're in? Some are like me, because the hysterectomy, I have had no periods, thankfully, since my 40s. But other people, if they've got heavy bleeding, they may have a polyp, fibroid. And these are things that women are going to be worried about because, of course, they're going to think it might be some sinister reason. And so they will have a scan, fortunately not as graphic as our urodynamic 50 Shades. So they have a very simple ultrasound scan, which will pick up that there is something either on their ovaries, on their uterus, which may be causing this heavy bleeding. Now that can be managed with medicine, or it could be managed with taking that polyp out. With actually not too bad a procedure could be under general, could be under-local, you could be awake. And so pre-menopause, or women, have a raft of issues that they are facing on a day to day basis, and still trying to get to work, still trying to bring up their children, and walk the dog, and swim and and and.

Hannah Gagen 15:23
I think it's that combination of all of the things, right? So when you talked about periods and things like that, so one of the other... I know other people in the stoma community who also have endometriosis, so why have endometriosis? Didn't think that was coming my way, but I suppose it's because it's when I had ulcerative colitis, there were all natural inflammatory responses. So I've got endometriosis.

Pete Reed 15:44
Explain what that means.

Hannah Gagen 15:47
So I can explain it really badly. But essentially this is the most basic version, is where bits of your womb, technically the cells grow on other bits of your body. So it is excruciating. It is horrific. So imagine like a normal period, I know you can't do that, but it's like... It's awful, and then it's like times 10, so the pain is excruciating. And it's really hard to explain that kind of pain, but it's like a burning deep sensation. So the options are various. I know we've got a brilliant ambassador called Battle With Endo, and then some others who have done loads of stuff on women's health project and things like that, talking about endometriosis as well. But at some point, I remember being again in hospital, I remember like, I was having... poo come out my bum, blood come out my bits, puss come out the middle. And you just like all these fluids all the time, your life becomes a journey of just fluids. And like what's mopping what up? I mean, I had back therapy to suck out the fluid from the infection. But then it would sometimes get some of the poo from the stoma. I was just like, "Oh my God, I'm just surrounded in fluids." So I suppose maybe just as a woman, it feels like there's just that added extra something, like you've got a sound of shell or tampon to take out with you, then you've got your stoma supplies, you're going to see supplies. And it's like, when people look at something like, "Why is your bag so big?" I'm like, "Babes, I've got half of Boots in here" You know what I mean? It's like, it's those things, I suppose, we just have to think about those extra bits and pieces.

Pete Reed 17:12
For those reasons, do you think there's more of a taboo with female discussions about a continence than they are for men?

Emkes 17:20
The thing is, they shouldn't be. That's what's weird, because we're really good now, talking about menopause, I think that's fantastic. So that's about less blood I guess, but all the hot flushes and fortunately I didn't have to go through all that... I'm jealous myself, You can be so jealous. That's a real positive for me. People being one of my colleagues, so foul, at school, she was so menopausal, and we can laugh about it now, but it was a really grim time for her. But now people are talking about it, so that's the bit I didn't get, and we're really good on stomas. Even Lego has got stoma figures.

Hannah Gagen 18:02
We did, yeah, we did a podcast for Lego, yeah, so yeah, it's really cute, it's on another podcast, I don't know, we have a cross advertising podcast. But yeah, we did one with Lego, and she's called Sarah, and she's in a water park. And the reason why Lego chose to make Sarah, the first stoma character, first character with a stoma bag, in a water park is because she would be there in her bikini, living her best life, not hiding it, and for representation purposes, that's phenomenal. So we did actually say to them, could you just do one with a catheter next time, like a little locker with some bits and pieces, which is what would be so good. But I think it's that point about why do stomas get spoken about, and catheters don't, if stomas have become, like we've had these campaigns, like, get your bag out, and it's quite visual. It's not like you're just going to go and open your legs to somebody and be like, look at my bits, it's very... Like, how showing an abdomen is obviously very different from showing your private parts, right?

Pete Reed 18:52
And nobody's doing Reels with their legs open, showing the genitals. Not on this platform, they're just...

Emkes 18:59
We said that the other day, we can't do fannies and willies, but we can get close. Yeah, I mean we can actually show what a character looks like. Everyone, when you say "catheter", what do everyone think about? We don't think about...

Pete Reed 19:10
We've got models, haven't you heard? I've seen this. Yeah, we've got Boris and Doris, so.

Emkes 19:14
When you say "catheter", what people actually think about is the big long indwelling catheter connected to a bag on your leg, which is, generally, a catheter obviously. But to let people know that there are other things available. And that is maybe something that you might be able to use if you're having issues emptying or if you're overflowing or for whatever other reason, you are unable to use your bladder properly. You don't necessarily need an indwelling. Indwellings, as we know, were invented brilliantly by Dr Foley. But that was in the 1930s.

Pete Reed 19:54
I read a little bit about your late friend Professor Roger Fennelly. Oh, brilliant man.

Emkes 20:00
I love him.

Pete Reed 20:00
A champion of all things, progress, busting taboos.

Emkes 20:05
He and two other neurological surgeons made a case some time ago, now, probably even 10 years ago, for the trauma experienced by patients with an indwelling catheter and they produced a video to show what was happening. As the bladder begins to empty and begins to get basically sucked into that balloon that's in your bladder to keep it in there. They did lots and lots of work. They spoke to me. They spoke to Melanie Reid, the Times journalist. And they were really, really pushing and trying to get a much greater awareness. Unfortunately, those men have all three of them now died. But I really hope that we can keep their legacy going. And they started this and they were absolutely determined that a patient going into A&E isn't necessarily immediately given an indwelling catheter. Because it's a bit easier. I can see that. It's a bit easier to put the indwelling catheter in. You've got a lady with a broken hip, for example, my mother a few years ago. And they said, oh, we just put a catheter in. She actually refused. So, as you recover from operations to get people moving, get them moving towards the toilet. My parents sadly died last year. One of the things that I was really impressed with at the nursing home was that they were getting them out of bed. They were encouraging them to get to the toilet and they were not using catheters unnecessarily. But that made a huge difference to my parents' dignity, to the respect that we felt for them. But actually, in a really simple sense, it made them walk. It made them, albeit ten steps. They did get to the toilet and back. And I've seen that in hospital as well with my parents in elderly wards. They were much better at getting people to move. But I don't think that's the case everywhere. I can understand. It must be so easy. I'm just probably a catheterian. So, the innovation that we're meant to be talking about, or we are talking about, is that even elderly people could be using self-catheterisation. If they've got the cognitive ability, if they've got the dexterity, if they haven't, their carer’s, I would have felt my mum and dad. Dad ended up with an indwelling, just because he was in retention. And it would have been difficult for him, but for other patients there is, there are possibilities of using the innovations that there are. Don't just go for the easy cause. It might actually be simpler in the long term to do something better.

Hannah Gagen 23:10
I think in terms of advice and places people can go because I think we spoke about earlier. One of I suppose I would say, depending on your condition, there are some brilliant charity websites. So, the Spine Injuries Association has great information. And actually, on February the 10th this year, they've got the first paralysed bowel awareness day in Parliament.

Pete Reed 23:29
So, February the 10th.

Hannah Gagen 23:30
February the 10th, yeah. And there will be one every year after that. So, that's definitely about educating MPs, peers and policy makers about the fact that the body is just not paralysed, but the bowel is as well and that's a huge piece of work by them. So, hats off to them. MS Trust is brilliant. So, they've got brilliant resources as well. The Urology Foundation are great. And then I would say if it's about self-management and knowing your right, check out the NHS Constitutional Rights. It very clearly says, what's in your rights and what's not, but I think you need to be able to translate that a little bit. And then also I'd say the Patients Association have got brilliant stuff on Shared Decision Making like, EG, what is it, what are the barriers to it? And then there's all kinds of this whole world out there that exists, like the patient information forum that believes information is a therapy in itself. So, it does take a bit of a reading and it does take a bit of control and effort to go and find out. But I do believe that getting great health care is 50% on us. It's not just the medics. You know, we have to take some responsibility ourselves if we can.

Jacq Emkes 24:31
I totally agree, and there's some amazing bladder chores that we have, advice lines who are picked up by nurses. So, they do actually have the professional advisors on their lines and they can issue lots and lots of information packs. But actually perhaps guide you through the huge amount of info that you might be able to get from Dr. Google. But you're not quite sure what is a trustworthy source, somewhere like Bladder Health UK, Bladder and Bowel UK, there's charities that will actually hold your hand and look after you. And I would really signpost them.

Hannah Gagen 25:12
I think TUF also now have a UTI, I think they've got a UTI information line as well now I think.

Pete Reed
How do you find TUF?

Hannah Gagen
The Urology Foundation online, you Google it in, and I think if you look at their resources they have something there too.

Pete Reed 25:26
Hannah what happens if people don't have a patient advocate, if they don't have a next-of-kin wife, husband and partner? What's your advice?

Hannah Gagen 25:33
In stoma care, the first thing would be your stoma care nurse is your most important advocate. I think outside of professional bodies and the nurses themselves, if you don't have a carer or a paid carer or a loved one, I'd say that there was some resources that you could also look at. I think it's really important for patients to have access to their own clinical records, which is over the years become something known as shared record shared. And there's people like websites called patients know best where you can look at that kind of thing. But the idea is much more empowering if you can see what they're seeing, then you're going to have a much better conversation about it. There are also patient decision aids you can find on the NICE website. So there are some in urology actually, there is one on UTIs, and I think there's another one on stress incontinence. But they're not there for all conditions but something like the patient decision aids are also really important as well.

Jacq Emkes 26:28
Not many people know that the NHS app is now improving and depending on what your GP allows, you can pick up your test results and letters to your GP, which actually has been incredibly helpful when you're going to see a consultant in a hospital to take those letters because they don’t seem to be able to communicate across…

Hannah Gagen 26:50
And actually Jacq you’ve just made me think. If you're going to have an appointment and it sounds so obvious, but write down your questions before you go into that appointment, because you know you're going to be like, you're in that medical situation. So I would say always write down the things that are bothering you. You don't want to avoid that thing where your hand touches the door and you turn around and go, oh, and another thing. You want to be able to have that proper conversation, it sounds really basic but having them on the phone as a prompt or something. So you get the most out of that appointment, they are quick appointments, right? Often. And the NHS is stretched but really push to get your questions across before you leave. Don't feel embarrassed to be like, oh I'm wasting your time, don't. It's your care, it's your appointment, make the most of it.

Jacq Emkes 27:28
My best GP who sadly is so important, he's not at my surgery anymore, but he would take my phone from me with my list. And he would start from the bottom because he said the most important question you wanted me to answer today is always the last one on your list. And he would just go through them. It is difficult for people because quite often they'll be told, oh, you're only allowed to talk about one thing in this consultation. But don't stand for that, just sit there with your list. You are the patient, you deserve all the hope you can get in that quick ten minute consultation. There are some fantastic apps as well. And there's one called "Confidence", which is quite... it was produced in Bristol which is giving lots and lots of information and directing you to charities. We should really highlight that a bit more, I’d forgotten about that one.

Hannah Gagen 28:29
Women, if you think about it, we have so many interactions with the health care system as soon as we start having our periods. If not before with vaccines and stuff. Whereas men, they come much later to it. They don't have that natural routine of going to the GP. So I think also, charities like Men's Health Charities, there was this really cool thing, like Men in Sheds, some of them did a few years ago, which was about bloke. So I know there's loads of amazing mental health charities like men talking about it. That has been one of the most delightful thing to see in years. There's actually men just having a chat about their health. Whether it's about wee or mental health, that's massively important. The prostate one. Boys need bins, we didn't talk about that, but again, the campaign to make sure that you can dispose of your catheters or underwear and toilets and stuff. That's a great one and that Prostate UK

Jacq Emkes 29:15
Girls need a considerably bigger bin. You wouldn't know this, but they are too small and usually overflowing, basically with blood products. So trying to get your catheter stuff into there is almost impossible, so they're horrible, aren't they?

Hannah Gagen 29:31
I just don't like when they're wedged next to the bog and they feel like you’ve got mad, fat thighs. Because you're like, oh my god, my thigh’s stuck to that, like, it's horrible. Yeah, it's not graceful.

Pete Reed 29:39
I tend to wrap my catheter up, put it back in the bag. Yeah. Do a little fold, put the little sticky thing over and take it away with me.

Jacq Emkes 29:46
Yeah, that's what I do.

Pete Reed 29:47
But just because it's easier. Much easier. And no, I know I didn't know that. I can't thank you both enough for sharing your wisdom. So that experience of where to go, who to ask, the advice and tips that you've just shared, your personal experiences, which are hilarious and amazing and traumatising. And it's a relief to me to talk about this stuff with people who have gone through their similar journeys as well. So I know the listeners will be grateful in the extreme, so on behalf of them let me thank you both for coming in. It's been a real pleasure talking to you. It's been a conversation about incontinence. And I think we're just, I know we're a small part of adding our voices to this journey. We've got pioneers who've, who started the ball rolling and there'll be many more, including us talking about this stuff into 2030 and beyond. I'm really grateful. Thank you for coming in.

Hannah Gagen 30:44
Thank you so much. Thank you for highlighting this. Yeah.

Jacq Emkes 30:48
So, so important. So important to normalise it and have a bit of a laugh. Thank you, Hannah. You're so welcome.

Pete Reed 30:56
This was the last episode in this series of Incontinence Talks. So thank you not only to Jacq and Hannah but also to Emma, Carmel, Samantha, Dani and Michelle for discussing such important topics with me. Wherever you are on your continence journey, I hope you found something relevant to you that's given you a lightbulb moment. To learn more, there are a host of amazing charities that can provide focus support depending on your particular needs, as well as lots more information at coloplast.co.uk. I'm Pete Reed. Thank you so much for joining us on Incontinence Talks and I hope we've made you feel more confident about your continence.

Hannah Paterson 31:34
Thank you for listening to Incontinence Talks. And remember to consult your GP if you have any worries about your own continence.