Bladder and bowel interacts and have a significant impact on people’s quality of life and well-being. Many suffer in silence, too embarrassed to mention it to their doctor or nurse, often missing out on life improving treatment and coping strategies.
How bladder and bowel affect quality of life
Bladder and bowel dysfunction affect people’s quality of life in many different ways. You have probably encountered the examples below, but your patients might experience additional challenges, based on their specific conditions and life situations.
- Diminished feeling of well-being1
- Decreased self-esteem2
- Anxiety and depression2
- Time-consuming bowel regimes3
- Restricted daily activities1,2 and social isolation2,3
Stigmatizing and life-changing consequences
When bladder and bowel dysfunction is caused by a neurogenic damage, QoL is generally worse. Neurogenic bladder and bowel have been described as one of the most stigmatizing and life-changing consequences after spinal cord injury, with adverse impact on a patient’s QoL.3
These are the words from a man who has been living with spinal cord injury for over 30 years.
If I would rank them, the bowel situation is the worst, the bladder problems second worst and the loss of sexual function third. I am a tetraplegic but still the continence issues are more upsetting than my limited hand function.
The majority do not seek professional help
No doubt, many people suffering from continence issues are anxious to conceal the problem, and reluctant to discuss it. It can be related to embarrassment or a belief that incontinence is normal in women after childbirth or both sexes after a certain age. Poor awareness of treatment options generates a feeling that nothing can be done.5
The quote below is from a woman suffering from both bladder and bowel dysfunction due to MS.
It’s so personal. People don’t feel comfortable with the subject and it’s exhausting having to keep explaining. Plus, for myself and many others it’s a big mental hurdle. Continence problems can really have a negative impact emotionally and on relationships.
With appropriate intervention, bladder and bowel symptoms and QoL can be significantly improved6, but two thirds of those suffering from incontinence don’t seek help due to shame, a belief that it is normal or can’t be fixed.5 Patients also tend to avoid the subject when seeing a doctor. Therefore, a greater responsibility rests with HCPs to ask about continence issues as part of a routine assessment.6
Incomplete assessment could affect both the choice of a suitable treatment and the monitoring of the most troublesome symptoms. Effective consultation where the patients’ individual symptoms and QoL issues are communicated is essential for a successful management plan.9
So how can we learn more about patient’s needs?
In a comparison between different types of studies, confidential questionnaires result in a more accurate picture than face-to-face interviews. This is not surprising considering the reluctance to discuss incontinence even with a known and trusted HCP.5
To conclude, HCP and patient need to find a common language for describing the bladder and bowel issues. Successful communication and understanding of patients’ issues could lead to improved rates of treatment, enhance patient satisfaction and QoL and potentially reduce health-care costs.9
For bladder and bowel assessment we have put together a Medical History form – a free download for you to use with your patients.
1. Whitehead WE, Borrud L, Goode PS, et al. Fecal incontinence in US adults: epidemiology and risk factors. Gastroenterology. 2009;137(2):512-17.
2. Edwards NI, Jones D. The prevalence of faecal incontinence in older people living at home. Age Ageing. 2001;30(6):503-7.
3. Ranson RN, Saffrey MJ. Neurogenic mechanisms in bladder and bowel ageing. Biogerontology. 2015;16(2):265-84.
5. Wu JM, Matthews CA, Vaughan CP, Markland AD. Urinary, fecal, and dual incontinence in older U.S. Adults. J. Am. Geriatr. Soc. 2015;63(5):947-53.
6. Zickler CF, Richardson V. Achieving continence in children with neurogenic bowel and bladder. J. Pediatr. Health Care. 2004;18(6):276-83.
9. Johannessen HH, Stafne SN, Falk RS, Stordahl A, Wibe A, Morkved S. Prevalence and predictors of double incontinence 1 year after first delivery. Int. Urogynecol. J. 2018. doi:10.1007/s00192-018-3577-7.