Dr Naomi Farrington is an Advanced Nurse Practitioner in Chemotherapy (Trainee) at University Hospital Southampton NHSFT, and an NIHR/HEE Clinical Lecturer at the University of Southampton. Her previous research has focused on continence management in people with cancer, and current projects include multimorbidity in older cancer survivors and investigating cancer services for people with dementia. She will be speaking at the upcoming Joint BGS, Macmillan and RCR OncoGeriatrics Meeting on Wed 27 - Thu 28 February 2019.
Bladder and bowel problems present huge complications for people across the age span. Around 14 million men, women, young people and children in the UK live with bladder problems and 6.5 million adults suffer from some form of bowel problem. These greatly impact upon wellbeing, for both patients and their caregivers. Quality of life for patients and those close to them can be further impacted by the addition of other factors, such as frailty, and comorbidities such as dementia. Despite this, people often delay seeking help for bladder and bowel problems for significant periods of time. These issues in older people may be viewed as simply part of the aging process, and therefore they may not receive the attention they need.
People who have cancer, and those undergoing treatment for cancer, can experience multiple bladder and bowel difficulties, both due to the disease itself and to the treatment. One of the most common problems is urinary incontinence after prostate surgery. Another is colitis caused by immunotherapy treatment. It is important to remember that these problems can often be resolved, and the vast majority of those living with them can be helped. When considering how this might be done, healthcare professionals and patients should take in to account:
- The root cause of the dysfunction – this will determine the treatment needed.
- The impact on the person and those close to them – both in terms of the effect the problem is having on their overall wellbeing and quality of life, and the likely impact of the suggested management strategy.
- The person’s circumstances – are they fit enough for potentially invasive investigations involved in urodynamic testing, or treatments like electrical nerve stimulation? Priorities will be very different if someone is approaching the end of life.
- What is practical to offer – including what is cost effective.
- When bladder or bowel leakage is not curable or when treatment will take some time, it is important that people are helped to manage containment effectively.
Various sources of assistance and advice are available for patients, including the Bladder and Bowel Community, Age UK, and Macmillan Cancer Support. Healthcare professionals should point patients towards these supportive communities. Advice for professionals is available from local continence services, NICE guidelines, and specialists working in uro-gynaecology. An excellent resource for finding out about continence products is the Continence Product Advisor, which can assist professionals and patients in choosing products to suit their needs including containment products such as pads, toileting aids, and clothing modifications.
My advice to patients experiencing bladder and bowel problems is to be brave enough to talk about them, and my advice to healthcare professionals is to be brave enough to ask about them.