What is enuresis?

Enuresis is emptying the bladder (urinary incontinence) during sleep. Many people are aware that enuresis, or bedwetting, is a common issue in childhood. However, it can continue from childhood into adulthood, or start at any point in adulthood, including in people who did not have bedwetting as children.

It can happen whenever the affected person goes to sleep, including at night or during daytime naps, or may just happen occasionally.

If there have never been six months of dry nights every night, urinary incontinence during sleep is known as primary enuresis. Primary enuresis is thought to affect 1 – 2% of all adults. Wetting that has started after at least six months of dry nights is called secondary enuresis. Secondary enuresis is more likely to be a symptom of another underlying health condition.

Enuresis is more common in women with other bladder problems, in older adults and in some others, including people with Down syndrome.

What is the difference between enuresis (wetting the bed) and nocturia?

Enuresis will only happen if the affected person is unable to wake to the bladder signalling that it needs to empty. If the person is able to wake up, they would get up and go to the toilet. Waking to go to the toilet is called nocturia. It is usually not considered to be a medical problem, unless it is happening two or more times a night.

Enuresis and nocturia can both cause embarrassment, frustration, disturbed sleep and relationship issues. There is information about nocturia in the Bladder & Bowel UK leaflet here.

What causes enuresis in adults?

Most people do not need to pass urine more than once a night and can wake if they need to do this. Not being able to wake up in response to the bladder signals causes enuresis. However, there are a number of reasons why someone may need to pass urine at night.

These include:

1. The kidneys not being able to reduce the amount of urine they produce at night in the way that they usually would. Arginine vasopressin is a hormone that tells the kidneys to make less urine. The body should produce more arginine vasopressin at night. If someone is not making enough arginine vasopressin, urine production at night will be closer to daytime levels.
   
   
2. If the bladder is not storing urine as well as it should be. This may be because the bladder is smaller than it should be, or because the muscles in the bladder wall are less stretchy than usual or are tightening when they should be relaxed. Extra tightening of the bladder wall muscles is called bladder overactivity. Many people with this problem will need the toilet more frequently in the day than usual, may get very little or no notice of needing to pass urine and may get some daytime urinary incontinence (bladder leakage).
   
   
3. Urinary tract infection can cause wetting due to an increased need to pass urine or due to scarring if there have been repeat infections.
   
   
4. Enuresis can be a symptom of type I and type II diabetes (both types of sugar diabetes) as well as a rare condition called diabetes insipidus. Diabetes insipidus is an inability to reduce urine production.
   
   
5. Enuresis can be caused by an obstruction somewhere in the urinary tract (the bladder or the urethra – the tube that urine flows down when going to the toilet). Blockages can be caused by stones in the bladder or urethra, or an enlarged prostate in men.
   
   
6. Constipation. This can be severe enough to partially block the urethra. Also, when there is constipation the full lower bowel can put pressure on the bladder and result in it being able to hold less than usual, which can result in enuresis.
   
   
7. Fizzy drinks and caffeine (tea, coffee, cola, many energy drinks and hot chocolate contain caffeine) may irritate the bladder and cause urinary problems.
   
   
8. Alcohol has a diuretic effect (it encourages the kidneys to make more urine) and affects sleep, so may make it more difficult for the person to wake to bladder signals.
   
   
9. Some medications including some used for mental health conditions, diuretics (medications that increase urine production) and medications to improve sleep, are linked with enuresis. If you think that enuresis is being caused by a medication that you are taking speak to your healthcare professional before stopping the medication.
   
   
10. Sleep apnoea (stopping breathing while asleep) and snoring have also been linked to enuresis.
    
    
11. Some neurological disorders or damage to the nerves controlling the bladder muscles may result in enuresis.
    
    
12. Smoking, being overweight, not taking much physical activity and high blood pressure are associated with enuresis in women.

Psychological problems including anxiety, depression, feeling tired all the time have been linked to enuresis. However, it is not clear if they happen because of the enuresis or make the enuresis worse.

For many adults with enuresis there may be more than one issue that is causing or contributing to the bedwetting.

Should I speak to my healthcare professional about enuresis? What will they do?

Enuresis should be investigated to make sure that a significant underlying health problem is not being missed. Your GP or other healthcare professional will ask you questions about any other bladder problems, any medications you are taking, and what other illnesses you have or have had in the past and whether you have had any surgery or injuries.

They will check a urine specimen to make sure you do not have a urine infection or type I or II diabetes (sugar diabetes) and may ask you to complete a bladder diary. The bladder diary is usually a three day record of your drinks and visits to the toilet to pass urine and any other symptoms, such as bladder leakage and how strong the urge to visit the toilet was.

Your GP or healthcare professional should explain the outcome of the assessment to you and outline what they think is causing the enuresis and the options for treatment. They may refer you for further investigations or to a specialist service for support.

What treatment is there for enuresis in adults?

Recommended treatment will depend on what the assessment suggests is causing the wetting. Sometimes simple lifestyle adjustments can be helpful, regardless of the cause.

These include:

1. Drink plenty of water-based drinks during the day, but avoid all drink in the last two hours before bed. Good daytime fluid intake can help to improve the amount of urine the bladder can hold.
   
   
2. Avoid caffeinated, fizzy and alcoholic drinks, particularly in the evening. This is because these can irritate the bladder lining and caffeine and alcohol may have diuretic effects (cause the kidneys to make more urine.)
   
   
3. Discuss the use of sedatives (medication for sleeping) with your healthcare professional. They change sleep and can make it more difficult to wake to bladder signals.
   
   
4. Weight reduction, if you are overweight, may help by improving snoring and sleep apnoea, which can cause or be linked to enuresis.

If the above lifestyle options do not help, then treatments that target the cause of bedwetting may be an option.

Inability to reduce overnight urine production 

If the kidneys are making too much urine at night then medication to help reduce this may help. Medication called Desmopressin may be suitable for some adults who are under 65 years old. Noqdirna may be a suitable alternative for some older adults.

Both Desmopressin and Noqdirna must be prescribed by a healthcare professional and are usually taken up to an hour before bedtime. They are not suitable for everyone and people over 65 years old may need blood tests to make sure that the treatment is suitable both before starting it and after four to eight days of taking it and again after a month of treatment.

If you are taking either Desmopressin or Noqdirna, you must not drink for an hour before having them and for eight hours afterwards.

Problems with bladder storage

If the bedwetting is caused by a problem with the way the bladder is storing urine, then medication to help this may be an option. Anticholinergic medications help the bladder wall muscle to stay relaxed during bladder filling and therefore may increase the amount of urine that the bladder can hold overnight. 

Enuresis due to diabetes

If enuresis is associated with diabetes, good management of blood sugar levels and fluid intake may be helpful. Discuss your diabetic treatment and enuresis with your specialist nurse or other healthcare professional.

Obstruction in the urniary tract

You may need to have scans or other investigations if an obstruction is suspected. This would then be treated. Options might include prostatectomy (having all or part of the prostate removed if it is enlarged), having the urethra dilated (stretched) if it is narrow, or having stones removed, if they are present.

Problems with constipation 

Constipation is usually treated with increased water-based drinks, dietary changes, including eating more fruit and vegetables and other high fibre foods and using laxatives (medications to help bowel emptying). Good management of constipation may help to resolve enuresis.

Enuresis as a side-effect of some medications

If the enuresis starts when you are on medicines for mental health problems or diuretics (water pills, usually used to treat heart problems), then speak to the person who prescribed the medicines. It may be possible for you to change to different treatments that do not cause enuresis. Do not stop taking prescribed medication without talking to your healthcare professional.

Sleep apnoea and snoring 

You may be referred to a respiratory (breathing) clinic to discuss options to treat problems with breathing during sleep. This can help to reduce or make enuresis better for some people.

Neurological disorders

Some neurological conditions or injuries can affect the nerves or part of the brain that helps to control the bladder. There may be appropriate treatments to help with this. Your healthcare professional should be able to advise you.

What other information is there?

If the enuresis is caused by more than one problem, it may need more than one treatment to help.

It is important that you talk to your healthcare professional about any changes to your bladder or bowel health and any new bladder and/or bowel symptoms, as they may indicate a different underlying condition that can and should be treated.

For further advice, help and signposting to NHS services contact Bladder & Bowel UK here or on telephone 0161 214 4591.

Download this information as a leaflet (PDF).

What is nocturia?

Nocturia is the need to frequently wake up in the night to pass urine. Nocturia is more common with increased with age and getting up once or two times a night is normal. However, more frequent visits to the toilet may indicate a problem that can be treated. If you start needing to make several trips to the toilet at night , you may find this distressing, or your sleep may be disturbed.

What causes nocturia?

Hormonal changes

• The body normally produces a hormone: anti-diuretic hormone (ADH). ADH enables the body to retain fluid overnight, effectively allowing your kidneys to have a rest. As you get older, some people produce less of this hormone with the result that they produce more urine at night. Look at the section on Nocturnal Polyurea (NP) for more information.

Prostate problems

• Men’s prostate glands often start growing with age. This gland surrounds the urethra (the tube that urine passes through before exiting the body). An enlarged prostate can press on your urethra and prevent your bladder from emptying properly, so you need to pass urine more often both day and night

Bladder problems

• Urge incontinence (also known as an overactive bladder). This is where you have a sudden need to pass urine and may leak before you are able to reach a toilet.
• Bladder infections: These are usually caused by bacteria entering your bladder. Symptoms include dark, cloudy and smelly urine, a burning feeling or pain when passing urine, and not being able to empty your bladder completely.

Medical conditions

• Ageing causes the heart and circulatory system to be less effective. This results in fluid collecting in the tissues of the body during the day, and you may notice fluid in your ankles or lower legs. At night, when you are resting, your heart and circulatory system work more easily and absorb this fluid into your bloodstream. It is then pumped back to your kidneys where it is passed out of the body as extra urine.
• Heart problems: If you have a heart condition, your heart and circulation become less efficient and you will notice swelling around your ankles. When you are lying down or your feet are raised up, fluid is absorbed into your blood stream and removed by your kidneys. This increases the need to urinate at night.
• Diabetes: High blood sugar increases your thirst, so you may drink more than usual and this leads to a frequent need to go to the toilet. High blood sugar levels also irritate the bladder causing you to pass urine more frequently
• Problems with the urinary tract e.g. kidney stones, urinary infections, or an overactive bladder (passing small, frequent volumes of urine and may be accompanied by urgency)
• Sleep related problems: You are more likely to feel the urge to go to the toilet while you are awake. Therefore, if you keep waking up in the night or have problems sleeping, you are more likely to need to pass urine.
• Sleep disorders e.g. sleep apnoea

Drinking fluids

• Excessive fluid intake, especially close to bedtime, will increase your need to go to the toilet during the night.

Is there anything I can do?

• Make sure you get a healthy fluid intake of 1.5 – 2 litres per day. Try reducing your intake of caffeine, artificial sweeteners, hot chocolate, green tea, carbonated drinks and alcohol. These can irritate your bladder and change your sleep patterns. Drink plenty of water and juices.
• If you regularly have swollen ankles, make sure you sit or lie down for about an hour during the day. Raise your legs and feet so they are at, or above, the level of your heart. It may also help to wear support stockings.
• Some medicines make your body produce more urine or promote its flow. In many cases this is how the medicine works to treat the condition, (for example, water tablets for high blood pressure). If you are unsure if your medicines could be causing nocturia, ask your doctor. Please do not stop taking your medicines without the advice of your doctor.
• Consider whether anything is disturbing your sleep. If your room is too light or too cold, this may wake you up. If you have painful conditions that disturb your sleep consult with your GP. Reduce any naps you take during the day to see if this helps you to sleep better at night. Also, avoid stimulants like drinks containing caffeine before you go to bed.

What specialist treatments are there?

If nocturia persists you may have a bladder or prostate problem that requires treatment.

Prostate problems

These may be treated in different ways and your doctor or nurse specialist will discuss the options with you. They may include treatment with medicines and possibly trans-urethral resection of prostate (TURP) surgery.

Urge incontinence

This is commonly treated using a group of medicines called antimuscarinics. These medicines relax your bladder so that it can hold more urine.

Anti-diuretic hormone (ADH)

ADH helps to regulate water balance in the body. A lower level of this hormone increases excessive thirst and the need to go to the toilet. In a few cases of nocturia, your health care professional can advise if medication can be taken before bedtime, to reduce production of urine overnight.

A low dose of diuretic ( water tablet) in the late afternoon / early evening may help to unload excess fluid before bed time. This causes the kidneys to process body fluid during the evening hours, rather than after you have gone to bed and promotes a better night’s sleep.

Your doctor or nurse will explain the benefits and potential side-effect of these medications. They may take a routine blood test before prescribing medicine to help your nocturia.

If you have any questions or concerns, always speak to a healthcare professional.

Download this information as a leaflet (PDF).

What is nocturnal polyuria (NP)?

NP is when somebody passes a normal amount of urine during the day, with larger volumes being passed at night. More urine is produced during sleep than would normally be expected, which is more than the bladder is able to hold. This results in getting up more than once in the night to pass urine, or in wetting of the bed (also known as nocturnal enuresis) during sleep.

There are a number of possible reasons why you might need to get up more than once during the night:

• Poor sleep
• Prostate / bladder issues
• Producing too much urine at night (nocturnal polyuria)
• A combination of these causes

What causes nocturnal polyuria?

Usually, the body produces a chemical (known as antidiuretic hormone or ADH), which tells the kidneys to cut down the amount of urine produced during sleep. If this process is disrupted for any reason, it can cause NP. We should be producing less than a third of our total urine output during the night, even with increased age (including over age 65). If we produce too much urine during the night, which is measured as more than a third of the daily total, this is described as nocturnal polyurea.

Potential causes may include:

• Your body is not producing enough ADH
• Drinking too much in the evening or eating food with a high-water content
• Excretion of excess water from the body . Some people develop swelling or puffiness in their feet or ankles as the day progresses. On lying down, the excess water which causes the swelling then passes back into the bloodstream and is converted into urine by the kidneys, causing you to wake during the night with a full bladder.

How is nocturnal polyuria treated?

The first step is that NP is identified. Any recommended treatment will be based on the underlying reason for the increased urine production at night, so varies from person to person.

What can I do myself to help with nocturnal polyuria?

It is important that you don’t suffer in silence, and speak to your doctor or nurse. They will begin by asking questions about your diet and fluid intake, and check for any ankle swelling.

You can also:

• Check your eating and drinking patterns in the evening to see if these need adjusting. You could consider reducing evening fluid intake (though avoid becoming dehydrated).
• Try eating most water-based foods, such as tomatoes, cucumbers, melons, jellies etc, during the daytime rather than in the evening.
• Try to incorporate some leg elevation rest time during the day to help your body eliminate excess water.
• Consider trying to increase exercise such as walking, as this will help with excess fluid going back into the circulatory system

What else might help with nocturnal polyuria?

Consider completing a bladder diary over three days and nights. Bladder & Bowel UK have one you can download. This will help you doctor or nurse to assess your symptoms and to direct correct treatment.

Ask your doctor to assess if you can be prescribed a diuretic (water tablet). This treatment works to help your body produce more urine during the day, rather than at night. If you are already prescribed these, speak to your doctor about taking it in the afternoon rather than other times. Diuretics are used with caution in older people, because it may precipitate water retention which can put strain upon the heart.

If you have any questions or concerns, always speak to a healthcare professional.

Download this information as a leaflet (PDF)

What is overactive bladder syndrome (OAB)?

An overactive bladder is where a person regularly experiences a sudden and compelling urge or desire to pass urine. It is not uncommon and can affect people of all ages, including children, adults and the elderly.

This sensation is often quite difficult to ignore. It can happen at any time during the day or night, often without any warning.

OAB syndrome is sometimes called detrusor instability or overactivity. Detrusor is the medical name for the bladder muscle. It can also be known as an irritable bladder. The cause of OAB syndrome is not fully understood. The bladder muscle (detrusor) seems to become overactive and squeeze (contract) when you don’t want it to.

It is characterised by several symptoms, including:

• Urgency: having to rush to the toilet to pass urine.

• Frequency: need to pass urine frequently by day.

• Nocturia: waking up to pass urine.

• Urge incontinence: leakage of urine because of not making it to the toilet on time

This condition can cause considerable distress for people and significantly affect quality of life. People with OAB might be anxious about needing to go to the toilet quickly and worry about toilet access. They might limit activities, possibly leading to withdrawal and isolation. Waking up several times at night to pass urine can lead to disturbed sleep not only for the individual but may also impact also on others in the house.

It is important to know that there are a number of things can often be done to improve OAB in someone experiencing the symptoms.

How do I know if I have got an overactive bladder?

The number of times people usually have to pass urine each day is very varied, but people with an overactive bladder tend to pass urine more often than they would expect during the daytime and several times in the night.

If your bladder squeezes without any warning, it can give you an urgent need to pass urine. This means that ‘when you have to go, you simply have to go’ – there’s no hanging about or delay. Often people with OAB have little or no time to reach the toilet and this is referred to as urinary urgency.

If the need to pass urine is so strong that you are unable to hold it, it can lead to involuntary leakage of urine.

If you have urinary urgency, this means that you might need to pass urine more often and more frequently than usual and in smaller volumes.

Your need to pass urine may be triggered by a sudden change of position, or even by the sound of running water. You may also pass urine during sex, particularly when you reach orgasm.

What causes OAB?

In OAB, the need to urinate is triggered by sensitivity from even from small amounts of urine in the bladder. This may be, but is not always, accompanied with unwanted bladder contractions.

Going to the toilet ‘just in case’ and frequent passing of urine for fear of leakage can lead to overactive bladder as this increases bladder sensitivity to small amounts of urine.

Excessive fluid intake, especially of caffeinated drinks, like coffee and tea, and fizzy drinks can irritate the bladder enough to cause or worsen the condition. Alcohol, a diuretic which increases the need to urinate, and smoking can also aggravate the bladder.

OAB may co-exist with stress urinary incontinence (leakage of small drops of urine on coughing and sneezing), which is known as mixed incontinence.

Overactive bladder can sometimes be a manifestation of other diseases or conditions, such as:

• Diabetes mellitus.

• Urinary tract infection.

• Pressure on the bladder from an enlarged uterus or ovarian cyst.

• Local disease in the bladder, such as ulcer or mass.

• Neurological disease. Conditions such as Parkinson’s Disease, Multiple Sclerosis or those who have suffered a stroke may also develop overactive bladder.

• Some medications may be associated with overactive bladder.

For this reason, it is important to seek medical help if you are experiencing symptoms of OAB syndrome.

How do I seek help?

We would encourage you to speak to your doctor or health care professional, who will ask some questions about your bladder symptoms and general health. They may also perform a physical examination.

A urine test to check for infection will usually be done, and you may be asked to attend an ultrasound bladder scan to check whether your bladder is emptying properly.

You might be asked to complete a diary for three of four days, logging how much you drink and how much, and how often, you need to urinate. Bladder & Bowel UK have one of these diaries in this section that you can download and use.

If your condition does not improve after initial treatment, you might be invited to further tests to investigate.

How can I help improve OAB syndrome myself?

Diet and fluids

Being thirsty is often a guide that your body needs water. Drinking less does result in a reduction the amount of urine produced, but the urine can then become highly concentrated which can further aggravate symptoms, needing more frequent visits to the toilet. Not drinking enough water can also cause constipation. Remember that food also contains water, particularly fruits and vegetables. It is also worth bearing in mind that some foods may further irritate symptoms, including highly spiced foods, citrus fruits and artificial sweeteners.

Aim to drink about 1.5 litres of fluid a day, adjusting the amount you drink according to your need, and spreading drinks throughout the day.

There are a number of drinks that can irritate the bladder, such as caffeinated drinks, carbonated drinks, drinks containing aspartame (an artificial sweetener found in diet drinks), hot chocolate, green tea, alcohol, blackcurrant juice and citrus fruit juice.

Drinks which are believed not to irritate the bladder include water, non-caffeinated herbal and fruit teas, milk and diluted fruit juice. Avoid caffeine and alcohol before going to bed. If you feel thirsty or need to take medications before bed, then try having small sips of water.

If you suffer from constipation, this can increase pressure on the bladder and be an irritant. Increased dietary fibre can help with constipation. Eating healthily can help with maintaining a healthy weight, which helps reduce symptoms of OAB and incontinence. It has been demonstrated that a 5-10% weight loss can help.

Toilet access

If you have an overactive bladder and have mobility problems, consider special adaptations, like a handrail or a raised seat in your toilet. Sometimes a commode in the bedroom makes life much easier.

Bladder & Bowel UK also have a Just Can’t Wait card, which helps give access to toilets not normally accessible by the public.

Bladder training and diary keeping

A technique known as bladder training might help you regain control of your overactive bladder. This is done by gradually increasing the amount of time between toilet visits, so that your bladder will slowly stretch and suppress its contractions over time. Suggestions of how to train your bladder include:

Instead of rushing to the toilet as soon as you get the urge to pass urine, try to hold on. You may find this difficult initially but try to distract yourself. The aim here is to gradually to increase both the capacity of your bladder, and the time between toilet visits to pass urine. Try to suppress the urgency feeling, for example when getting up from a sitting position, when hearing running water or putting the key in the door. Your health professional will be able to further guide on an individual bladder training plan.

Keep a diary, making a note of the number of times you pass urine, and the amount (volume) that you pass each time. Also record any times that you have a leak. Have a jug handy to measure the volume passed each time you go to pass urine.

Complete your diary for the first couple of days as you would normally go to the toilet, to give a baseline. Record each visit in the diary, including when and how much you urinate.

The aim is then to increase the time between toilet visits, holding on for as long as you can when you get the initial urge feeling. This will probably seem difficult at first. Don’t worry and try to keep calm and relaxed. If you usually go to the toilet every hour, try to hold on a few minutes longer. It can help to try distracting yourself by counting backwards from 100 or doing a crossword puzzle. Practicing this may take several weeks or longer but stick with it. For most people it will become easier over time. Eventually, the aim would be to pass urine only 5-6 times in 24 hours (about every 3-4 hours). After several months you may find that you just get the normal feelings of needing the toilet, which you can easily put off for a reasonable time until it is convenient to go. Your health care professional will be able to further guide and individually instruct a treatment plan.

Pelvic floor exercises

Doing exercises to strengthen your pelvic floor, also known as Kegel exercises, might help you with bladder training and reducing the time between visits to the toilet. See our section on pelvic floor exercises for more information.

Medicines

In some cases, medicines are appropriate for people experiencing symptoms of OAB. These medicines are often referred to as antimuscarinics or anticholinergics. They work by blocking certain nerve impulses to the bladder, which stops it contracting when it should not contract. Medication can improve symptoms in some cases, but not in all, and the amount of improvement varies from person to person. Side-effects are not uncommon and can include a dry mouth and constipation. Some carry a higher risk of confusion or drowsiness than others. Your doctor or healthcare professional will guide you. If your healthcare professional feels medicine is appropriate for you, after taking them you should notice less trips to the toilet, fewer bladder leakage episodes and less urgency or dashing to the toilet. However, it is uncommon for symptoms to go completely with medication alone, and your doctor or nurse may recommend more than one approaches so that symptoms do not return.

If these approaches do not help with your symptoms of OAB, it may be that further specialist tests are required, and other measures might be recommended. More advanced treatments can include botulinum toxin (botox) injection; percutaneous tibial nerve stimulation (where a fine needle is inserted into a nerve in the ankle, and a mild electric current is passed through the needle and carried to the nerves that control bladder); sacral neuromodulation (a procedure which targets the sacral nerve to restore normal communication between the brain and bladder/bowels), and surgery. Your healthcare professional will guide you on which further treatments are right for you.

More information

Download this information as a leaflet (PDF)

What is stress incontinence?

Stress urinary incontinence is when the pelvic floor muscles around your bladder and anus (back passage) become weak or stretched. Leakage from your bladder can happen when you cough, sneeze, laugh, run, or jump. Usually only a small amount of urine is passed.

Research suggests that women who complete pelvic floor muscle training experience fewer leaking episodes and report a better quality of life.

In men, some studies have shown that pelvic floor muscle training can reduce urinary incontinence – particularly after surgery to remove the prostate gland

What causes stress incontinence?

Stress urinary incontinence can happen at any age. Pelvic floor muscles may become weakened by pregnancy, childbirth, and delivery, straining to empty the bowel, repeated heavy lifting, menopausal changes, long term coughing, constipation and being overweight, lack of general fitness and high impact sports.

It is caused by a weak sphincter (a muscle at the bladder outlet), or by poor support to the bladder outlet from the pelvic floor muscles and ligaments. This usually happens because the muscles of the pelvic floor are weak or damaged.

Things that can weaken these muscles include pregnancy, childbirth, menopause, and some medication. People who are overweight, have a cough or who have been constipated for a long time may also be prone to stress incontinence.

What are the pelvic floor muscles?

The pelvic floor is made up of layers of muscles, stretching like a hammock from your pubic bone to the bottom of your backbone. These muscles help to hold your bladder and bowel in position, as well as the uterus (womb) in women. They prevent leakage from your bladder and bowel, only relaxing when your bladder or bowel is emptying.

What can I do myself to help with stress urinary incontinence?

You can help yourself by making some lifestyle changes in order to reduce pressure on your bladder and pelvic floor muscles.

• Exercise regularly, including pelvic floor muscle exercises. Avoid exercises that increase the pressure on your abdomen such as high impact aerobics, jogging/running.
• Avoid smoking, which can aggravate bladder weakness through coughing.
• Avoid gaining excess weight. If you are overweight, a weight loss diet might help your incontinence.
• Drinking plenty of fluid each day, typically 1.5-2 litres (6 – 8 large cups or glasses, unless otherwise medically directed ). Drinks containing alcohol or caffeine, for example tea, coffee, or sugary fizzy and energy drinks may irritate your bladder and should be avoided. You can have drinks that do not contain caffeine, such as decaffeinated tea or coffee.
• Limit the amount of caffeine and alcohol you drink to prevent bladder irritation and avoid increased urine production.
• Trying not to become constipated by eating a healthy diet with plenty of fruit and vegetables
• Doing pelvic floor exercises. These can improve your muscle tone (strength), your continence and quality of life. Your health care professional will explain these exercises.
• Seeking medical advice if you have a long-term cough

All of these can also be discussed when you attend your consultation with the doctor, physiotherapist or nurse specialist. They will be able to advise and support you make these changes.

When should I seek further treatment for stress incontinence?

Although you may feel embarrassed talking to someone about your symptoms, we would encourage you to have a chat with your GP if you have any type of urinary incontinence. They are used to having these conversations and you should be encouraged to know that this can be the first step towards finding a way to effectively manage the problem.

Many people wrongly think that incontinence is a normal part of ageing, or that it cannot be treated. We would recommend seeking further advice who can assess and guide on treatment and management.

Will I need any tests?

These are some initial tests that you may have as part of your assessment:

• Urinalysis: This test usesa sample of urine to find out if there is any infection or any blood in the urine.
• Bladder diary: You will be given a chart (bladder diary) so that you can keep a record of the amount of fluid you drink and the amount of urine you pass, for a 3 day period. You can also record other information on the chart such as incontinence. ( link to our diary )
• Bladder scan: This is to find out if there is any urine left in your bladder after you have passed urine. The nurse will check the residual urine using an ultrasound machine to scan the bladder.
•  Physical examination: Your health care professional may need to undertake a physical examination to make a further assessment, for example a pelvic/vaginal, rectal or prostate examination.

Some further tests may be required if the cause of your urinary incontinence is not clear. Your health care professional will usually start treating you first and may suggest these tests if treatment is not effective.

Pelvic floor exercises

These are exercises that improve and strengthen the pelvic floor muscles. It is important that you are shown how to do these correctly and you will be referred to the physiotherapist or specialist nurse for this treatment. They will assess your pelvic floor muscle strength and then advise an individual programme of exercises for you to follow.

Are there any other treatments?

If pelvic floor exercises and conservative options do not help, your health care professional will discuss further treatments, for example, you may benefit from a referral to a Bladder and Bowel specialist nurse, physiotherapist or a doctor who specialises in urinary incontinence.

Further treatments can include medication (tablets), nerve stimulation, physiotherapy or surgery.

More information

Download this information as a leaflet (PDF)

What is a Urinary Tract Infection (UTI)?

A UTI is an infection within the urinary system. The infection can be in the kidneys, ureters (the tube that carries urine from the kidney to the bladder), the urethra (the tube through which urine leaves the body) or the bladder. Infections affecting the urinary tract are very common and affect most women at least once in their lifetime. They can occur at any time but are most likely in women who are sexually active, pregnant or have been through the menopause.

What causes a UTI?

UTIs can be caused by bacteria entering the urethra and moving up into the bladder. The most common bacteria causing an infection is E. coli (Escherichia coli). This tends to more commonly occur in women, because the opening of the bottom (anus) is so close to the opening of the urethra where urine comes out. The urethra in women is shorter than that in a man which makes it easier for the bacteria to access the urinary tract.

Other factors may include:

• Not drinking enough fluids. You should aim to drink 8 glasses of fluid every day to prevent dehydration (1.5- 2 litres fluid)
• Alcohol can cause dehydration, increasing the risk of a UTI
• Medicines or conditions which weaken your immunity, for example diabetes
• Pregnancy
• Having a catheter (either indwelling or intermittent)
• A bladder that doesn’t emptying completely, for example related to an enlarged prostate in men, or a prolapse womb or bladder
• Other conditions that can block the urinary tract, for example, kidney stones
• Sexual intercourse
• Constipation
• Bladder and / or bowel incontinence, can increase the risk of infection
• Perfumed soaps , wet wipes etc, can cause inflammation of the delicate genital skin and wash away vaginal secretions.

What are the common symptoms of a UTI?

Many people have little or no symptoms but some experience the following changes:

• Dark coloured or strong-smelling urine.
• The need to pass urine more frequently.
• A sudden need to dash to the toilet to pass urine ( urgency)
• Burning/stinging when you pass urine.
• Passing cloudy urine.
• Being incontinent of urine, when normally you are not
• Blood in your urine.
• Tenderness or pain in the lower part of your abdomen

Other symptoms may include:

• Pain in your back or side
• A high temperature above 38C.
• A very low temperature below 36C.
• Feeling shivery or shaking uncontrollably, feeling hot then cold
• Feeling of being cold /clammy skin.
• A sudden onset of confusion or agitation, particularly in an older person.
• Not passed urine all day.
• Shortness of breath .
• Sickness (nausea or vomiting)

It is really important not to ignore any of these symptoms and seek medical advice, as an untreated kidney infection can be serious if not promptly addressed.

How can I help prevent getting a UTI?

• Keep hydrated. To prevent dehydration especially in warmer weather, you may need to increase your fluid intake. You should aim for 1.5-2 litres of water per day. Remember, alcohol can lead to dehydration
• Check the colour of your urine. If it is dark orange/brown you may need to increase your fluid intake. Your urine should be a pale yellow colour.
• Be aware of how much urine you are passing at each time. If you are passing small amounts, increase the amount of fluid you are drinking.
• Consider foods containing lots of water such as jellies, ice-lollies, soups, melons, cucumbers, tomatoes, strawberries, peaches, and oranges.

What is good hygiene practice to prevent getting a UTI?

• The following tips can help you avoid developing a UTI, particularly if you are prone to getting them.
• Everyone with a vagina should wipe front to back, after you go to the toilet, to prevent bacteria entering your urethra.
• If you experience constipation this can increase the risk of getting a UTI. See more information from Bladder & Bowel UK about constipation.
• Allow yourself time on the toilet to empty your bladder fully.
• Wear loose cotton underwear, and avoid wearing tight fitted synthetic underwear, tights and tight trousers.
• Shower rather than a bath.
• Sexual hygiene – passing urine and washing gently with warm water after sex can help reduce the amount of bacteria present.
• Avoid soaps, shower gels and intimate hygiene products (wet wipes or talcum powder); these can irritate the urethra.

Should I see my doctor about a UTI?

Sometimes simple changes as mentioned above can help flush things out. However do speak to your pharmacist, GP or nurse if you are worried or feel unwell as treatment may be required. Recurrent infections can cause considerable discomfort and distress, and you should speak to your medical professional who might recommend further investigation.

Download this information as a document (PDF)

What is a bladder diary?

A bladder diary is a useful tool that can be used to record the number of trips to the toilet to pass urine (wee), to measure the volume of urine passed and any episodes of wetness or leakage. You will also be asked to record what you are drinking, how much, and when you are having your drinks.

Why is completing a bladder diary helpful?

A bladder diary can help your healthcare professional, as part of an assessment, to better understand how your bladder is working. It provides information on the amount you drink, the amount of urine your bladder can hold, how often you pass urine, and any wetting or episodes of leakage. It may also help identify if there are any patterns or links which contribute to your symptoms. It is recommended to keep a diary of your bladder habits for at least 3 days, so you can give your healthcare professional as much information as possible, about your condition. A one-day diary may not provide enough information to give a true picture of how your bladder is working.

Top Tips: What to record whilst keeping your diary

• Record when you go to bed and when you get up in the morning to start your day
• How often you need to pass urine Keep a record of toilet visits to pass urine throughout the day and night
• Have a measuring jug handy by the toilet, to record the amount of urine you pass at each toilet visit; this should be recorded both day and night
• It is important to record if you are getting up frequently in the night to pass urine
• If you pass urine but couldn’t measure it eg at work, away from home, put a tick/s in the column to indicate that you have passed urine
• Record any episodes of bladder leaks and any additional information you think may be important about when this occurs, eg: coughing, sneezing, during exercise etc
• You could measure the mug / glass that is frequently used, so as not to have to measure every drink if the same are used.

It may be helpful to complete the diary, choosing a time when you will be mostly at home, or over a weekend and near a time when you are due to see your nurse or doctor. You may also want to consider recording on a day when you are at work or away from home as your drinking patters may be different eg: Friday, Saturday, Sunday.

Recording in your diary

The Bladder & Bowel UK Bladder 3-day diary is free to download – don’t forget to take your completed diary to your health care professional appointment.

• Record if damp, wet, or soaking
• Make a note if you experience urgency or need to get to the toilet quickly
• Record as 1 if you could hold on for a short period of time without worry
• Record as 2 if you had to rush to the toilet, otherwise you would have experienced leakage
• Record as 3 if you leaked or were wet before you reached the toilet Record if you changed your pad
• Keep a record of your fluid intake – write down what you drink (i.e, water, juice, coffee, alcohol etc) and how much. It is helpful to measure the amount of fluid you drink, or if you can further describe for example, small glass, mug, teacup etc
• Record activities eg out for a walk, exercising, at home.

Download this information and the Bladder & Bowel UK Bladder 3-day diary   as a document (PDF)

Introduction

It is important to eat meals regularly for bowel health and good metabolism. Food choices are also important to ensure healthy digestion and as part of the prevention or management of constipation and other bladder and bowel issues. 

Metabolism is the word used to describe all the reactions in the body that change food into energy. A healthy metabolism will promote healthy weight, and overall wellbeing. Eating breakfast everyday and having regular meals will boost your metabolism and help your digestive system work properly.

What you eat is also important. The bowel needs both soluble and insoluble fibres to assist elimination and to stimulate normal soft bowel movements.

What is fibre and what does it do?

Fibre is the part of some foods, particularly fruit, vegetables and cereals, that the body cannot fully digest. It is also sometimes known as roughage. It helps to increase the size of stools, making them softer and easier to pass.

Some fibre is broken down by the bacteria that are found in the large bowel. The bacteria use the fibre to produce short chain fatty acids and gas. The short chain fatty acids provide energy for the cells of the large bowel. They also help reduce the risk of heart disease, raised cholesterol, high blood pressure, type 2 diabetes and bowel cancer. That is another reason why it is important to have eat enough foods containing fibre.

Eating sufficient fibre may also help to control body weight and, as it requires more chewing, can increase the time taken to complete meals and help digestion. Short chain fatty acids may also help with weight management by controlling fat metabolism.

How much fibre should I be eating?

While most people are not eating enough fibre, too much can cause abdominal pain and bloating. Most adults should try to eat about 30g of fibre each day. If you need to increase your fibre intake then do so gradually, otherwise you are more likely to experience abdominal pain and bloating. 

As fibre draws water into the bowel, or keeps it there, it is important to make sure you are drinking enough water every day. Most adults need 1.5 – 2 litres a day, but you may need more than this if you are overweight, in a hot environment, or are very active. The general rule is to drink enough water-based drinks every day to ensure that your urine remains a pale straw colour.

Some people with certain bowel conditions may be advised to reduce the amount of fibre they eat. Always follow the advice of your healthcare professional. 

What is the difference between soluble and insoluble fibre?

Many plants contain both soluble and insoluble fibres, but the amounts of these that different plants contain varies. 

Soluble fibre dissolves in water. It absorbs water from the bowel and makes stools bigger and softer, which allows them to move more easily through the bowels. Oats, rye, barley, onions, leeks, root vegetables, apples and bananas all contain soluble fibre. 

While soluble fibre can help with constipation, it is more likely to increase gas production than insoluble fibre and therefore may cause more bloating and discomfort for some people. However, it can be helpful for people with loose stools as it absorbs water. 

Insoluble fibre does not dissolve in water. Insoluble fibre encourages water to pass into the bowel. Like soluble fibre, the extra water in the bowel makes stools bigger, softer and easier to pass. Wholegrain cereals, nuts, and seeds, leafy vegetables, green beans and potatoes with their skins are higher in insoluble fibre. 

Insoluble fibre can help constipation but may make loose stools worse as it encourages water to move into the bowel. For most people a balance of both types of fibre is useful, which is why a varied diet is important. Beans and pulses contain both soluble and insoluble fibre.

Which foods contain the most fibre?

Many different foods are high in fibre, including wholegrains such as many breakfast cereals, whole wheat pasta, wholegrain bread, oats, barley, rye, brown rice, fruits and vegetables, peas, beans and pulses, nuts and seeds, potatoes with their skins.

How can I increase the amount of fibre I eat?

If you eat five portions of fruit and vegetables each day and also chose whole grain where possible (e.g. bread, pasta, rice) then you should be able to manage to have the recommended 30g per day. You could:

 Choose a wholegrain breakfast cereal such as a whole wheat biscuit cereal, muesli or porridge. Try adding some fresh fruit, dried fruit, seeds and/or nuts.

• Have wholemeal bread or bread with seeds in
• Have whole wheat pasta, bulgur wheat or brown rice.
• Eat potatoes with their skins, such as baked potato, potato wedges or boiled new potatoes – you can eat these hot or use for a salad
• Try fruit, vegetable sticks, rye crackers, oatcakes, unsalted nuts or seeds for your snacks
• Have vegetables with your meals, either as a side dish/salad or added to sauces, stews or curries. Try to have leafy vegetables such as kale and spinach regularly and consider mashing vegetables like swede, sweet potato or parsnip with mashed potatoes
• Add pulses like beans, lentils or chickpeas to soups, stews, curries and salads.

Other information about food

It is important to have a balanced diet. That means that foods containing protein, carbohydrates and fat as well as fibre, should be eaten in all meals.

Drink about 1.5 – 2 litres of water or water-based drinks a day. Avoid having too much caffeine, fizzy drinks and alcohol as these can cause problems for the bladder and bowel. It is particularly important to drink well if you are increasing the fibre content of your diet. The water is needed to help the fibre pass through the bowel easily.

More information

Download this information as a leaflet (PDF)

Any changes in your bowel habit should be reported to your GP for further assessment. GPs are used to seeing people with bowel issues. It is not something you should put up with or self-manage, and treatments are available.

What is bowel incontinence?

Bowel incontinence, also known as faecal incontinence or bowel leakage, is the inability to control bowel movements. This includes stool and wind from the back passage.

It can be very distressing to experience these symptoms and many people tend to avoid seeking help and advice for fear and embarrassment. You should be encouraged to know that there are many different options available to help manage and improve bowel incontinence symptoms, so that it does not limit your everyday life.

What is ‘normal’?

The pattern of bowel emptying varies from person to person. The normal range is from three times a day to once every third day, for the passing of a formed stool that is not hard or too soft.

What causes bowel incontinence?

There are several factors that can lead to loss of bowel control. Underlying medical conditions, recent surgery or treatments can impact stool consistency and faecal incontinence. Other factors may include dietary intake, food intolerances and medications, including the use of laxatives.

It is not uncommon for bowel incontinence to be caused by a combination of problems. These may include:

• Injury during childbirth. The muscles around the anus (back passage) may be damaged during the process of giving birth. The muscles of the anus may be torn or split. Nerves (which send messages to the brain for the control of movement and feeling) may become damaged in the pelvic floor (muscles in the abdomen) or nerves to the anus. Whilst damage may be seen at the birth, often the weakness does not show until later in life.
• Operations to the anal area or other causes of damage to the anus and the area close by may affect the anal muscles and result in bowel control problems
• Growing older, the muscles may also weaken so that earlier mild problems become more severe later in life.
• Medical illnesses or diseases of the nervous system are another possible cause.
• Diarrhoea or loose stools. Stool that is loose or liquid due to diarrhoea, is harder for the weakened muscles of the pelvis to control. Liquid stool can pass over the top of the constipated stool (overflow diarrhoea) and can leak out of the bottom.
• Weak sphincter muscle or weakness in the rectum can lead to loss of stool. This can be due to hormonal changes, childbirth or injury.
• Irritable Bowel Syndrome (IBS)
• Coeliac Disease
• Inflammatory Bowel disease (e.g. Crohn’s disease)
• Other conditions, which may affect nerves in your bottom e.g. diabetes, stroke, neurological conditions.
• Anxiety can be a trigger, and it is important to have support to manage this.

Food and drink can affect bowel incontinence:

• Some foods act as natural laxatives and sometimes we can eat foods that may trigger our bowel. This can lead to looser stools and bowel incontinence. Examples of these items can be spicy foods, coffee and other caffeinated drinks, alcohol, chocolate, prunes, prune juice, figs, molasses and liquorice.
• Fibre is an important part of a balanced diet. It important to remember that everyone is different, and people react differently to different fibre contents.
• Artificial sweeteners are also known to cause softer stools.
• Foods that are high in fat can cause diarrhoea.
• Food intolerances can cause softer stools.

Medications can also affect bowel incontinence:

• A review and adjustment of medication may be useful, and you should speak to your doctor or nurse. However, some medications may be necessary long term to manage underlying medical conditions.
• Regular use and overuse of laxatives can lead to softened stools that become more difficult to control. Reducing or stopping these medications may resolve the issue. This should be done in consultation with your healthcare professional.

How are people affected by bowel incontinence?

• We know that bowel incontinence can affect people in differing ways and may include:
• A sudden need to dash to the toilet or urge to poo that you are unable to control
• Leakage or soiling, without realising you need the toilet
• Leakage when passing wind
• Bowel incontinence refers to a continued issue (not a one-off incident that may be due to an upset tummy and diarrhoea)
• The impact on day-to-day life and activity restriction

What tests might I have?

It is important to understand the cause of your bowel incontinence and treat you correctly and your specialist may advise that you have certain tests. These may include any or all of the following:

• Blood tests to check the thyroid gland is working correctly and check your calcium levels.
• Physical examination. Your specialist might examine both your abdomen (tummy) and perform an internal finger examination of the back passage.
• Colonoscopy / CT Colonoscopy/ Flexible sigmoidoscopy – a fine endoscopic tube is passed into the anal canal and examines the inner lining of the bowel. Either the full length of the bowel is viewed (colonoscopy) or the examination is limited to the rectum and last section of the large bowel (flexible sigmoidoscopy). This test is used to eliminate any other problems within the bowel.
• Anorectal manometry is a test performed to evaluate anorectal sphincter disorders. This test measures the pressures of the anal sphincter muscles, the sensation in the rectum, and the neural reflexes that are needed for normal bowel movements. Anorectal manometry may be recommended to you if you have one of the following: leakage of stool, chronic constipation. dyssynergic defaecation (muscles and nerves within the pelvic floor are not functioning as they should).
• Endoanal ultrasound. This test is done in an out-patient clinic. An internal probe is passed into the anal canal and uses ultrasound to image the anal sphincter muscles.
• Defaecating proctogram. This test is done in the radiology department. It is an examination of the lower bowel and rectum using x-rays. It shows how your rectum functions during the emptying of your bowels.  The images obtained will help your clinician understand what is causing your symptoms.  

What non-surgical treatment might your doctor recommend to help with bowel incontinence?

It is important to understand what is causing bowel incontinence to treat it correctly. However, for many people it is possible to improve symptoms through dietary and lifestyle changes.

Try reducing your intake of caffeine (coffee, tea, cola and energy drinks) and fizzy drinks as these stimulate the bowel to work quicker and cause loose stool.

There is a difference between insoluble fibres (that are not digested by the bowel) and soluble fibres (that are). To improve symptoms of bowel incontinence, you might try to reduce your intake of insoluble fibre, including seeds, wholegrain breads, bran, high fibre cereals, nuts and skins on fruit and vegetables. Soluble fibre is needed as it helps to absorb water in the bowel helping the stool to bind together and not be as loose. Oats are a good source of soluble fibre

If adjusting medications and dietary manipulation has not helped to bulk or firm up your stool, there are some medications that may be considered. A bulking agent such as ispaghula husk can be used for both soft stools and constipation. It bulks the stool by absorbing water in the gut, therefore promoting normal movement. It is important to drink adequate amounts of fluid with this medication. The medicine comes as granules in a sachet which are mixed with cold water. It is important to follow the manufacturer’s guidance on preparation and consumption. Your doctor, nurse or pharmacist will be able to further advise.

Medicines such as loperamide or Immodium slow the gut’s normal activity. This medication works by keeping stool in the bowel for longer and allows more water to be absorbed by the body, causing a firmer stool. It can be used to help reduce bowel urgency and leakage. It is best taken half an hour before meals where possible. The amount of loperamide to slow the gut is individual to each person; the dose is slowly increased to avoid constipation. It is important to speak to your doctor, nurse or pharmacist, and they will further advise. A liquid formulation is available on prescription only, which enables smaller doses to be used than the tablet or capsule formulation. Capsules can be bought over the counter or obtained on prescription.

Non-surgical management options may also include anal sphincter or pelvic floor muscle exercises. These exercises can help to strengthen the muscles around the back passage and pelvic floor, which are used to control your bowel (and bladder). You may be referred to a specialist nurse/physiotherapist, who will be able to further assess.

Your healthcare professional might recommend bowel training. This can involve making dietary changes to reduce diarrhoea or constipation, advice on toilet routines, being instructed on correct sitting position on the toilet to help empty your bowel.

There are a number of products to help contain leakage or soiling. These include plugs or anal inserts that are placed in your bottom, and pads that can be worn inside your underwear.

Trans anal irrigation is performed to remove any stool that has not been passed naturally and help with bowel management and control. If this treatment is offered, you will be instructed on use and you will be given ongoing support and review. Trans anal irrigation systems (both large and small volumes) are available on prescription following clinical assessment.

Percutaneous tibial nerve stimulation (PTNS) might be a treatment option. Its availability varies by area. It is a treatment that can sometimes improve symptoms in patients who have bowel incontinence or urgency by stimulating the sacral nerves that regulate bladder and bowel function. It may help defer defaecation and dashing to the toilet, resulting in a decrease in episodes of incontinence. The advantage of PTNS is that it can be given in the outpatient clinic and is a non-surgical technique.

Other treatments may be considered if non-surgical measures do not help. These options include Sacral Nerve Stimulation (SNS) and surgery which your healthcare professional would discuss with you.

More information

Download this information as a document (PDF)

Continence products are absorbent pads or underwear designed to contain urine and/or faeces in people who are not able to get to the toilet either some or all of the time. There are many different sizes, shapes and makes of product available. Some are disposable (designed to be used once then thrown away), others are washable (designed to be cleaned, dried and reused).

This information is about disposable products. Products to contain incontinence are usually called continence containment products, pads, or products. Here they will just be referred to as products.

Where can I buy products?

Products are available to buy from most supermarkets, chemist shops and disability shops as well as online. They are also available from the Bladder & Bowel UK shop, through the website. Some online suppliers will provide a limited number of free samples.

Are products available free of charge?

Products may be available from the NHS (depending on local policies) for people who have

• Had a specialist assessment of their bladder and bowel health and
• Where appropriate, have undergone a treatment programme, supported by a healthcare professional with specialist – knowledge or
• Have been assessed as unable to become continent with an appropriate treatment programme

Products are not available for treatable conditions. Many bladder and bowel issues are treatable. Therefore, adults experiencing difficulties with their bladder or bowel should speak to their GP or other healthcare professional.

How do I find out if products may be provided by the NHS?

If you think you, or an adult you care for, may be entitled to have products provided for them, speak to the GP or other healthcare professional. They will know who should do the assessment for bladder and bowel health in your area and will make a referral if appropriate. Some local bladder and bowel services will accept self-referrals.

What type of product will be provided?

If appropriate you/the person you care for should be offered a product that meets their assessed needs. In some cases, this may be a different product for overnight to the one suggested for during the day.

The product offered may be a one-piece or a two-piece product. The one-piece product (often referred to as a slip product) has an absorbent area in the groin with tabs to hold it in place around the waist. The two-piece product consists of an absorbent pad, with a pair of pants (known as fixation pants) to keep it in place. These are as effective as the one-piece product, but are often more discrete.

All the products come in different sizes and absorbencies. It is important that the product fits and is used correctly, or it may be more likely to leak.

What will happen if products are provided?

This will vary slightly according to where you live and local policy. What is provided will depend on what the assessment has shown. However, once the decision is made by the healthcare professional that products are needed, samples should be provided. The samples will be of a product or products that are available locally and that should meet the need for containment of the incontinence.

Once the samples have been tried, you will need to contact the healthcare professional to let them know whether the product worked well. If it did, the healthcare professional will order a supply of products and let you know how and when to get more.

The healthcare professional should show you how to store the product, how to put it on and when to change it. There is also information on how to use products in the Bladder & Bowel UK leaflet ‘How to get the best out of your continence products’. Most manufacturers also provide product fitting guides online.

You will be told how many products per day are going to be supplied. The maximum number per day is usually four. Products are usually delivered to home and you will be sent several weeks supply at once.

A reassessment of bladder and bowel health and product needs will normally be done at least once a year, although this will vary slightly depending on local policy.

I keep running out of products – can I get more?

Sufficient products should be supplied to meet assessed needs. Products do not need to be changed as soon as the person using them has passed urine, as the super absorbency in the product will keep the top layer dry. They but should be left on until they are full or nearly full (for more information on when to change the product see the Bladder & Bowel UK leaflet on ‘Getting the Best Out of Your Products). If the product is changed too soon you are more likely to run out.

If you are running out of products regularly, speak to your healthcare professional. They may be able to reassess your needs or provide a product that needs changing less often.

If you need to purchase extra products, your healthcare professional will be able to tell you where to get these. Products are available to purchase online from most of the companies that supply the NHS. They are also available from disability shops including the Bladder & Bowel UK shop, through our website. Supermarkets and chemist shops also sell some products.

My needs have changed and the product no longer works well

If your needs change and the product start to leak regularly, or you are getting sore skin, then contact your healthcare professional. You should try to do this about six to eight weeks before the next delivery is due. This allows time for an assessment to be done, samples of a different product to be tried and a decision made about which product will be best now.

In most areas, once a delivery has been made the product cannot be changed before the next delivery.

What should I do with products provided for me that are not needed?

Products are provided by the NHS on a named person basis. They should be used for that person only and not be given or sold to anyone else. Most areas will arrange a collection of any unused products that are no longer needed.

Contact your healthcare professional to find out what the local arrangements are.

More information

Download this information as a leaflet (PDF)
Getting the best out of continence products
Using continence products during your period

You can find out more about companies who supply continence products on  Disabled Living’s Directory here.

Toileting Aids and Urinals

It is encouraging to know that there are a large variety of toileting aids and urinals available, but important to know that no single product will suit everyone’s needs. It is not uncommon for people to use a combination of products. It is a case of finding what best suits an individual’s need and this will be identified following a full assessment which may be undertaken by a nurse, occupational therapist, physiotherapist, or with a multi-disciplinary approach.

For some people – adults, children and young people – accessing a toilet can be at a challenge. For others, it might be an impossible task to undertake independently. Thankfully, there are many toileting aids available to help people manage their toileting needs more independently.

Hand-held urinals

A hand-held urinal is a device which you urinate into, which then contains the urine until it can be disposed of. Hand-held urinals can give people the opportunity to independently manage toileting either in their home or when out and about. Handheld urinals are particularly useful in the following circumstances:

• When there is an urgent and/or frequent need for bladder emptying and getting to the toilet in time is an issue .
• Where limited mobility or flexibility makes using the toilet difficult.
• When going on long journeys or any other time when access to a toilet is difficult.
• To promote independence and less reliance of other thus being more independent and private with toileting.

Bedpans

Bedpans are used for passing urine or stool while in bed or on a chair.

Commodes

A commode is a portable toilet, with a disposable or reusable pan or bowl beneath. A commode can be very useful and can enable independent living with limited help, and they come in a variety of forms e.g. static, movable, multi-purpose, shower chair.

Toilet seat raisers and frames

Toilet raisers increase the height of your usual toilet seat to make getting on and off easier if moving between standing and sitting is difficult.

Urine directors

Urine directors can help direct the flow of urine for a man who has a short or retracted penis. Some men have a urine stream that sprays and a urine director can assist with accurate direction of the stream.

Bottom wipers

A bottom wiper is a device which helps you reach your bottom to clean it in people who have, for example, poor hand control or reduced ability to turn around.

Bidets and specialist toilets

A bidet looks similar to the bottom of a toilet. They produce a jet of water which washes the bottom area following use of the toilet, which can be useful if you have a problem wiping yourself after using the toilet. Other more specialist toilets are available. These can be expensive, but may be a consideration.

Urinals on prescription

Some urinals are available on prescription. Speak to your healthcare professional or contact us at Bladder & Bowel UK for further information. You can find out more about companies who supply continence products on  Disabled Living’s Directory here.

Download this information as a document (PDF).

Urinals on prescription (PDF)

Travelling does not necessarily need to be more difficult for someone who has a bladder and/or bowel condition or incontinence. However, it may take more planning and preparation to make it as straight forward as possible.

How can I make travelling with a bladder or bowel condition easier?

• Contact the airline or travel company to discuss your individual needs and how they may be able to meet these before booking/travelling
• Think about what you will need to carry with you and have any supplies you need for the journey easily available. This may include medication that you need to take on the journey, continence products such as urinals, pads or catheters, cleaning materials including wipes and bags for disposal. You may wish to have these in a separate small bag. Make sure that you have spares with you in case you get delayed.
• Carry hand sanitiser and wet wipes with you, so that you can still clean yourself and your hands if you are unable to reach a sink and soap- .
• If you plan to change your routines or any products that you usually use while away, try these out before you go, to make sure they work for you.

Accessing the toilet

If you need to use the toilet frequently or urgently, or have mobility issues, and are flying or travelling by train or coach, try to book a seat near the toilet and on the aisle. You could use a small disposable continence pad inside close fitting underwear if you have concerned about possible leaks if you are unable to get to the toilet quickly enough.

If you are using your own car and have sufficient privacy or if you are travelling somewhere with limited access to a toilet you could consider using a urinal. These are available for all genders and can be used discretely in your seat. If you chose one with a lid it can be emptied into a toilet later. Special absorbent powders are available that change urine into a semi-solid gel that is still fully flushable. These will reduce the risk of splashes and spills. There are a wide range of urinals available both to purchase and on prescription. There is more information section of this information library about urinals and toileting aids.

If possible, research where the toilets are on your journey and at places you will visit before you leave home. There are some useful websites to help you locate toilets in the UK including Loocations, The Great British Toilet map and Changing Places, which are accessible toilets with full size changing tables and hoists. Apps to find toilets include Flush, The Toilet Finder, The Toilet Map and Toilets 4 London.

Many disabled toilets require a RADAR key to unlock them. These are available to purchase at a number of online retailers. Bladder & Bowel UK provide a free ‘Just Can’t Wait’ card that is widely recognised and may allow increased access to toilets. To order one, follow the link in the top menu on this website to ‘Just Can’t Wait’ card. 

Clothing

When you are travelling consider wearing clothing that is comfortable and easy to rearrange. Elastic waists, and drop front pants (ones that have poppers or Velcro on the side seams) can be easier to manage.

Dark coloured clothing reduces visibility of any leaks and loose clothing is easier to remove and to change. Consider having a spare set of clothes and some wet wipes in a plastic bag in your hand luggage or travel bag, in case you need to change when travelling.

Disposable continence products

If you are worried about leakage when you are travelling, you could consider using a seat protector on the journey. Both washable and disposable seat protector pads are available to purchase. You may also be able to purchase a more absorbent version of your usual product to use on the journey.

Many disposable products are quite bulky and can take up a lot of your suitcase. You may be able to use smaller products, that take up less space, or pack them in a vacuum bag to reduce the space they need. Washable products take up less space and may be an option for those that can manage to launder these while away. Men could consider using a sheath with a leg bag for urinary incontinence.

If you purchase your products, the company you buy them from may be able to deliver the products to your holiday destination, or you may be able to send a supply ahead yourself. However, it is a good idea to take some with you, in case there is a problem and they are delayed or do not arrive.

Climate can affect continence products. High humidity or damp environments may reduce the absorbency of disposable continence products. High temperatures can affect adhesive tapes, such as those on some continence products and ones used to secure sheaths.

Catheters

If you use and indwelling catheter and are going on a long journey, you may wish to use a larger drainage bag, to reduce the frequency with which it will need emptying. If you are going to be sitting for a long period of time, make sure that there are no kinks in your catheter or drainage bag tubing.

If you use clean intermittent catheterisation you may be able to use a catheter with an integral drainage bag, or you could use a portable urinal to hold the urine until you can access a toilet. If you have any concerns about managing on the journey or while away, talk to your healthcare professional. They may be able to make some suggestions that would help you.

If you are travelling abroad obtain a medical validation or travel certificate from your catheter provider. This will explain in different languages why you are carrying catheters. It also has a section asking officials to be discrete.

If you are travelling in a country with poor water quality (places where you are advised not to drink the tap water), use bottled or cooled boiled water or consider asking your healthcare professional if you can have ready-to-use hydrophilic catheters to use while you are away.

Antibacterial wipes will allow you to make sure that any surfaces you use for your equipment are clean. Hand sanitiser will allow you to clean your hands prior to catheterising if you have difficulty finding clean water and soap.

Your healthcare professional should be able to discuss safe options that would be appropriate for you.

Transanal irrigation

You should follow your healthcare professional’s advice if you are using transanal irrigation. However, you may be able to adjust the timing of your irrigation, so that you can have a bowel motion before you leave home and not need another until after you have reached your destination.

If you are in a country with poor water quality (places where you are advised not to drink tap water), then use bottled or cooled boiled water for your irrigation. You may be able to warm this to the correct temperature, by placing the bottled water into a basin of warm water for a few minutes before using it. It is important to check the temperature of the water is correct before you use it.

Drinking when travelling

While it is tempting to restrict your fluid intake when travelling this can cause dehydration and increase the likelihood of urinary tract infections and constipation. Concentrated urine can also irritate the bladder lining, which may trigger urgency or wetting. It is important to drink plenty of water-based drinks to prevent these.

Drinks containing caffeine (tea, coffee, hot chocolate, cola and many energy drinks), fizzy drinks and alcohol can all increase urine production and may also irritate the bladder lining triggering urgency.

Traveling with bowel issues

Travelling can upset your normal body functions, including digestion. Try to stick to your usual diet routines to avoid feeling bloated, nauseous or uncomfortable. Try to move around as much as you can when during your journey, as this will help both your digestion and your circulation.

If you are worried about having a bowel motion while travelling, discuss with your healthcare professional whether it would be possible for you to have an enema or suppository a few hours before the journey.

Special considerations if you are flying

Let the airline know when booking and at least 48 hours before your departure if you need extra support at the airport or during your flight, or if you need to carry medication or other medical supplies. You do have a right to have support to move around the plane, including to get to the toilets if you have a sensory, physical or learning disability. However, you must fly with a companion if you need help with using the toilet.

If you use medication, continence products, sheaths, catheters, or bowel irrigation, then make sure you have some in your hand luggage in case your main luggage is lost or delayed. You could also divide your products between your luggage and that of a travelling companion.

If you need to carry more than 100mls of liquid medication or other liquids for medical reasons, you must check what is allowed with your airline before you fly. You will probably need a letter from your doctor explaining what any medicines and medical supplies are for and you will need to declare them at security.

Airlines exempt some equipment from luggage restrictions. Consider contacting the airline to see if continence products are exempt from restrictions if you are going away for more than a few days and need extra luggage space.

Try to use the toilet at the airport prior to boarding the plane and try to use the toilet on the plane prior to landing. This will help if you are delayed with taking off or landing. If you use an indwelling catheter, empty your catheter bag before the flight.

Consider completing a travel certificate before you leave home. This explains your condition and any supplies that you need to carry through security. It will also outline that you need extra privacy. You can ask to have any searches done in a private area at the airport. Contact your transport operator before you travel if you are worried about luggage or body searches and possible exposure of your continence products. You can also ask to be allowed to board the flight early to ensure you have time to get settled with everything you may need during your flight easily accessible to you.

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