For Mental Health Awareness Month, Bladder & Bowel UK’s Children’s Specialist Nurse, looks at how bladder and/or bowel issues can cause stress and affect a young person’s mental health.

Historically, continence problems (wetting and soiling) in childhood were thought to be the result of an underlying psychological, emotional, or behavioural problem. A journal article written in 1972 stated that… enuresis has long been considered a sign of emotional disturbance…

We have thankfully come a long way in the last fifty years and have a much better understanding of the causes of wetting and soiling. We now recognize that nearly all children who have these problems have an underlying medical condition, such as constipation. Wetting and soiling often result in distress, psychological, emotional or behavioural problems, rather than being the cause of them. Therefore, the correct treatment will often result in improved mental health and/or behaviour.

Often families will say that their child does not appear to be upset by the wetting or soiling and will deny they have had a wetting or soiling accident. This obviously increases the overall stress within the household. However, it is helpful if families can understand that many children are unaware of the bladder or bowel leakage when it happens. For those that are aware, or who become aware a little later, the denial aspect is a coping mechanism and the way that many children will use to help them manage and deal with the problems they are having.

A number of studies have highlighted the effect that uncontrollable bladder or bowel leaks have on the mental health and well-being of children. Therefore, it is important that families ask their child’s GP, health visitor, school nurse or other healthcare professional for help to resolve the problems.

The belief that any wetting or soiling problems will get better with time, or as the child becomes older is not accurate. Most bladder and bowel issues that cause the problems need active treatment and may get worse with time rather than better. Therefore, families should not delay seeking help.

Research in continence

In 2018 a research team interviewed young people with bladder or bowel problems as part of a study. The young people described some of the emotional issues they were going through daily. Many described how keeping the problem a secret from their peers felt like a burden and described being constantly embarrassed and frustrated that no one appeared to understand what they were going through. One young man described his problems as “not life threatening, but life ruining”. This reflects the emotional impact continence problems can have.

Other research projects have investigated the mental well-being and quality of life of informal caregivers who are looking after a family member with a bladder and/or bowel problem. They found that the mental health and quality of life of many of the carers was negatively affected by the continence issues. Those who contact the Bladder & Bowel UK helpline often relate how stressful the problem is and describe difficulty within the family when there are disagreements about how the issues should be addressed.

Continence problems can affect people of all ages

Incontinence in an elderly person is often the trigger for a move into a care home, as the stress and difficulty caused by the day-to-day issues of caring for an individual with a continence problem is often too much for the family member to bear.

Bladder and/or bowel issues affect individuals of all ages. All those involved in supporting them need to be mindful of how having an ongoing bladder or bowel problem may affect an individual’s mental health and well-being. As well as treating and managing the underlying bladder or bowel problem it is important that affected individuals are treated holistically so any associated stress, anxiety or mental health problems can be addressed. It is also important that health and social care professionals recognize that caring for an individual with a continence problem has an impact on the carer and their wider family. They should be provided with the appropriate advice and support regarding managing the individual’s problems, but also on looking after their own mental health and wellbeing.

Providing the right information and support and ensuring any bladder or bowel health issue has been assessed and the appropriate treatment put in place can go a long way in reducing stress and anxiety and improving mental health. However, it is also important that we create opportunities for affected individuals to discuss any mental health issues, by asking targeted questions in the right way, having a non-judgmental listening ear and signposting to support.

More information and support

Bladder & Bowel UK have lots of information and resources on the website at www.bbuk.org.uk to support people of all ages with bladder and or bowel difficulties.  These are all free to download and print.

Bladder & Bowel UK also have a confidential helpline staffed by specialist children and adult nurses. You can contact us by completing our web form, by email at bbuk@disabledliving.co.uk or by telephone on 0161 214 4591.