This blog post is written by specialist nurse, Karen Irwin, discussing advice for healthcare professionals on how to approach the subject of bladder and bowel health with patients and carers. 

It is thought that that less than 40% of people with urinary incontinence seek help for their condition from a GP or healthcare professional. This figure is even higher for those with faecal incontinence. It is estimated that 14 million men, women, young people and children of all ages are living with bladder problems and 6.5 million adults in the UK suffer with some form of bowel problem (NHS England Excellence in Continence Care 2018).

Bladder and bowel care is fundamental to all holistic nursing and other health professional’s care. It is everyone’s business to identify and provide initial help to those with continence issues. It is not just the remit of those who work and specialise in bladder and bowel services.

For many, bladder and bowels are seen as a taboo subject. This increases the difficulty for professionals, as well as for the public in initiating conversations and in finding the right language. Many professionals may worry about managing the outcome of the discussion, if the subject is broached due to limitations of their knowledge: what is the right information to provide, what are the next steps and where can their patient go for more help and support. These legitimate anxieties together with knowledge gaps may result in patients not being asked about their bowel and bladder health.

Bladder and bowel conditions have a huge impact on all areas of an individual’s life, from self-esteem and wellbeing to quality of life. However, it is important that healthcare professionals let patients know that the conditions that cause bladder and/or bowel issues can be managed, treated and sometimes completely cured with the right support, advice and interventions. Healthcare professionals should therefore encourage individuals to have the initial conversations and avoid self-management or putting up with continence issues. Informing people that that much can be done to treat and improve symptoms and signposting to relevant services is important.

Healthcare professionals are often placed in a privileged and trusted position, where they can take and make opportunities, to speak to people about their bladder and / or bowel, opening conversations or building on information shared about an individual’s continence needs. Making every contact with patients a health promotion opportunity provides key opportunities including, but not limited to pre- and post-natal care, routine health checks, smear or prostate screening.

Setting the scene

So how, as health professionals, do we confidently start that conversation?

• Try to remove the taboo by asking people about their bladder and bowel health
• Be confident when asking questions
• Consider what information is required and what questions should be asked
• Consider what to do with the information once shared
• Know what local services are available for those with bladder and bowel issues and how to access these

.  How do we broach the topic? 

• Do not routinely recommend pads or other disposable continence products. If someone discloses a continence issue – there are many treatments and other forms of management that can stop or lessen the problem.
• ‘Trigger’ conversations can include simply asking people “does your bladder or bowel ever cause you any problems?” Conversations can develop from this.
• Utilise tools which can accessed locally or freely downloaded from the Bladder & Bowel UK website. These are designed to support staff working in any care setting.
• Knowledge will boost confidence – seek out and access training, education and updates on bladder and bowel health and care. This may be provided locally within your place of work, or contact us as Bladder & Bowel UK for further advice on courses, symposiums and bespoke training (BBUK@disabledliving.co.uk).
• Find appropriate patient information that you can share. This includes information on the Bladder & Bowel UK website at and the Bladder & Bowel UK helpline.
• Familiarise yourself with local referral pathways for those patients need specialist treatment or management.
• Understand what is usual and what is not normal – for example, lumps and bumps where they should not be, unexplained bleeding or sudden changes in bladder or bowel habits.
• Choose the right language: terms such as “do you have any problems controlling your bladder” or “do you have any problems going to the toilet” might lead to open dialogue.

Only by understanding and addressing the barriers to open conversation about intimate issues can we remove the stigma surrounding bladder and bowel health and ensure patients get the timely support and treatment they need.

For more information and resources for professionals working with bladder and bowel issues, visit our professionals’ section here.