World Continence Week 2024: Reflecting and raising awareness

Dr Aine McGovern, Consultant in Medicine for the Elderly at Glasgow Royal Infirmary, has a specialist interest in bladder and bowel health in older people. She is Chair of the BGS Bladder and Bowel Health Special Interest Group (SIG). Her blog discusses World Continence Week 2024.

Maintaining bladder and bowel health is first and foremost about maintaining dignity.  Where on your priority list is maintaining your own faecal continence at this moment? You may be in work, sitting next to a colleague, or in another public place. I assume maintaining your faecal continence right now is high on your priority list. This will always be the case. This does not change as we age.

In the middle of World Continence Week (17-23 June 2024), let us as geriatricians reflect on where we place our patient’s bladder and bowel health on the priority list in our day-to-day practice.

Bladder and bowel health is not the most popular subspecialty in geriatric medicine, nor is it the most glamourous. However, if we ask our patients ‘What matters to you?’, we know this is important for everyone.

Firstly, do we ask? The International Continence Society’s guidance¹ on management of urinary incontinence in older patients living with frailty emphasises active case finding is essential. Many of our older patients still believe incontinence is a normal part of the ageing process.

Secondly, do we assume? Dementia does not equal incontinence. We need to advocate for our patients to ensure everyone has a thorough history and examination, and an individualised management plan for their bladder or bowel problem. We are not afraid to perform rectal examinations on our patients with constipation, but how many external vaginal examinations do you do on your female patients with urinary incontinence?

Thirdly, we need to work more closely with our urogynaecology/urology and colorectal colleagues. We can learn more from each other. Across the UK, services may differ, but the multidisciplinary team approach needed to manage bladder or bowel health is universal. Building working relationships can be mutually beneficial. Nocturia is a multisystem, often multifactorial, condition, where the end organ happens to be the bladder. We are the clinicians who are experts in multisystem multifactorial problems and I know our surgical colleagues agree. Our colorectal teams have a wealth of knowledge and useful devices that can help our patients gain back the confidence they need to live active sociable lives.

Please catch up on the thoroughly entertaining talks we heard from our surgical colleagues at the recent Spring BGS Bladder and Bowel Continence Day.

Finally, we need to keep up to date. Exciting immunovaccinations have been developed for our frail patients with recurrent urinary tract infections, who previously had limited treatment choices². Another development includes non-invasive urine collection devices for female patients that offer an alternative to catheterisation³.

Let us all please raise the priority we put on the bladder and bowel health of our patients. Our patients and their families will thank us if we do.