Read Standard 6: Bladder and bowel health

Rationale

Bladder and bowel health is closely linked with frailty.⁷⁰ Good bladder and bowel health reduces the risk of infection.⁷¹ It can also promote and maintain a person’s independence, dignity and broader health and wellbeing. Good diet, fluid intake and keeping active are important for good bladder and bowel health.⁷² Many bladder and bowel issues can be caused or impacted by medication. Medicines should be prescribed and reviewed in line with Standard 7.

Open conversations about bladder and bowel health can lead to early intervention. Staff should discuss any problems with sensitivity and compassion. The person’s dignity should always be respected.⁷³

Management of ongoing bladder or bowel issues should address the underlying cause.⁷¹ People should have access to effective multidisciplinary treatment. The team should include a minimum of continence nurses and specialist physiotherapists. It may include urogynaecologists, urologists, colorectal surgeons and gastroenterologists who specialise in functional pelvic conditions.⁷¹

Systematic use of incontinence pads is often unnecessary. It can negatively impact a person’s mental and physical health, independence and sense of identity.⁷⁴^,75 Products should be the right size and fit for the person. Urinary catheterisation can allow some people to manage incontinence, reduce the risk of kidney problems and promote independence. A catheter can be uncomfortable and may increase likelihood of urinary infection.⁷⁵ Having a catheter may affect self esteem and body image. It may impact sexual wellbeing and intimacy.

Constipation can have a significant impact on older people, sometimes leading to a range of physical, emotional and social issues including risk of delirium.⁷²^{, 76} It can cause discomfort and pain which in turn may discourage physical activity. People at risk of constipation should be given lifestyle and dietary advice. Laxatives should be prescribed regularly or as required in line with Standard 7.

Criteria

6.1

Organisations undertake health promotion activity to promote good bladder and bowel health.

6.2

Staff are trained and knowledgeable about:

the importance of bowel and bladder health to wider health and dignity
how to proactively and sensitively enquire about a person’s bladder and bowel health
routine management of continence issues
how and when to refer to a relevant specialist.

6.3

Organisations ensure that bladder and bowel issues are addressed and recognised as part of routine care in all settings.

6.4

People with continence issues are supported:

to access the assessment and treatment they need
by knowledgeable and sensitive staff
to be equal partners in decision making
to manage their own care.

6.5

People receive an assessment of any issues they experience with their bladder or bowel and are involved in developing a plan for treatment or management.⁷¹

6.6

Organisations should have pathways and protocols for:

the identification, assessment and treatment of constipation
the insertion and removal of catheters
the treatment of UTIs including antibiotic prescriptions
regular review of medicines that may cause constipation
preventative interventions for people experiencing bladder and bowel issues.

6.7

Catheters should be:

avoided where possible
used when safe and clinically appropriate to do so
reviewed to ensure their use is safe and required
removed as soon as possible.

6.8

When people require continence products:

they are provided with fit-for-purpose continence products or equipment
their needs are reviewed in line with changes to their health or care.

6.9

People receive laxatives as required if their medicines can cause constipation.

6.10

People receive timely access to antibiotics to treat urinary tract infection when they experience symptoms in line with current guidelines.

What does this standard mean for...

What does the standard mean for people?

You can discuss any concerns you have about your bladder or bowel with sensitive and supportive staff.
Staff will identify and treat any underlying causes for your bladder or bowel issues.
Your bladder or bowel issues will be proactively managed and treated where possible.
You will be provided with continence products that are right for you if you need them.

What does the standard mean for staff?

Staff, in line with roles, responsibilities and workplace setting:

promote and enable good bladder and bowel health
discuss people’s bladder and bowel function in a sensitive way
involve people in discussions about the management of bladder and bowel issues
ensure people have continence products that are fit for purpose
refer people for specialist continence support where required.

What does the standard mean for the organisation?

Organisations:

provide access to timely assessment and management of continue issues and access to equipment
have processes in place to support the identification, assessment and treatment of constipation
have process and pathways for safe insertion and removal of catheters.

Examples of what meeting this standard might look like

Evidence of routine enquiry about people’s bladder and bowel issues.
Referral pathways to specialist continence teams.
Evidence of treatment and management plans for bladder and bowel issues.
Risk assessments for catheter use.
Provision of continence products in the right size.