Carer of the year announced
Wellbeing for carers: put on your oxygen mask before helping others
Accessing respite
Caring for someone in hospital
Also in this edition:
Is my child incontinent?
Money talks : disposable vs reusable products?
Dear diary... a day in the life of someone experiencing incontinence
A free community event for Tasmanians hosted by Continence Health Australia
Come along if you’re dealing with incontinence (whether it’s leaking wee or poo) or caring for someone who is. Hear stories of hope and get helpful advice in a welcoming space. We’d love to see you there!
Date: Saturday 10 May 2025
Time: 11:15am -1:30pm
Venue: Hotel Grand Chancellor, Hobart
Cost: Free with complimentary morning tea and lunch
Consumers Leanne Murphy and Alan White will share their stories.
International obstetrician gynaecologist Dr Premitha Damodaran and local Tasmanian physiotherapist Emma Green will provide advice about getting help for continence health.
Open question and answer session.
Welcome to the Autumn edition of Bridge magazine, our flagship publication about all things bladder and bowel health. In this edition, we are celebrating approximately three million at-home carers across Australia. Many of these carers are responsible for the complex role of providing bladder and bowel care. They are the silent backbone of our society, offering unwavering support to loved ones with immense dedication. Continence Health Australia's Carer of the Year Award highlights their extraordinary contributions and serves as a reminder of the compassion and resilience that define these everyday heroes.
We would like to congratulate everyone who was nominated for the award, and especially our 2025 winner, Keren, who you can read about on page 4.
Also in this edition, we talk to psychologist, Tanya Osicka, about the importance of carers looking after their own wellbeing and ‘putting on their own oxygen mask before helping others’. We hear from Mandy about what it is like to help care for a loved one in hospital and from Maria who lives with urinary incontinence and pelvic pain.
We look forward to seeing many of you at our National Conference on Incontinence in Hobart, Tasmania from 7-10 May 2025.
Jim Cooper | Interim CEO Continence Health Australia
WE VALUE THE STORIES OF PEOPLE LIVING WITH OR CARING FOR SOMEONE WITH INCONTINENCE. READING OTHERS' LIVED EXPERIENCE CAN MAKE A HUGE DIFFERENCE TO SOMEONE IN A SIMILAR SITUATION.
IF YOU WOULD LIKE TO SHARE YOUR STORY WITH US, PLEASE EMAIL MANAGING EDITOR, SARAH TAYLER MEDIA@CONTINENCE.ORG.AU
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Print ISSN 1836-8107. Online ISSN 1836-8115. Published quarterly by Continence Health Australia (formerly Continence Foundation of Australia) and supported by the Australian Department of Health and Aged Care under the National Continence Program. Medical information: The information in the Bridge Magazine is for general guidance only and none of the information provided is intended to replace the advice of a professional including that of a doctor, continence nurse or continence physiotherapist. Copyright: The Bridge Magazine cannot be reprinted, copied or distributed unless permission is obtained from Continence Health Australia. Images: Unless otherwise indicated, the photographs used in the Bridge Magazine are those of models and bear no resemblance to the story unless specified. Advertising: Continence Health Australia appreciates the support of advertisers in publishing the Bridge Magazine. Advertising conforms to the standards required by Continence Health Australia, but endorsement is in no way implied by the publishing of said material. Continence Health Australia does not make any representations or give any warranties about the accuracy, reliability, completeness or suitability of any advertised products or services. Testimony: Any testimonial, opinion, review, recommendation or lived experience of a product or service published in the Bridge Magazine is not intended to represent the views of, or any guarantee or warranty by, Continence Health Australia, and all Individual results may vary. Liability: To the extent permissible by law, Continence Health Australia will not be liable for any expenses, losses, damages (including indirect or consequential damages) or costs which might be incurred as a result of any of the information contained in the Bridge Magazine being inaccurate or incomplete in any way and for any reason. References: For a list of references for any articles appearing in the Bridge Magazine, please email media@continence.org.au. To become a member of Continence Health Australia: email membership@continence.org.au or Phone 03 8692 8400.
Every year, Continence Health Australia calls for nominations for the Carer of the Year Award, which publicly acknowledges the vital role that unpaid carers play in supporting the health and wellbeing of so many in our community.
We are delighted to announce that the recipient of the 2025 Carer of the Year Award is Keren Franks, who was nominated by her sister-in-law. Keren has been a carer for her daughter Bella for over 22 years, which ultimately inspired Keren to establish her own registered charity, Young Leaders of Tasmania
Keren has been a primary carer for her daughter Bella since birth, “I remember the early years, they were very much just one diagnosis after another,” Keren recalls.
Bella was born with Kabuki syndrome, which is a rare, congenital, multisystem disorder characterised by multiple abnormalities including distinctive facial features, skeletal abnormalities, intellectual disabilities, and other medical conditions. The features of Kabuki syndrome can vary from person to person, however for Bella this also involves bilateral kidney reflux (where urine flows back from the bladder to the kidneys) and frequent urinary tract infections.
Around age five, Bella also began to experience severe constipation, pain, and often had toilet accidents. She was also diagnosed with Lichen Sclerosus, which is a chronic skin condition that commonly affects the genital and anal areas.
“Keren is selfless in her work and passionate about promoting and advocating for people living with a disability ,” said Allison, Keren's sister-in-law who nominated her for the award.
“A lot of my caring role is supporting Bella with the Lichen Sclerosus, dealing with flare ups of symptoms. Plus the constipation which leads to bowel impaction that she regularly experiences.”
Bella has needed full-time support with her personal care since birth, but Keren speaks selflessly about her contribution as a primary carer, “I do it because I love the person I care for. It’s just what any compassionate parent would do.”
Keren admits that caring for a loved one is not always easy, and she’s had to overcome difficult feelings of isolation and grief.
“You have these hopes and dreams for the baby you think you’re going to have, and then you’re thrown into such a different world with medical appointments, surgeries and planning flights to hospitals. It was
“Keren and Bella’s story has been one of strength, courage and determination.”
challenging watching my friends’ children being out of nappies and walking, and then seeing Bella still in a walking frame and incontinent.”
“The hardest thing for me to understand was that we are not alone and we are not isolated. There are people out there with amazing programs to help families reach out and get connected," says Keren.
"If there is one piece of advice I could give to other carers, it’s to reach out and use support. I have met some amazing carers who are now life-long friends. I have also had the most wonderful support from my husband and family. Ron is such a hands-on dad and has been a pillar of strength in our family, and my mum has always been there to help me in my caring role, too.”
Keren also prioritises her own wellbeing and says this is one of the most important things she can do as a carer.
“You can’t pour from an empty cup. I’ve always tried to keep the view that if I don't look after myself, then I can’t help Bella.”
“I joined a gym and make time for exercise, which is my main form of self-care. But you could get a massage or go for a walk on the beach. Whatever makes you feel good, you should try to make time to do it and not feel guilty about it.”
Before moving to the Southern Support School, Bella started her education in a mainstream school setting, where Keren witnessed the positive impact Bella was having on her peers. “Initially we were just amazed at how much their personal growth and leadership skills were evolving organically through working with Bella, and how Bella was teaching them about disability and inclusion.”
This inspired Keren to establish the charity, Young Leaders of Tasmania and the School Buddies Program, where children from mainstream schools complete a disability awareness practical leadership program. This involves students being buddied with a child living with a disability and working alongside that child, through weekly visits to the support school.
“The program helps to reduce the stigma of disability and increases the understanding that underneath the surface, everyone is the same and we all feel the same emotions.”
Through Keren’s lobbying, Young Leaders of Tasmania has now gained State Government funding to roll out the program across all support schools in Tasmania.
Congratulations to Keren, who will be awarded the Carer of the Year Award at the 33rd National Conference on Incontinence in May 2025.
Mandy recently lost her husband, George, who battled with complex medical problems stemming from rheumatoid arthritis.
After suffering for many years with what he thought were recurrent chest infections and pneumonia, George was diagnosed with rheumatoid arthritis after a work injury. Further tests with the specialist confirmed it was affecting his lungs with a secondary diagnosis of rheumatoid arthritis-associated interstitial lung disease (RA-ILD).
AND MANDY’S JOURNEY
George’s condition declined from 2015 when he had to medically retire from work due to ongoing pain. Soon after, in 2018, he had a pleurodesis, which is lung surgery to glue the lung to the chest wall to stop it filling up
What is rheumatoid arthritis?
Rheumatoid arthritis is an incurable autoimmune disease that causes inflammation in the joints and surrounding tissue. It can also cause damage to the heart, lungs and nervous system.
with fluid (pleural effusion) and causing him breathing difficulties. By 2020 his condition had worsened, and he was put on the transplant wait list for new lungs. In late 2020, George ended up on life support in ICU needing an urgent lung transplant. Following his life-saving transplant, he spent a total of 266 days in hospital, 216 of those days were in ICU. While this was life saving it was also life changing in ways that George and Mandy could never have imagined or prepared for.
“An ICU stay has a huge impact on a patient both physically and mentally. George had a very complicated recovery and had to learn to breathe, talk, write, eat, drink, and walk again. Surviving the mental health impacts of his long ICU stay was just as challenging,” Mandy tells Bridge.
“George's recovery was all that mattered at that point and he was in for the fight of his life. I took extended leave from my full-time job to ensure I was there for him every day. He had delirium (a type of confusion often related to illness) on and off from being critically ill, the medications, lack of sleep and the ICU environment itself. He became very anxious, scared and overwhelmed. He couldn't talk, so he would write down 'Mandy is my voice, she is my advocate', and got frustrated when the hospital staff didn’t listen.”
He was so scared and anxious in ICU that he would mostly sleep in the day when Mandy was there and
"I don’t think I have slept properly for four years,"
Mandy told Bridge.
stay awake at night because he was worried about what might happen to him. “For example, I always had to check his medication, as he was allergic to a yellow colouring used in various medicines, it has quite a few different names and has been missed on occasion by the pharmacist and accidentally provided to him. So George always liked me to check them for him before he took anything new," says Mandy.
Even though George was in hospital, Mandy, as his full time carer, would spend all day by his side. As was George’s wish she would dress him, shower him, collect medications if they weren’t available in the hospital, wash clothing and assist with other personal care duties, as he was not comfortable with the nurses doing these things.
George fought to recover and Mandy finally managed to get him home by finding a lot of the expensive equipment he needed second hand online. “I was always paying attention to the equipment they were using at the hospital. I would go home at night and search and search for a good price. I just knew for his own wellbeing I had to get him home where I could take care of him and our family could be whole again. I am a very dedicated and determined person who knew my husband wanted to come home, so I made sure it happened.”
George eventually, with lots of time and effort from both him and Mandy, was able to walk with a walker at home and get out and about in a wheelchair even with his ventilator (breathing machine). They loved going fishing, going to the football to watch the Brisbane Broncos and going for walks by the beach with their 15-year-old daughter.
It wasn’t easy for George to accept Mandy’s help, and it wasn’t easy for Mandy. Physically and mentally draining—caring for George was a 24/7 job. “In the last six months, he had to have his feeding tube connected at midnight and off at 6am, as well as driving him to dialysis appointments (treatment to remove waste and fluid from your body when your kidneys don’t work), other medical appointments because he was under so many different teams. Often I had to raise things with various teams as they got missed in the grey areas of which treating team they fell under."
“Caring for George was different to the way life was before his transplant, and it was hard, but it became normal for us and I don’t regret one second of looking after him as it kept him at home and out of hospital allowing us to be together as a family,” Mandy recalls.
George ended up needing dialysis three times a week once discharged from hospital, so he became anuric (no urine production). After George’s transplant, he was often on multiple antibiotics from infections which impacted his digestive and gut health requiring the use of faecal incontinence products.
There were also occasions where George had acquired c-diff which meant he had to use a separate bathroom and Mandy had to use protective mask, gloves, gown and sporicidal disinfectant wipes to clean the bathroom.
Cdiff (Clostridium difficilecolitis)
A bacteria that causes diarrhoea and can be life threatening. Often caused by antibiotics disrupting balance of gut bacteria or
In the past few years George’s mobility declined, and he needed an air mat on the bed and was awaiting a suitable zero gravity recliner with an air cell pressure relieving cushion to prevent pressure sores and reduce discomfort from pain. "To help avoid breakdown of his skin from faeces against his skin and friction from the continence aids, we used Molicare wipes and Cavlion spray and ensured all dressings (eg: sacral dressings) were removed with a spray adhesive remover like Brava to avoid skin tears."
"After trying many incontinence products we found the Tena active fit pants in conjunction with the Tena Duo protection layer best suited George's needs both at home and when we went out."
Mandy and George struggled to access financial help with continence aids and other medical products they needed to care for George at home. Mandy had searched endlessly and fought through all the red tape to apply for every support possible. Eventually, Mandy was able to submit a NDIS application for George which was initially rejected but with persistence, an internal review, and support from George’s treating teams it was approved in late 2023.
“It wasn’t until we had a Support Coordinator with NDIS that we found out about getting a continence assessment and how we could use the NDIS funding to help with George’s incontinence needs (ndis.gov.au/ participants/using-your-plan/who-can-help-start-yourplan/support-coordination/finding-support-coordinator).
My advice for carers would be to use services such as the carergateway.gov.au to find out what supports and funding you may be able to access. There is help and support out there, finding it is just hard when you don’t know where to look and have limited time to research."
“I just hope that our experience wasn’t in vain and telling our story can help other people who are going through it,” said Mandy. While caring for George fulltime and raising their daughter, Mandy commenced studying her master of rehabilitation counselling and will use that going forward to help other families.
Sadly George’s health took a turn for the worse in 2024, after 12 months of antibiotic treatment for nontuberculous mycobacteria lung disease and having a heart valve replacement. He had to have a nasal gastric feeding tube as he was unable to meet his
CALL THE NATIONAL CONTINENCE HELPLINE FOR SUPPORT AND ADVICE 1800 33 00 66 (8AM-8PM AEST MON-FRI)
nutritional requirements due to ongoing nausea and vomiting. George’s passion for life kept him fighting on, but he sadly contracted a bacterial infection causing sepsis and he passed away peacefully surrounded by his family in December 2024 at the age of 64.
“Once the person you are caring for passes away, suddenly life goes from 24/7 caring for your loved one to nothing. There's a huge part of you missing and you are left with unimaginable grief while surrounded by all the medical equipment and supplies that we fought so hard to get and were essential for everyday life but now don’t need anymore."
For information and support with grieving visit griefline.org.au
“Becoming a carer is hard, but stopping being a carer is harder.”
Taking regular breaks from your caring duties is important to avoid burnout and maintain your own health and wellbeing. There are services that can help.
If you are reading this and thinking, “I just don't have time to organise anything,” there are people that can help you. Perhaps you don’t know what services are available in your area or how to go about organising a break. You may feel it’s not worth the disruption or that you don't have the time and energy to bother. Your regional respite and carer support service (carergateway.gov.au) can help you to find out about respite options in your area and give you advice and support. They may also be able to help you to organise bookings and find out if financial assistance is available to help cover any cost.
Contact your local carers association to find out what is available in your area. Call Carer Gateway 1800 422 737 or visit carergateway.gov.au.
It is important for carers to be aware of 24-hour support services, including Lifeline (phone 13 11 14) and Beyond Blue (phone 1300 224 636). If you or another person is in an emergency, or at immediate risk of harming yourself/themself or others, please phone 000.
It is common for carers to feel reluctant about using respite. You may worry about leaving the person you care for, or feel that nobody can look after them as well as you do. Nobody can replace your expertise or the one-to-one care you provide at home, but remember that respite providers employ trained and skilled staff and operate under strict regulations and standards.
• In-home: a support worker looks after the person you care for in your home
• Facility or residential-based: the person you care for stays for a short period in a care facility like an aged care home or supported accommodation
• Community-based: the person you care for joins a day program at an adult day centre, neighbourhood house or community health centre
• Alternative family care: your family and friends may be able to help with your caring responsibilities while you take a break
• Recreation-based: you and the person you care for can join organised recreation, social or leisure activities either together or separately
• Emergency respite: if you need to deal with sudden illness, accidents, or emergencies
• Equipment to support or ease your role
You can help by giving the respite provider as much information as you can about your loved one's routines, preferences and requirements.
Concerns are normal, but they need to be balanced against the risk that you will burn out. Regular breaks can give you time to re-energise, enjoy different activities and concentrate on other relationships. They can help you to be a better carer.
Remember that respite can also be a break for the person you are supporting. It can give them the opportunity to meet new people and to experience a new environment and change of routine. CONTINUED
COMMON CONCERNS FOR THE PERSON YOU CARE FOR
The person you care for may be anxious or reluctant to be looked after by strangers. This may be compounded if English is not their first language, if they find it difficult to communicate their needs, or if they don’t cope well with change. Start with small breaks and build up to longer ones. It may help them to adjust if you share the care with respite workers the first few times. For example, stay with them the first time they use a day program or be at home for the first few visits by an in-home respite worker.
do I find respite care that can accommodate complex medical issues?
FOR MORE INFORMATION ON CARING FOR SOMEONE WITH INCONTINENCE, SCAN THE QR CODE TO DOWNLOAD OUR FACT SHEET
DISPOSABLE vs REUSABLE CONTINENCE AIDS (PRODUCTS)
Living with bladder or bowel problems that cause incontinence can come at a huge cost. It can impact all areas of your life, from work, to spending time with family and friends and taking part in your favourite activities. It can affect your confidence and lead to social isolation, depression and anxiety.
Continence problems also come at a huge financial cost. The Economic Cost of Incontinence in Australia report by Continence Health Australia found that 99% of people experiencing incontinence were using pads, liners, or pull-ups at an average cost of $1,835 per year. This is on top of other products such as chair or bed mats ($144 per year), hygiene and odour control products ($76 per year), and skin care products such as barrier creams and wipes ($48 per year).
With this in mind, how can you maximise your confidence and comfort, while also maximising your budget? In recent years reusable continence pads and pants have come a long way, but there are still pros and cons to all products.
1 IN 4 AUSTRALIANS ARE AFFECTED BY BLADDER AND BOWEL CONTROL HEALTH ISSUES, HOWEVER, IT IS RARELY TALKED ABOUT AND PEOPLE AREN’T AWARE THAT HELP IS AVAILABLE.
Did you know that there are specific products to help manage adult incontinence?
Women’s sanitary pads are not a good product to use because they aren’t designed to absorb urine or faeces leakages. Ask at your local pharmacy or call the National Continence Helpline for more information.
REUSABLE PRODUCTS:
• Can be more discreet as they look more like underwear
• Can be more comfortable and kinder to skin
• You don’t have to keep going to the shop to buy more, or worry about running out
• Time and money to wash them
• Have to be cared for correctly to avoid skin irritation
• Can't usually absorb as high volume as disposable
• More expensive to buy, but you can reuse them
CALL THE NATIONAL CONTINENCE HELPLINE 1800 33 00 66
(8AM-8PM AEST MON-FRI) FOR FREE ADVICE FROM A NURSE CONTINENCE SPECIALIST
The Continence Aids Payment Scheme (CAPS) is an Australian Federal Government scheme that provides a payment to assist eligible people who have permanent and severe incontinence to meet some of the cost of their continence products.
WHO CAN APPLY FOR CAPS FUNDING?
• People over five years of age
• Australian citizens or permanent residents
• Have permanent and severe incontinence of bladder and/or bowel caused by an eligible condition
Visit health.gov.au/our-work/continence-aids-paymentscheme-caps for more information or call the National Continence Helpline 1800 33 00 66 for free and confidential advice on funding for continence products.
• Can absorb high volumes of urine or faeces
• No washing, just throw away
• Easier when going out as you don’t have to carry the used ones with you (if you can find a suitable bin)
• Cheaper to buy initially
• Need space to store them
• Cost can add up because you have to buy more
• Friction can irritate skin, might have to try different products to find one that works for you
What does good continence care in residential aged care look like? And how to advocate for better.
Many families caring for a loved one will reach the stage where they can no longer offer the care needed at home. Faecal incontinence, decreased mobility and dementia are the three major reasons for admittance to a residential aged care facility. We talked to Bernadette, manager of a residential aged care facility, to find out what you should look for when choosing care for a loved one who is experiencing incontinence.
“When someone is admitted to residential aged care they should have a full continence assessment and a care plan should be developed in consultation with the resident and their family. Having the correct continence aid for the individual needs of the resident is most important. Once they are settled in, the continence aids suitability is continually monitored. The care plans are reviewed if there is a change in the residents' care needs or at least six monthly. A good home will always have open disclosure and good communication with the familiy."
“A good care routine for someone with incontinence in residential aged care should include regular meal, snack and drink times. This will help them stay regular and enable you to anticipate when they might need help to get to the toilet. A regular toilet routine can help avoid accidents or interruptions for them while they are
“Dignity and independence for our residents is always a high priority, with continual review of care needed.”
socialising during mealtimes or activities by scheduling trips to the toilet to suit each resident. If not managed properly, residents experiencing incontinence can become anxious about socialising and leaving their room in case they have an accident.”
“One of the hardest parts of managing continence in residents is making sure they stay hydrated. During warmer months especially, giving them additional fluids is always a priority. Many think drinking less means they do not need to urinate as frequently or be incontinent. So encouraging the residents to drink adequate fluids daily to reduce the incidents of urinary tract infection is always a challenge.”
DID YOU KNOW...DRINKING LESS CAN ACTUALLY MAKE YOU WEE MORE OFTEN?
Concentrated urine (wee) can irritate your bladder and makes you need to go to the toilet more regularly.
“A well-designed room at a residential home will always have a line of sight to the bathroom for prompting the residents. We also give our staff training on continence care, which is very important to give them confidence when toileting the residents and ensure the right continence aid is being used for each individual. If you think a loved one is not getting the correct continence care at their aged care facility, you should always communicate with staff and go to the manager, if needed, to discuss any concerns.”
If you want support communicating with the aged care facility, you can contact the Older Person Advocacy Network (opan.org.au) or the Aged Care Quality and Safety Commission (agedcarequality.gov.au).
NEED HELP WITH CARING FOR SOMEONE
Free advice from a nurse continence specialist is available Monday to Friday 8am-8pm AEST from the National Continence Helpline team.
Alternatively, speak to your doctor to arrange a full continence assessment and to develop a plan for the correct treatment and care.
Incontinence can happen to men, women and children at all ages and stages of life. It is a health condition that has multiple causes, and it can be prevented, treated and managed to improve your health and quality of life. Incontinence does not need to be seen as an unavoidable consequence of certain life transitions or medical conditions.
URINARY INCONTINENCE:
can range from slight leakage when you cough or sneeze, to complete loss of control of the bladder. Involuntary loss of urine (wee) can have many causes and is often treatable.
FAECAL INCONTINENCE :
INCONTINENCE SHOULD NOT BE ACCEPTED AS AN INEVITABLE CONSEQUENCE of pregnancy, birth, chronic disease, menopause or ageing.
59 % 12 %
OF PEOPLE HAVE DISCUSSED THEIR INCONTINENCE WITH A HEALTH PROFESSIONAL
OF PEOPLE WERE RECEIVING FORMAL CARE OR TREATMENT TO HELP THEM MANAGE IT
In the absence of infections or other medical conditions, EFFECTIVE INTERVENTIONS (TREATMENTS) can range from lifestyle changes including diet, weight loss and pelvic floor exercises to the use of medicines and surgery.
While incontinence is a common condition, IN MANY CASES, IT CAN BE PREVENTED, BETTER MANAGED AND EVEN CURED.
DON’T LIVE WITH THE SYMPTOMS, FIND OUT WHERE TO GET TREATMENT AT CONTINENCE.ORG.AU OR SCAN THE QR CODE.
has many causes and can be permanent or temporary as a side effect of medicines, health conditions, or medical treatments. If you aren’t able to control your bowel and suffer involuntary loss of faeces (poo), you may be living with faecal incontinence. References: Continence
We talked to Dr Tanya Osicka, Health Psychologist at Tanya Osicka Psychology, about how carers can look after themselves and avoid burnout.
Q: WHAT ARE SOME OF THE MENTAL HEALTH CHALLENGES THAT CARERS FACE?
A: It has been well established by research that carers experience adverse mental health outcomes when compared to the population. For example, figures published by Carer's Australia in 2024 reported that carers experience reported reduced wellbeing; and that the most common challenges reported by carers were worries about the future of the person they are caring for, money worries in relation to the care recipient, feeling a high level of responsibility as a carer, and worries about not being able to continue providing care in the longer term.
"IN MY WORK AS A HEALTH PSYCHOLOGIST, THE MOST COMMON ISSUES CARERS REPORT ARE CHRONIC STRESS, WORRY, ANXIETY, LOW MOOD OR DEPRESSION, FRUSTRATION, EXHAUSTION AND BURNOUT, GRIEF, AND RESENTMENT."
Many carers tell me that it is an honour to provide care, but even when carers dearly love the person they are caring for, the toll of providing regular care can impact their wellbeing.
In the case of caring for a loved one with a life-limiting illness, anticipatory grief (the grief experienced whilst a person is dying) may be a longer-term experience. In general, providing care can have a high impact on the carer's finances and ability to work, rest, socialise, and attend to their own mental health and physical health needs. Even when formal or informal respite care is available, some carers experience guilt for taking time out for themselves.
When our body is stressed and/or anxious, the brain releases hormones and activates the sympathetic nervous system in what is commonly called the 'fight or flight' response. Whilst this sympathetic nervous system activation is helpful in the short term as it increases our heart rate and gives us more energy to help us resolve a stressful or challenging situation, ideally the person returns to a parasympathetic nervous system, or resting state in a short time. However, when our bodies are in this fight or flight state of arousal for a prolonged amount of time this constant activation can lead to digestive and gastrointestinal issues, high blood pressure, headaches, sleep problems, weight gain, bodily pain and tension, and depression and anxiety.
CONTINUED
For some carers, it has been the demands and stress of the caring role that has led to their current mental health symptoms, for others the pressures of caring for others exacerbates pre-existing mental health symptoms. Many of the carers that I see are also juggling multiple life demands. Whilst Carer's Australia research (2024) shows the wellbeing benefits of carers maintaining employment; balancing care needs with employment and the care of other family members can add significant pressure. A term often used in the media is that of the 'sandwich generation' of middle-aged adults who are taking care of their children and their ageing parents, often while managing their employment and their own health needs as they age.
'Stress is inherently part of life, and in the short term can mobilise us to act in a crisis. However, when stress occurs over the longer term, such as when providing care, it becomes chronic stress."
Dr. Tanya Osicka, Health Psychologist
It can also be challenging for carers when there has been a prior negative relationship with the person they are caring for. For example where there is ongoing conflict, for those caring for a parent who was abusive, or caring for in-laws when there has not been a positive relationship in the past. It can be very helpful to discuss these challenges with an experienced psychologist, counsellor, or family therapist.
Q: WHAT IS IT ABOUT CARING FOR SOMEONE WITH A MEDICAL CONDITION THAT CAN CAUSE BURNOUT OR EXACERBATE MENTAL HEALTH PROBLEMS?
A: Research in the Australian Journal of General Practice in 2019 (Wang & Du) reported a three times higher prevalence of psychological distress in the primary carers of people with disabilities compared to the general population. Almost half of the study participants reported that the caring role had impacted their physical health and wellbeing, which was attributed to the high provision of care needs, restrictions to their own social life and leisure time, and financial stresses.
Burnout is the experience of emotional, mental, and/or physical exhaustion that results from long-term chronic stress. While burnout is a term that has historically been applied to the workplace, we now know that burnout can arise due to the demands of multiple life demands, including the provision of care.
People with burnout may experience feelings of cynicism, emptiness, anger, feelings of helplessness and hopelessness. For those experiencing these or any other physical or mental health symptoms it is important to speak to your GP so that a full physical and mental health assessment can be done.
Some people do not even consider themselves a carer, particularly teenagers and younger adults who are caring for a parent or family member. However, Carers Australia reports that there are over 390,000 young carers up to the age of 25 in Australia.
Q: WHAT SHOULD A CARER DO IF THEY ARE FEELING BURNT OUT OR LIKE THEY CAN'T COPE WITH THEIR CARING RESPONSIBILITIES?
A: The experience of carers who feel exhausted, burnt out and unable to cope need to be taken seriously, as this is unlikely to resolve without intervention. It is important to speak to family or loved ones and let them know what you are experiencing and to make an appointment with a GP as soon as possible, as delaying treatment is likely to further increase distress levels. As well as checking your physical health, a GP can use mental health assessment tools such as the K10 or DASS-21, and prepare a Mental Health Care Plan for Medicare subsidised psychology sessions if your symptoms indicate this.
IT IS IMPORTANT FOR CARERS TO BE AWARE OF 24 HOUR SUPPORT SERVICES, INCLUDING LIFELINE (PHONE 13 11 14) AND BEYOND BLUE (PHONE 1300 224 636). IF YOU OR ANOTHER PERSON IS IN AN EMERGENCY, OR AT IMMEDIATE RISK OF HARMING YOURSELF/THEMSELF OR OTHERS, PLEASE PHONE 000.
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“I find that the oxygen mask analogy is such a helpful way to help my psychology clients see the need to prioritise their own wellbeing,” Health Psychologist, Tanya Osicka, tells Bridge. “While it may be ok to neglect yourself in the short term, it is very hard to look after others if you are experiencing challenges with your own physical and emotional health.”
Remember to stay hydrated, eat healthily where possible, and exercise regularly.
Avoiding or limiting alcohol and substance intake is important, as carers are at increased risk for alcohol and substance dependency.
2 Have regular time off where care needs can be attended to by family, friends, community support agencies, or respite care.
3 Attend to your health needs. Seeing your GP for health checks and for any new symptoms, regular dental appointments and eye checks.
4 Spend positive time with family, friends or social groups, and have a laugh to take your mind off your responsibilities where possible.
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Time spent on your hobbies and interests. This can be as small as reading a magazine in the garden, or catching up on your favourite TV show. You could sign up to a class to ensure you have regular time for yourself each week, local councils often have free or low-cost class options such as tai chi in the park.
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See a psychologist or counsellor for a supportive and non-judgemental place to discuss the demands of the carer role, and to support your overall mental health. The Cairnmillar Institute (cairnmillar.org.au) provides a Community Clinic with low or nocost options for support, which can be accessed in person or online. In addition, many other university and psychology training providers offer free or low-cost psychology and counselling services.
Keep active. Walking is great and low cost. Using YouTube for exercise, yoga, or stretching (speak to GP first prior to commencing any new exercise).
8 Time in green and blue spaces (eg parks, nurseries, lakes, the beach) is known to be beneficial for mood and wellbeing.
9 Prioritise sleep hygiene. Keep to a regular sleep routine where possible. Sleep deprivation can exacerbate feelings of overwhelm.
10 Many carers find online support groups and forums helpful. Search online for a local group or contact community support services such as Carer’s Gateway, Carers Australia, Friend Line, Little Dreamers (for carers up to 25), Young Carer’s Network, and Moira Carer Connect.
Incontinence affects many children and adults with autism and/or intellectual disability for a range of different reasons. “The best advice I have for parents around toileting for children with autism and/or intellectual disability, is that independent toileting can be a longer process and taking breaks is normal, as it can be an exhausting task,” said Jessie Smith, school nurse at a specialist school.
The 4-year-old health check before they start school is a good time to consider starting your toilet training again. Talk to the maternal health nurse at the check and don’t assume their disability is causing your child's incontinence. You can also go to the doctor to rule out any underlying medical issues.
Once medical issues are ruled out you don’t have to keep going it alone, there are health professionals who can help, such as nurse continence specialists and occupational therapists.
CHILDREN WITH ADDITIONAL NEEDS MAY EXPERIENCE:
• Sensory issues – children may like or dislike the sensation of being in a wet or soiled nappy. They might also like the deep pressure that nappies provide (try replicating the feeling with tight undies or pants). A child may struggle with being overwhelmed or distracted by strong smells or noises in the bathroom. They might not register the sensation of having a full bladder or bowel.
• Vision issues – children may experience problems with depth perception making the toilet look like a huge gaping hole.
• Routine change – a child may be resistant to toilet training if they like bonding time over nappy changes and are not sure how else to connect with parents because of social issues.
•Posture and balance – some children may struggle to maintain the upright position needed to sit on the toilet.
• Misunderstanding expectations – some children take instructions very literally, so you might need to provide very detailed instructions of what is expected in the toilet and provide visual cues such as printed instructions.
IF YOU NEED HELP WITH TOILET TRAINING BOOK A TIME FOR A NURSE CONTINENCE SPECIALIST TO CALL YOU, OR CALL 1800 33 00 66 (8AM-8PM AEST MON-FRI)
THE MOST COMMON REASON FOR CALLS TO OUR HELPLINE IS CONSTIPATION IN CHILDREN. IF YOUR CHILD IS CONSTIPATED, CONSIDER THE FOLLOWING LIFESTYLE CHANGES:
1. Increase fluid intake
2. Increase dietary fibre
3. Increase daily movement
4. Stick to regular toilet times
READ 7 SIGNS YOUR CHILD IS CONSTIPATED FROM OUR SUMMER 2025 EDITION
“Achieving continence can improve quality of life for the individual and the family, it is worth the effort, but it can be really hard work so be kind to yourself .”
BIO: Since giving birth to her four children, Maria has experienced daily urinary leakage (incontinence) that requires the use of pads or absorbent underpants. Additionally, she has ongoing pelvic pain that continues to affect her daily life...
NAME: Maria
FAMILY: Husband and four children aged 14, 12, 9, and 7
OCCUPATION: Early childhood teacher
CONDITION: Pelvic pain and urinary leakage
CURRENT TREATMENT: Pelvic floor exercises and lifestyle changes
My average day is quite busy, balancing work, family, and personal time. Mornings start early, getting my children ready for school and preparing for my day at work. My job involves a lot of movement—engaging with preschoolers, setting up activities, and managing paperwork. I have been in the field for almost eight years, my day at work includes planning and facilitating engaging learning experiences for young children, observing their development, and supporting their growth in a nurturing environment.
The more physically demanding parts of my day affect my pelvic pain and bladder leakage the most. This can be activities such as bending down to interact with children, lifting materials, or even standing for long periods. It also makes simple things, like rushing to the bathroom between tasks, more stressful. My leakage is triggered by coughing, laughing, or sneezing. The pressure from these actions makes it hard to control my bladder and usually results in urinary leakage. It’s frustrating and makes me more self-conscious in everyday situations.
Before having kids, I enjoyed activities like travelling, reading for long periods, and going out with friends without having to worry about time or responsibilities. Now, with my busy schedule and the demands of family life, it’s harder to find time for these things. Sometimes, even simple activities like taking a quiet walk or enjoying a meal out can be challenging with the kids’ schedules and needs. I do miss those moments of freedom, but I enjoy being with my family, even if it means adjusting my priorities. By the end of the day, discomfort from my pelvic pain makes it harder to relax and unwind.
I’m currently receiving treatment for both bladder control and pelvic pain. I started by visiting my GP, who referred me to a continence nurse. The nurse has been helping me with exercises to strengthen my pelvic floor muscles and manage my symptoms. Additionally, I’ve been learning about lifestyle changes that can help, like maintaining a healthy weight and avoiding certain triggers.
“THE TREATMENT HAS BEEN A GRADUAL PROCESS, AND WHILE IT’S HELPING, I STILL HAVE A LONG WAY TO GO."
For bladder leakage, I use disposable pads for convenience and comfort. I prefer a well-known brand like Tena or Poise, as they offer good absorbency and reliability. While I know reusable options exist, I find disposable pads more practical for my busy lifestyle, especially given how frequently I need to change them. I feel they provide the best protection throughout my day, and the ease of use makes them my go-to choice.
"TENA OR POISE OFFER
The problems with my bladder and pelvic pain impact my life in several ways. Financially, it can be costly, as I need to purchase pads regularly and seek ongoing treatment, which adds up over time. Socially, I often feel self-conscious, especially in group settings or when I need to laugh or cough, worrying about leakage. At work, I have to plan bathroom breaks carefully and sometimes limit physical activities with the children. It also affects my family life because I can’t always engage in spontaneous activities or outings, as I need to be mindful of my condition. Overall, it adds an extra layer of stress and requires careful management to balance everything.
My advice to others suffering from pelvic pain or leakage would be to not ignore the issue and seek help as soon as possible. It’s important to talk to a healthcare professional who can guide you through treatment options, whether it’s seeing a GP, a continence nurse, a pelvic health physio, or a specialist. Working on the strength and coordination of your pelvic floor muscles through exercises can make a big difference. I’d also recommend finding products that work for you, whether they’re pads, liners, or other solutions, and not feeling embarrassed to use them. Above all, take care of your mental health—it’s okay to ask for support from friends, family, and support groups. You’re not alone in this.
While it might feel isolating at times, reaching out for support and discussing your experiences can help you feel more empowered. I’ve learned that taking small steps toward managing the condition, whether through treatment, lifestyle changes, or simply being kind to myself, makes a difference. It’s an ongoing journey, but with the right resources and support, it’s manageable.
“LIVING WITH PELVIC PAIN AND BLADDER LEAKAGE CAN BE CHALLENGING, BUT IT’S IMPORTANT TO REMEMBER THAT IT DOESN’T DEFINE YOU.”
Dr Aniruddh Deshpande,
Paediatric Urologist and Head of Surgery
“ALL CHILDREN AND FAMILIES SHOULD SEEK HELP AND SUPPORT FOR URINARY INCONTINENCE— NO MATTER IF IT APPEARS TO BE SMALL AMOUNTS OR RELATIVELY INFREQUENTLY.”
“Bedwetting once a week is clinically significant, the size of the accident doesn’t matter,” Dr Aniruddh Deshpande, Paediatric Urologist and Head of Surgery at The Children’s Hospital at Westmead tells Bridge. “Small regular daytime accidents can impact children's mental health, especially older girls and non-caucasian children.”
In 2011, Dr Deshpande and his colleague published a study on the impact of incontinence on children's lives. Though the study was published over a decade ago, not much has changed. “Most children of preschool age will have the odd accident. It has to be at least once a week to be considered clinically significant over the age of five in the daytime and the age of seven for nighttime wetting. But the size of the accident is not that important, because even small accidents can affect children mentally,” says Dr Deshpande.
SIGNS TO LOOK OUT FOR IN OLDER CHILDREN AND TEENS
Your school-age child or teen may not feel comfortable telling you that they are experiencing urinary incontinence, so here are some signs they may have a problem:
• An unusual amount of underwear in the laundry basket
• Smelly underwear, although it is not unusual for underwear to be smelly after school
• Skid marks in underwear
• Avoiding social activities, school camps or sleepovers away from home
• Avoiding sports due to leakage during strenuous activities
Urinary leakage is not often physically harmful in itself (if there is no underlying medical condition), the harm comes from the impact it has on the child’s selfesteem and mental wellbeing. You have to be kind, compassionate and understanding when you talk to them about their leakage. Reassure them there is help available and with treatment and time it can be resolved.
COMMON CAUSES OF URINARY LEAKAGE (INCONTINENCE) IN OTHERWISE HEALTHY SCHOOL-AGE CHILDREN
“One cause of urinary issues can be bladder/ bowel dysfunction. This is when you get bowel (poo)
“Three-quarters of children with constipation actually poo every day, they just don’t poo enough. So that is why skid marks are often an indicator of constipation .”
leakage and constipation at the same time, and the combination of symptoms impacts the bladder for example recurring urine infections and wetting or leakage.”
“Another cause of wetting in children can be if the pelvic floor becomes out of sync with the bladder in young girls—treatment for this is retraining the muscles.”
“I see a lot of neurodiverse children with ADHD,” Dr Deshpande tells Bridge. “ADHD and leakage are very strongly linked due to the neural networks in the neurodivergent brain. Our understanding of these processes is on the rise.”
“I also see cases where a child has had too much screen time and other distractions, so they learn to ignore their normal bladder and bowel sensations. This takes a lot of work to relearn, but it is possible. I encourage parents to get help as soon as possible, as the older the child is, the more it will impact their selfconfidence and self-esteem.”
“The four most important things to prevent continence issues are a consistent toilet routine, eating fibre such as whole grains, fruits and veggies, drinking enough fluid (4-6 cups a day), and regular exercise. If you reflect on your child’s day you might be able to make some lifestyle changes to help their condition."
“Often your school-aged child or pre-teen will not confide in you about their toilet issues. But once you notice some of the signs there are tools medical professionals can use to decipher if the incontinence is due to a physical issue or a mental issue.”
While your GP will probably be your first port of call, they will get help from additional experts. Most significant or refractory (not responding to treatment)continence problems are best dealt with by multiple health professionals to make sure the mental, physical and lifestyle aspects are all covered. People involved in your child’s team may include a paediatrician, paediatric urologist, continence nurse, psychologist, dietitian, physiotherapist and/or an occupational therapist.
“The first thing I tell the parents of my patients is to manage their expectations. It takes a long time to make change with continence problems, especially if it involves the child relearning brain/bladder connection. Parents are the daily caregivers and have to make changes diligently. Unfortunately, there is no shortcut when it comes to bladder problems in children.”
“Parents also have to remember that the reason they are seeking treatment for their child’s wetting is to improve their quality of life, so one of the most important aspects is supporting the child or teen with body image and self-esteem. Anxiety around social, sports or school events can be common.”
Short-term things you can do to help them get involved with regular activities while they work on their bladder control could be purchasing reusable continence underwear which are absorbent, neutralise smells, and most importantly are very discreet. There are several brands which make underwear for children from 2-16 years old in bright colours with nice patterns which, at a glance, look like normal underwear. A small change like this could significantly increase your child’s confidence while you work on longer-term changes.
As all parents will know, getting children of any age to cooperate and stick to a plan isn’t always easy. While Dr Deshpande doesn’t recommend bribery with lollies or chocolates to stick to their medical regime, he says there can be a place for a ‘token economy’ in certain situations to help children be consistent and work with you on their treatment.
If you or your child are affected by any of the topics covered in this article, contact the FREE National Continence Helpline.
1800 33 00 66
(8am-8pm AEST Mon-Fri) for advice from a qualified nurse continence specialist or book in with your GP for guidance and referral to a specialist.
WHY I BECAME A SPEAK TO A NURSE CONTINENCE SPECIALIST 1800 33 00 66
LENA BECAME A NURSE CONTINENCE SPECIALIST AFTER MEETING A PATIENT WHO HAD SUFFERED WITH INCONTINENCE FOR OVER A DECADE WITHOUT TELLING ANYONE.
"I visited a patient one day to assist her with management of her wound care. She was in her 40s with two teens at home. She eventually told me that she had been having continence issues since the kids were born and had never told anyone. I felt so sad for her that she had been carrying this on her own for so long and managing without any help. Incontinence affects people's lives in so many ways; you can't wear the clothes you want, you can't do activities you used to do."
After becoming a nurse continence specialist, Lena worked for many years in the community visiting clients to help them with their incontinence issues. Lena then moved to the National Continence Helpline team to treat people via telehealth in 2024. "Moving from visiting clients in person to telehealth has been an adjustment, but it is great for them because it makes a huge difference to people living in remote places, or parents caring for a child with autism. They can let the child play in their own environment while we do their consult so it is more relaxing for everyone."
"I love working on the National Continence Helpline because there are such varied calls every day. One call might be about how to access funding for continence aids or product advice and the next call might be about toilet training advice for young children."
(8AM-8PM AEST MON-FRI)
AVERAGE WAIT TIME LESS THAN 60 SECONDS
Lena, Nurse Continence Specialist
"My main goal through continence nursing is to let people know they have options."
Fact #1 Aging doesn't mean you have to experience incontinence. Some people think it is normal to be incontinent when you get to a certain age, but it doesn't necessarily have to be that way. I have had clients who are 90 years old who are still in control of their bladder and bowel motions. Incontinence can impact anyone at any age and can often be treated, better managed or even cured.
Fact #2 Surgery is not the only treatment option for most continence problems. Clients tell me they are worried about getting treatment because they have heard surgery horror stories. I wish more people knew there are quite a few treatments to try before they need to consider surgery. Speak to someone you trust such as your health professional, friend, or relative about your continence problem. Or take the first step towards help by calling the National Continence Helpline for free, confidential advice.
WHAT TO EXPECT WHEN YOU CALL THE HELPLINE
Your call will be answered by one of our nurse continence specialists who will listen to your story without judgement and offer confidential advice.
No question is too big or too small. The Nurse Continence Specialist is able to give you advice on how to improve and manage the continence problem, give details of local clinics, funding and product advice, including where to get product samples. The nurse can explain what to talk to your GP about and tests that may be needed. They can help you describe the problems you are having using medical terminology, which can be useful when explaining your symptoms to other health professionals.
Topics people call the helpline about include, but are not limited to:
1. Prevention and management of incontinence (loss of bladder and bowel control)
2. Women's health – bladder or bowel issues from pregnancy, childbirth, pelvic floor dysfunction, prolapse and/or menopause
3. Men's health – prostate, after dribble
4. Children's health – toilet training, bedwetting, day wetting, soiling, constipation
5. Bladder or bowel issues from medical conditions such as diabetes, dementia, and Parkinson's Disease
6. Funding schemes including CAPS and NDIS
7. Continence product advice
Anyone! You can call the helpline if you are experiencing incontinence, are caring for someone living with incontinence, or you are a health professional calling for advice about a patient. Health professionals can also call and arrange for the helpline staff to contact one of their patients.
For free advice call the National Continence Helpline on 1800 33 00 66 (8am-8pm AEST) to speak to a nurse continence specialist.
If you have a story to share about your experience calling the helpline for advice on your bladder or bowel health, please get in touch. Readers value reading other people's lived experience. As a thank you, Continence Health Australia offers a $100 giftcard for any articles we publish.
Email Managing Editor, Sarah Tayler media@continence.org.au to share your journey.
"I became involved in the Great Dunny Hunt in 2021 after seeing it promoted in my local paper in the lead up to World Continence Week. We were just coming out of Covid-19 lockdown, and the hunt seemed like a great incentive to do some exploring.
I mostly relied on a variety of online resources to locate toilets that were missing from the map. As I found toilets that were not on the map, I would use multiple sources to verify that it existed and collect information. I spent a fair bit of time looking at online maps and photos looking for accessibility ramps and checking the exact location. Council and government websites were also great sources for checking the facilities, hours and access requirements for a dunny. Each spot would take about five minutes of research. I did not submit around a quarter of my finds due to lack of information, since I wanted to ensure accuracy. Nobody wants to turn up and discover a toilet isn't actually there. Many toilets have names like Toompie Hall and Stanley Rest Area, and when I searched for some missing toilets by name on the map I would find that they existed but had been entered wrong and were sometimes a couple of kilometers from where they should be (so I moved them). Apart from fixing existing toilet locations, I managed to add 129 toilets to the map during the first hunt, with everybody from the campaign contributing over 600 toilets in total.
Some of my favourites were the SA/NT border toilets (I can't believe they weren't on the map) and discoveries like the Boorabbin Memorial (a memorial to three truck drivers who died in a bush fire). There is so much history in these little stops on the highway."
THE MARYBOROUGH TOWN HALL PUBLIC TOILET (THE CISTERN CHAPEL)
These toilets were renovated as part of a push to promote the town and they make quite an impact.
“THE NATIONAL PUBLIC TOILET MAP EXISTS TO ENABLE OVER SEVEN MILLION OR MORE AUSTRALIANS AFFECTED BY INCONTINENCE TO PLAN THEIR TRIPS WITH CONFIDENCE AND OVERCOME RELUCTANCE TO LEAVE HOME.”
Search for the closest public toilet anywhere in Australia on the National Public Toilet Map!
The National Public Toilet Map has over 22,000 public toilets listed, including opening times and available facilities.
Go online at toiletmap.gov.au or download the National Public Toilet Map app via the Apple App store or Google Play.
