SUMMER 2025
CHILDREN’S HEALTH EDITION
Getting toilet-ready for school
Raising a child with spina bifida
Is your child constipated?
Toilet training explained
Also in this edition:
Returning to work after prostate cancer
Living with no bladder
Learning healthy habits early
Toilet Tactics is a free resource to help promote healthy bladder and bowel habits in schools.
SCAN HERE FOR MORE INFORMATION
Toilet Tactics is an initiative of the Continence Foundation of Australia and is supported by the Victorian Government and Australian Government.
Toilet Tactics is an initiative of Continence Health Australia and is supported by the Victorian Government and Australian Government.
A Note
FROM THE CEO
Our first edition of 2025 brings with it some changes. After a reader survey in late 2024, we listened to your feedback and included articles relevant to different audiences, as well as the themed content. We are also bringing back printed editions, so if you would like your copy of the Bridge magazine in print, please sign up by scanning the QR code below with your mobile phone camera. This summer's edition of Bridge Magazine focuses on children's bladder and bowel health. We talk to occupational therapists, continence nurse specialists, and a school nurse to learn how to manage toileting issues in children, the process for getting help, and the treatments available. We also talk to Sara about her experience raising a child with spina bifida, and to Paul about returning to work after being diagnosed with prostate cancer.
Our organisation is developing and has changed our name and branding to reflect our new goals and values. The Continence Foundation of Australia will now be known as Continence Health Australia. Sign up to our emails to keep updated with new projects and exciting changes throughout this year. We would also like to thank Dr. Gian Sberna, our CEO who has decided to step down from his position. We sincerely thank Gian for his leadership and significant contributions during his tenure. The Board will undertake an executive search for a new CEO in the coming months. During this transitional period, I will be acting as interim CEO.
Jim Cooper | Interim CEO Continence Health Australia
free service staffed by nurse continence specialists who can provide information, referrals and resources 8am - 8pm AEST
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 does not replace the expert and individual advice 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. 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.
Foundation of Australia @AusContinence
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 media@continence.org.au
Getting Going
HOW TO TELL IF YOUR CHILD IS CONSTIPATED
As a Continence Nurse Consultant in a Perth hospital, Kerry Murphy’s job is educating parents and teaching children what is not normal when it comes to bladder and bowel symptoms. “A lot of issues are preventable,” says Kerry. “But your children might not tell you about their toilet problems. They might even deny them. So you have to do a bit of detective work and pay attention.”
“You don’t just potty train your child when they are a toddler and then forget about it. Even once they are at primary school and high school you should try your best to monitor how much fluid they drink, what type of food they are eating, how much exercise they do. They are the key things to maintain healthy bowel habits every day.”
SEVEN SIGNS YOUR CHILD IS CONSTIPATED
1 Skids in their underwear. Parents often think this means this child isn’t wiping properly. But it can be a sign of constipation.
2 Taking too long or not long enough on the toilet; if your child takes longer than ten minutes to do a poo they are most likely constipated. If they hop straight off it could mean they aren’t emptying their bowels completely.
3 Complaining of a sore tummy, sore bum, or feeling nauseous.
4 Extreme emotional reactions to doing a poo such as refusing to poo on the toilet and only going in their nappy. Being worried or scared of the toilet could mean it is painful for them to pass hard poo.
5 Too much or not enough poo. This refers to volume and frequency. Kids should be aiming for once a day, a similar amount each time. Several small poos a day or one very large poo every few days could mean they are constipated.
6 Bad breath, lots of wind or very smelly poo.
7 Poo that is not a smooth long sausage (small pebbles or loose diarrhea). See the Bristol Stool Chart for pictures and descriptions: continence.org.au/bristol-stool-chart
“We recommend children who are constipated sit on the toilet after each meal. It teaches the child to take time and listen to their body.
TALKING ABOUT TOILET HABITS WHILE MAINTAINING YOUR CHILD’S DIGNITY
Kids don’t just learn healthy habits by themselves, we have to purposefully teach them and model the behaviour, while ensuring we don’t embarrass or humiliate them or knock their self-esteem in the process. “Nursing is all about building a relationship with the child,” Kerry explains. “Getting creative with solutions to their problems. Being culturally aware. Partnering with families and helping make it fun. Get books about farts and then talk about it so they know that farts can be a sign that they need to go and do a poo. We have to tell them that they should be pooing once a day, and we should tell them that their wee should be light yellow so that they know when something is wrong. They need to know if they are up more than once a night for a wee, that is a problem. Teaching them life skills to help themselves be healthy.”
Making poop fun!
“Constipation in kids is more than a one-off medical intervention, it is a permanent adjustment to lifestyle.”
“Continence nursing is also about empowering our patients,” Kerry tells us. “It doesn't matter if you work in paediatrics or aged care. If you can empower patients to make decisions and do things for themselves using aids, or sticking to their abilities, you will have much better results. Working with small children and adolescents is a little bit different, older kids tend to be good in appointments but then not stick to the work you give them, take a few more risks, and the parents are a lot less involved.”
GET HELP WITH CONSTIPATION IN CHILDREN
If you relate to the issues discussed in this article, but don’t know where to get help, phone the free National Continence Helpline 1800 33 00 66 8am-8pm AEST Mon-Fri to speak to ask a nurse continence specialist any questions you have relating to toilet training, constipation, bladder or bowel health.
BOOKS, APPS AND VIDEOS TO HELP YOU DISCUSS GOING TO THE TOILET WITH YOUR CHILDREN
All kids and adults learn differently and making sure you communicate about toileting in an ageappropriate way that suits your child is important to make sure the message about what is normal for their body gets through. Think about what their interests are and how they like to consume new information. Look for something to read, watch, or play together to get the conversation about bladder and bowel habits started.
1. BOOK: Constipated Koala: Dealing with CONSTIPATION in kids by Abraham Thomas
2. APP: Potty Time: videos, songs, books, and rewards chart.
3. VIDEO: Constipation in Kids | What Your Poo is Telling You (YouTube)
4. BOOK: It Hurts When I Poop!: A Story for Children Who Are Scared to Use the Potty by Howard J. Bennett
5. CARD GAME: Who Did This Poo?
6: BOOK: Everything I Know About Poop by Jaume Copons
7. VIDEO: Constipation in Kids | Poop Withholding and What To Do When Kids Won't Poop! (YouTube)
8. BOOK: The Gas We Pass by Shinta Cho
Kerry Murphy, Continence Nurse Consultant
Debbie Atkins, Occupational Therapist
“Along with the capacity to learn a new routine, there are two key components that contribute to successful toileting: Development of sensory awareness and motor control."
MYTH BUSTING
“What works for one child is different for another,” Debbie tells Bridge, “If you see something on social media saying it will solve your child’s toilet training in two days or two weeks and it doesn’t work, it doesn't mean you've done anything wrong at all. Firstly, you have to be very careful about which information you read. And secondly, remember that we all learn differently. We all experience change differently, and it is more helpful to recognise and adjust to your child's individual learning needs.”
Toilet Time
WHEN TO SEEK HELP ABOUT MY CHILD’S TOILET HABITS
“The sooner the better,” Debbie Atkins, occupational therapist at Toilet Time, tells Bridge Magazine. There are so many aspects of going to the toilet that can affect young children's lives, and acknowledging there may be a problem early is important. If you struggle to go from nappies to undies, notice a change in your child’s toilet habits, such as an increase or decrease in going to the toilet, a regression in skill development, or expressed fearfulness or refusal to go to the toilet, it might be time to seek help.
Be mindful of information you read on social media and online, and instead try to get help from reputable sources such as Raising Children Network, Continence Foundation of Australia website, or the Continence Foundation helpline (1800 117 850 8am-8pm AEST Mon-Fri).
Be aware that accurate and appropriate information can change over time. The toilet teaching methods that may have worked for your neighbour or mother-in-law may not be suitable for your child, or in line with current health advice. So try not to get disheartened by comments from other parents or family members about your child’s individual toileting journey.
One of the biggest myths especially around nighttime toileting is that you should restrict fluids before bedtime. This advice can be problematic for many reasons. Having concentrated urine (that can occur with a lower fluid intake) is a bladder irritant and may actually contribute to more frequent urination. Plus, if your child doesn't remember to drink much at school during the day, they may become dehydrated, and this can contribute to constipation.
WHAT TO DO IF YOU SUSPECT YOUR CHILD MIGHT HAVE A BLADDER OR BOWEL PROBLEM
Observe and monitor your child’s toileting patterns and find out what is normal for them. A bladder and/or bowel record chart/diary can be a helpful starting point. You can also look at the bathroom/toilet environment, which can especially impact children's ability and willingness to sit on the toilet long enough to do a wee or a poo.
WHERE CAN I SEEK HELP FOR MY CHILD'S INCONTINENCE?
“Your medical practitioner (GP) is always an important first contact as underlying bladder or bowel dysfunction is one of the primary reasons for toileting difficulties,” Debbie tells Bridge. “Your GP can then refer you to paediatric allied health clinicians with a range of skills to support children and their families, including a continence nurse, physiotherapist, psychologist, dietician, developmental educator and an occupational therapist.”
“After ruling out underlying medical conditions, most toileting issues are greatly influenced by a healthy diet and daily fluid intake."
"There can be a range of additional factors that impact on a child's confidence and capacity with learning toileting skills and an occupational therapist is a great addition to your child’s care team.”
BEING REFERRED TO AN OCCUPATIONAL THERAPIST
The role of a paediatric occupational therapist is to support development of a child's capacity to participate in a toileting routine independently across home, school, and community settings. An appointment with an occupational therapist can be in a clinic, online via Telehealth, or in your home. The occupational therapist can help to assess your child’s developmental skills alongside consideration of the toilet environment and daily routines (both inside and outside the home). This assessment then contributes to a collaboration to find strategies that support your child’s learning within functional daily routines.
OTS OFTEN CONSIDER:
1 Postural control needed to sustain a sitting position on the toilet
2 Difficulties with awareness of the bladder or bowel sensations (this is often called interoception)
3 Coordinated motor control of pelvic floor muscles
4 Sensory issues/ regulation (emotional comfort within the bathroom environment, including sounds, smells, or textures that may cause distress)
5 Attention span/distractibility
6 Skill building
7 The child's understanding of the behavioural expectations as they change from nappies to a toilet routine
8 Collaboration with families and other education and care providers to ensure a consistent approach to developing a routine
SO, WHEN SHOULD I ASK FOR HELP WITH MY CHILD’S TOILETING?
“Always seek early advice. Any issues with incontinence in childhood should be dealt with straight away. Difficulties with toileting can commonly become a longterm problem for the child with associated long-term health, emotional and social impacts. However, early advice with medical, allied health and developmental strategies can often result in quick improvements and better long-term outcomes."
If your child experiences regular wetting, soiling and/ or chronic nighttime wetting then please get in touch with the free National Continence Helpline 1800 33 00 66 8am-8pm AEST Mon-Fri or contact your GP for guidance and referral to a specialist.
MAKING SURE YOUR CHILD IS TOILET-READY FOR
School
There are lots of aspects of school readiness, including getting dressed, putting shoes on, and eating independently. An oft-forgotten part of the routine is using the toilet. Even if your child has been toilet trained for many years, big changes can cause children to regress and experience incontinence (having accidents). This can be a one-off or spiral into an ongoing issue.
To meet this challenge head-on and make sure your child has the best chance at starting school without toileting mishaps, we spoke to Jessie Smith, a school nurse at a specialist school that caters for children aged 5 -18 years with additional needs.
“It is important for your child to know where the toilet is at their new school, the rules around when they can go to the toilet, and who they should ask to go to the toilet,” says Jessie. “If your child is experiencing incontinence already, it is important to raise this at your four-year-old health check at the doctor. This is a really good opportunity to rule out any medical issues that could be causing or contributing to your child's continence issues.”
COMMUNICATING WITH YOUR CHILD ABOUT TOILETING
As toddlers grow and mature into preschoolers their increasingly broad vocabulary and confidence in speaking and asking questions can mislead you to think they are grasping life skills without being explicitly taught. So perhaps what you perceive as incontinence could just be your child not understanding what is expected of them. If you are worried about your child’s toilet habits, the first thing to rule out is misunderstandings with the process. Four- and five-yearolds will still need basic life skills such as visiting the toilet explained to them, and the communication process that will work for one child might not work for another. Ways to learn about and discuss toilet routines could be:
• Visuals such as a worksheet, infographic poster or book to show them what to do (step-by-step process)
• Verbal communication and reminders about expectations (“Have you washed your hands?”)
• Watch short educational videos online and discuss them with your child (learning about how your body tells you it is time for the toilet)
Once you have ruled out miscommunication around toilet expectations with your child, it is important to see a medical professional for advice.
Starting school
QUESTIONS YOU MIGHT GET ASKED AT A DOCTORS’ APPOINTMENT
For most parents, the first port of call is their child’s GP. Some questions they might ask you at an initial doctor’s appointment could include:
• Has your child ever been continent or has this been a persistent issue?
• Frequency/how often do accidents happen?
• Does it happen daytime or nighttime?
• Are accidents poo and/or wee?
• What is currently happening in your child’s life, are there any external stressors?
• Medical history – physical and mental
• Social – any big life changes or challenges at home?
Once the doctor has an understanding of the background of your child’s toilet troubles, they can either offer advice and treatment options or refer you for testing and specialist opinion/treatment. Make sure to update your childcare, preschool or school if you agree on a treatment plan with the doctor as this will help them offer consistency for your child outside of the home environment.
GET SUPPORT
If you are worried about your child’s toileting and are not sure where to go for information and advice, call the Free National Continence Helpline 1800 33 00 66 (8am-8pm AEST Mon-Fri) to ask a continence specialist any questions you have relating to your child’s toileting.
Before starting school your child will likely visit their classroom a few times for orientation. This is a great opportunity to show them where the toilets are and make sure they can use the facilities independently. Once they get their uniform, practice going to the toilet at home to make sure they can get their new clothes on and off without help. At the start of the term, help them develop good toilet habits such as going to the toilet when they arrive in the playground before the bell rings so they are ready for morning lessons.
To help your child’s confidence consider discussing these points with them during orientation:
• Safe people to talk to if they need to use the toilet or have had an accident
• Where the toilet is
• How to find their change of clothes if they have an accident
• Toilet card/visual (for children who struggle with communication)
• Communicate with school to create a toileting plan
WORKING WITH SCHOOL ON A TOILETING PLAN
Toileting plans should be family-led and follow what you already do at home to keep it consistent and empower and educate families. Toileting plans should try to find a bridge between NDIS, families and school funding to get the equipment or staff put in place to support your child. Most of all, toileting plans should put the child and their emotional well-being first.
"SCHOOL-AGE CHILDREN EXPERIENCING INCONTINENCE NEED TO HAVE THEIR PRIVACY
RESPECTED AND BE SPOKEN TO USING RESPECTFUL LANGUAGE,” JESSIE SAYS. “WE DON’T SAY, LET'S CHANGE YOUR NAPPY, NAPPIES ARE FOR BABIES. WE SAY, LET'S GO TO THE TOILET. AND WE DON’T EVER ANNOUNCE PUBLICLY THAT A CHILD HAS HAD AN ACCIDENT”.
Jessie Smith, School Nurse
“We’re
always looking for ways to make our sites and
workplaces more inclusive and supportive for our employees and we hope the installation of these disposal bins will enable men recovering from prostate cancer to transition back to work easily and with greater dignity.”
Cancer Foundation of Australia (PCFA) and sharing his story through social media and local radio, he can make a difference to the lives of other men who have been in his situation.
RETURNING TO WORK AFTER
Prostate
Cancer
Paul Guest works at Lendlease construction company. He is also a prostate cancer survivor and a BINS4Blokes supporter. Since being diagnosed with prostate cancer, Paul has advocated for BINS4Blokes and the installation of incontinence product disposal bins at his place of work, to enable males recovering from prostate cancer to transition back to work with greater dignity.
BINS4Blokes.org.au is a Continence Foundation of Australia national advocacy and awareness campaign to promote the installation of incontinence product disposal bins in male public toilets and encourage men to seek help for incontinence.
In Australia, one in five men are likely to be diagnosed with prostate cancer in their lifetime. Following removal of the prostate (radical prostatectomy), incontinence rates can be high.
AN
ESTIMATED 2.4 MILLION MEN ARE AFFECTED BY INCONTINENCE, 42% ARE UNDER THE AGE OF 50.
Paul understands the impact of living with prostate cancer. His hope is that by raising funds for the Prostate
Paul’s message to anyone living with prostate cancer and incontinence is “Don’t be embarrassed talking about these things, and don’t wait until you are too old to do the stuff you want to do. Once you have been through prostate cancer you will have a very different outlook on life."
Paul acknowledges the challenges associated with recovering from prostate cancer, living with incontinence, and working on a construction site. It’s a tough industry, Paul tells Bridge, and without adequate facilities to dispose of continence products, returning to work can be delayed, stressful and embarrassing.
Work colleagues who have experienced prostate cancer have regularly shared their experiences with Paul, including the challenges associated with managing incontinence and disposing of used continence products. Without adequate facilities, Paul said it’s not uncommon for some men to carry used products in their personal belongings, until the end of their workday.
Paul’s efforts to promote BINS4Blokes has led to a number of incontinence product disposal bins being installed at three construction sites, as well as Lendlease’s national corporate workplaces in Sydney, Melbourne, Brisbane and Perth.
Impacted by prostate cancer and/or living with incontinence? Call the National Continence Helpline 1800 33 00 66 for free and confidential advice from expert continence nurses (8am-8pm AEST Mon-Fri).
Pictured: Paul Guest
Sara’s Story
RAISING A CHILD WITH SPINA BIFIDA
When Sara was pregnant with her second child, she was told her unborn baby, Kezia, had spina bifida. “I felt both upset and challenged by the fact that I was going to have a baby with spina bifida. But my husband and I made the joint decision that we would face this journey together.”
WHAT IS SPINA BIFIDA?
Spina bifida is a type of neural tube defect, which occurs when a baby’s spine and spinal cord don’t form properly during the first month of pregnancy. The condition can cause a variety of symptoms depending on its severity.
KEZIA’S EARLY CHILDHOOD
Kezia was born in January 2002, with one of the most serious and severe types of spina bifida called myelomeningocele, which can affect the bladder and bowel, along with cognitive impairment and learning difficulties. After a six-week stay in hospital, Sara and her new baby were finally able to come home.
As a result of the spina bifida and nerve damage, Kezia had a ‘patulous (loose or open) anus’, which meant that the muscles in her anus weren’t tight enough, resulting in faecal incontinence. Sara recalls, “I would have to keep her on stool softener to keep the poo soft enough because she would get very constipated due to her bowel not working properly. Sometimes this caused
the poo to become too soft, causing regular faecal incontinence as she had no control over her sphincter or anus opening.”
Kezia also needed to be catheterised up to five times per day and would get frequent urinary tract infections. Sara needed to monitor her symptoms closely, often looking for signs of fever and cloudy urine, with frequent visits to the doctor’s office.
SCHOOL LIFE
When Kezia reached school age, she was accepted into a special development school that could support her needs.
“Kezia was too young to do her own catheters then, so I trained the district nurses to do her catheters in her morning tea and lunch breaks. The nurses had never catheterised a child before, so it was a learning curve for everyone.”
GROWING UP WITH SPINA BIFIDA
Growing up, Kezia had regular appointments with a team of health professionals. This included seeing a urologist and continence nurse every 3-6 months, along with a paediatrician to monitor her progress.
CONTINUED
Pictured:
Sara and Kezia
She also underwent numerous orthopaedic surgeries to assist with ‘straightening her ankles and feet’. “Her spinal cord is tethered and with tethering the cord doesn’t stretch up and down like it would you and me.
"By age 11, Kezia learnt how to do her own catheters with education including children’s books specific to her needs and gentle training from myself and the nurses that helped her at school. It took many years for Kezia to gain the skills and took a lot of patience and perseverance from me. I was a bit pushy at times.”
She also switched to a transanal irrigation system, which helped with her bowel problems and faecal incontinence. Transanal irrigation is a simple procedure where water is gently pumped into the bowel to assist with the evacuation of faeces. “Kezia went from having poos every hour and having an accident every time she giggled or jumped on the trampoline, to now not opening her bowels for 24 to 48 hours and being (mostly) free of faecal incontinence. I’m not saying she never has an accident now and again, but it is so much better managed with this routine.”
THRIVING AS AN ADULT
22 years later, Kezia is now thriving, and Sarah could not be prouder. While Kezia is cognitively impaired and has some mobility challenges, it is not as severe as expected. “We were told she would never talk or walk. She can now walk short distances and has improved her communication skills and is confident enough to speak her mind. Kezia has friends, a boyfriend and genuinely enjoys life.”
After successfully completing an interview process, Kezia now volunteers as part of an activity department at an aged care facility. She also enjoys arts and crafts, volunteers at an art gallery once a month, and regularly cooks a meal for her family.
Kezia continues to have the support of her healthcare team, with visits to her doctor every three months, her urology team once a year and her neurosurgeon and cardiologist every two years.
WORKING AS A CONTINENCE NURSE
After working as a nurse in different medical settings around the world, Sara began training to be a nurse continence specialist (continence consultant) when Kezia was 16. " I love working one on one with families and children to make their world better. I enjoy helping them to navigate it all, because it can be very daunting.”
Sara now runs her own business called ‘Continence Continuity’ which focuses on supporting her clients with continuity of continence care.
“I’ve been there as a parent, when my child has done a poo, and I can smell it from across the room and felt mortified about what other people must think; that my child should be old enough to not do a poo in public.”
“It’s a rollercoaster ride for many parents. I feel their pain and anxiety through it all. I offer reassurance first and then gently guide them and offer recommendations, always keeping in mind that not everyone’s journey is the same, and we all deal with things differently.”
SUPPORT AND ADVICE FOR OTHER PARENTS
One of the biggest support avenues for Sara during this journey was the ‘Spina Bifida Support Victoria’ Facebook group, where she found solace in meeting other mums and dads who have children with the condition.
For those who have a child with spina bifida or any child that is experiencing urinary or faecal incontinence, Sara’s advice to parents is “be kind to yourself. So much of the time, as parents, we want things fixed, we want it sorted out today. But try not to beat yourself up. It may take baby steps to navigate everything as it can be very overwhelming. You can’t wave a magic wand and have it all fixed in one day. It all takes time, patience and energy.”
SARA AND KEZIA
KEZIA
Lifestyle Habits
FOR A HEALTHY BLADDER AND BOWEL
If you are concerned about your child’s toilet habits and think they may be suffering from constipation, speak to your GP to ensure there are no underlying health conditions that could be causing it. Once medical conditions are ruled out, there are four main areas to focus on.
FLUID: Pack a water bottle on outings and offer your child a drink from it regularly. Make sure you offer water with every meal. If they really struggle, try juicy foods to aid hydration such as watermelon and cucumber. Keep milk intake to 2- 2 ½ cups per day.
FIBRE: There are lots of ways to increase dietary fiber, offering more fruit and veg with every meal is a great place to start trying to increase your child’s intake.
EXERCISE: Moving your body can help get the bowels going. Try adding a ten minute-family walk after dinner or throwing a ball in the backyard.
TOILET ROUTINE AFTER MEALS: The bladder and bowels have a memory of their own. Going to the toilet at the same time each day can help your body get into the routine of pooing regularly. Make sure you give your child some time on the toilet at least twice a day without rushing them and keep it relaxed by chatting, reading some books, or perhaps offering some privacy for older children.
FIBER, FUSSY EATERS, AND FOOD CHAINING
It is all well and good telling parents to make sure they offer their children plenty of fiber, but it is another challenge ensuring the children actually eat it. Fussy eating can occur at many stages of childhood and can be driven by several factors. If you think your child’s fussy eating is contributing to their low fiber intake and therefore causing constipation, you can try a few different things. Depending on their age and willingness to try something new you could offer them: pear juice frozen into an icy-pole, trail mix with dried fruit in it, flavored popcorn, or add ground flax seeds to your homemade baked goods. Once you have found something they will eat, you can try a concept called food chaining. This is where you start with a food your child will eat and slowly transition to something similar that you would like them to eat. In this case, foods with more fiber. Another important thing to remember is continual exposure to the foods you want them to eat. If it isn’t on their plate, they can’t eat it. They might not eat it the first twenty times it is offered, but eventually they might give it a go, especially if they watch you eating it at the table with them.
Visit continence.org.au for more bladder an bowel health advice.
Living with
no Bladder
MAUREEN IS A BLADDER CANCER SURVIVOR LIVING WITH A STOMA.
She is healthy, happy and enjoys spending time in the garden, going to music festivals, and watching her grandkids grow. This is her journey through bladder cancer, which all started with frequent urination at night (nocturia).
Maureen’s experience with incontinence was not long, but had a permanent impact on her life. In May 2021, aged 71, she went to her GP for routine blood tests and mentioned she had been waking at night to use the toilet. The GP tested her urine and found traces of blood. He referred her for a pelvic ultrasound which uncovered a lesion (tumour) in her bladder. At this point, she had no pain and didn’t think it was anything serious. While waiting for an appointment with the urologist to discuss her bladder lesion, she woke one day in June 2021 with pain and the need to urinate every few minutes. Unable to go too far from the toilet, her daughter collected an antibiotic script from the GP for a suspected UTI. A few days later in the early hours of the morning, Maureen woke in extreme pain and had to call an ambulance. “I am not one to make a fuss, but the pain was worse than I experienced in childbirth with my three kids, and I knew it was an emergency,” Maureen recalls. On the way to the hospital in the ambulance, Maureen was given morphine due to the intense pain she was suffering. Once at the hospital, they did a CT scan and she was prescribed medication to manage the symptoms. At this stage, there was no mention of anything sinister in the bladder. Maureen remained on the medication to help her incontinence symptoms for a month until she was able to see the urologist. He sent her for a cystoscopy to examine her bladder and told her she had a rare aggressive leiomyosarcoma. Using an MRI, PET scan and a biopsy, the urologist confirmed it was a muscle-invasive tumour that had not spread.
although my dear Mum did for many years – as they did back in the 40s and 50s. I mention this because there's currently an ad on TV warning against smoking as it can lead to bladder cancer. There's no history of cancer in my family and it sure came like a bolt from the blue!"
Although Maureen’s surgery cured her pain and incontinence, the addition of the stoma has changed her life.
TREATMENT
Maureen underwent surgery to remove her bladder (cystectomy), uterus (hysterectomy), and lymph nodes. The urologist said due to the wall of the bladder being thin it couldn’t be saved. During the lifesaving procedure to get rid of her cancer, Maureen had an ileal conduit (stoma) to replace the function of her bladder.
WHAT HAPPENS WHEN YOUR BLADDER IS REMOVED?
"It was a total mystery and shock to get a cancer diagnosis," Maureen recalls. " I have never smoked,
During the surgery, the urologist removed Maureen’s bladder and used a part of her small intestine that links to the kidneys to create a stoma. The stoma is a small tube which collects urine in a bag outside your body. Maureen was shown how to change the bag and can now care for it independently.
Pictured: Maureen
LIVING WITH A STOMA
Having a stoma is a huge change both physically and psychologically. Maureen tries not to dwell on the stoma and keeps herself busy and positive by getting out and about. “I have to be aware of it in the garden, and you are advised not to lift anything heavier than 10kgs,” says Maureen. She has also joined stoma support groups over Zoom organised by Bladder Cancer Australia (beatbladdercanceraustralia.org.au) and the NSW Stoma Association.
“I feel very lucky to be cancer-free and be enjoying my life with my six grandkids.”
Six months after her surgery, Maureen developed a parastomal hernia, which happens in many stoma patients due to the abdomen being weakened by the operation. It doesn’t give her pain, but she does feel very conscious of it in terms of body image because it protrudes from her lower abdomen. “I am always telling my grandkids to cherish their healthy bodies. I have generally been very fortunate with good health over my life. I stay active, connected, positive and always keep the glass half full.”
If you are experiencing frequent or urgent urination and are concerned about your bladder, contact your GP or call the free National Continence Helpline 1800 33 00 66 8am-8pm AEST Mon-Fri to speak to a continence nurse specialist.
Preventing a parastomal hernia
Parastomal hernias are very common among bladder cancer patients. However, there are things you can do to reduce your risk after surgery.
1. Avoid heavy lifting
2. Strengthen abdominal muscles with appropriate exercises from a physio
3. Use support belts or underwear
4. Prevent constipation and straining on the toilet by staying hydrated, eating fruit and veg, exercising regularly, and maintaining a regular toilet routine
5. Manage your weight to avoid extra pressure on the area
"I'D LIKE TO ENSURE BLADDER CANCER PATIENTS ARE WELL EDUCATED ON WAYS TO MINIMISE THE DEVELOPMENT OF A PARASTOMAL HERNIA. FOR EXAMPLE, TAKING CARE LIFTING HEAVY ITEMS AND WEARING SUPPORT GARMENTS OFFERED ON THE STOMA SCHEME.”
Pictured: Maureen with her daughter
Training
EXPLAINED
“If you’re thinking about starting the toilet training process, there are a few things to consider first,” says Janine Armocida from the National Continence Helpline. “Everyone has a different opinion about when and how you should toilet train your child. Most of the advice you receive from family and friends will be with the best intentions, though sometimes it can put enormous pressure on you as a carer and your child.”
WHEN SHOULD I START TOILET TRAINING?
Most children are developmentally ready to be toilet trained from about two years of age. For some children it will be later, and for others it will be earlier (as young as 18 months). We are all different! If your child is neurodiverse then toilet training may take longer and there may be a delay in showing readiness signs. Alongside the child being ready, it’s also important to identify when the best time is for you as a family to start the toilet training journey. Try to avoid busy periods, or big changes in the household and allow yourself the time and space to see the process through.
Overall, toilet training shouldn’t be stressful, and as a carer you need to be there and support your little one as they learn and master a new skill.
WHAT ARE SOME SIGNS OF TOILET READINESS?
• Being able to stay dry for two hours
• Regular soft, easily passed bowel motions. If your child’s bowel motion is hard, dry, large or difficult to pass make sure they are eating and drinking well. Pears, prunes and kiwi fruit are good foods for the bowels. If you think your child may be constipated see your GP or pharmacist and they can advise you on laxative use if needed.
• Can follow simple instructions and sit for 2-3mins
• Can pull their pants up and down
• Can wash and dry their hands
• Tells or shows you signs of having a wet or soiled nappy
• Dislikes wearing a nappy.
WHAT EQUIPMENT DO I NEED?
• Clothes that are easy to get on and off
• Cleaning supplies – expect accidents
• Children’s books about toileting
• Potty or toilet steps with a toilet insert - There is no right or wrong choice of equipment here, this is up to you to decide. You should always supervise your child on the toilet and keep the door closed when it is not in use, especially if you have younger children.
• Training pants or underpants - Both options are suitable. Training pants can help your child to feel a little uncomfortable and absorb some of the urine (wee). Or you can go straight to underpants and your child can help choose their special underpants to help make the experience fun and exciting.
• Supplies for going out - extra clothes, bag for wet clothes, baby wipes, an extra potty for the car.
HOW DO I START TOILET TRAINING?
It’s important to prepare your child for toilet training, so they understand the process and what to expect. Before actively toilet training, get your child to sit on the toilet or potty once or twice a day. This could be first thing in the morning and/or before bath time to get them used to the toilet or potty and make it part of their normal routine, so they get used to it. Let your child see you sit on the toilet. Teach your child the difference between wet, dry, poo and wee. Always keep your language positive, simple and try not to react or say anything negative during toilet training time.
Use clear language and tell your child to sit on the toilet/potty when they first get up, 30 minutes after a meal or snack, and before going to bed. This will equate to about two hourly visits, or six visits a day.
Stay positive throughout and give clear direction to sit on the toilet/potty, rather than ask them if they want to sit. For example, “Charlie, it’s time to sit on the toilet now please”. Once your child becomes reliably dry then you can try “Charlie, what is it time for now?”, then change it to “Charlie, do you need to go to the toilet?” as your child gains independence.
SHOULD I PRAISE OR REWARD MY CHILD?
All rewards need to be small and immediate for them to be effective. It could be a cuddle, a high five, a sticker on a chart or even the option to call someone important. Try to plan the rewards based on what you know your child likes and responds best to.
Always praise your child for following your directions or taking themselves to the toilet. “Well done sitting on the toilet”, “oh fantastic you’ve done a wee in the toilet”, “let’s put a sticker on your chart for sitting on the toilet and another one for doing wee, you are so clever”.
SETBACKS AND FURTHER SUPPORT
It’s important to remember that there may be some setbacks during toilet training, and it’s okay to take a break if needed.
Helpline
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.
WHAT CAN I ASK?
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 (bladder and bowel dysfunction)
2. Women's health bladder or bowel issues from pregnancy, childbirth, pelvic floor, prolapse and menopause
3. Men's health – prostate, after dribble
4. Children's health –toilet training, bedwetting, day wetting, soiling
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
WHO CAN CALL?
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.
SHARE YOUR STORY
If you have a story to share about your experience calling the helpline for advice on your bladder or bowel health, get in touch. Readers value reading other people's lived experience. As a thank you, the Continence Foundation offers a $150 giftcard for sharing your bladder and bowel health journey. Please email media@continence.org.au if you would like to get involved.
