Bladder & Bowel UK Newsletter October 2019

Bladder & Bowel UK Newsletter October 2019

MANAGING BLADDER AND BOWEL ISSUES IN NURSERIES, SCHOOLS AND COLLEGES BBUK'S BOWEL EDUCATION DAY Excellent attendance of healthcare professionals

UPDATED RCN GUIDANCE Bowel Care document

THE NATIONAL BOWEL AND BLADDER HEALTH PROJECT

Charity number: 224742

October 2019

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Explore Our Key Features

Managing bladder and bowel issues in nurseries, schools and colleges...………...……………….....……..……4 Early intervention toilet training...……………………………………………………………….........................................6 Empowering children and their families to improve bedwetting.................................................................8 Bladder & Bowel UK's Bowel Education Day 2019....................................…..................………………….....10 Updated RCN Guidance - Bowel Care.....................................................................................................14 The National Bowel and Bladder Health Project......................................................................................16 Loo of the Month......................................................................................................................................18

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If you would like to support our helpline please call us on: 0161 607 8219 or email: bbuk@disabledliving.co.uk www.bbuk.org.uk/helpline-supporters

Managing Bladder and Bowel Issues in Nurseries, Schools and Colleges

Best practice guidance document for managing continence problems in nurseries, schools and colleges across the UK is launched.

The Bladder & Bowel helpline often gets enquiries that relate to managing bladder and or bowel symptoms or conditions in schools. These calls appear to have increased. Although the reason for this is not certain, it is likely to be related to the trend towards later toilet training resulting in an increase in children who are not independent with this skill prior to starting school. This is probably compounded by the increase in numbers of children with additional needs who are now attending mainstream school. While early intervention to support toilet training is recommended, some families continue to be advised to wait until the child is ‘ready’, with assumptions that delay is inevitable.

Some helpline calls are from concerned school staff who do not understand the child’s needs, or their role in offering support. They are often concerned by the safeguarding implications of providing intimate care. Sometimes the families do not know what is reasonable to expect or are struggling to make themselves available to visit school at any point that their child wets or soils to assist in changing. Sometimes healthcare professionals are not clear on what schools must provide.

In response to these enquiries alongside direct

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requests from healthcare professionals, Bladder & Bowel UK teamed up with ERIC to produce comprehensive, practical information for nurseries, schools and colleges. Available as a free downloadable resource, Managing Bladder and Bowel Issues in Nurseries, Schools and Colleges provides the clear, concise guidance for school leaders, proprietors, governors, staff and practitioners that has been requested numerous times. It is written in straightforward language to make it as widely accessible as possible.

Topics covered include: How to promote good bladder and bowel health in schools Hygiene standards / provision of school toilets Managing episodes of incontinence in schools Safeguarding and health and safety considerations National legislation for the four countries of the UK A sample continence policy and care plan Sources of help and support for educational establishments and families As Sharon White, OBE and CEO of School and Public Health Nurses Association says in the foreword, “This guidance not only helps us better understand the key and far-reaching role that education has to play in better managing continence issues, but also highlights the critical interface and role of health such as school nurses, paediatricians, continence services, and other agencies, including the children and young people themselves.

Educational attendance, attainment and health are intrinsically linked. Therefore, the more we can do to minimise the negative impact on a pupil’s health and well-being, the more likely they are to flourish and grow.”

This guidance has been widely reviewed, supported and/or endorsed by several national organisations, including The Association of Continence Advisors, The Paediatric Continence Forum, British Association of Paediatric Urology and Continence Nurses, The School and Public Health Nurses Association and the National Association for Primary Education (NAPE).

It is available to be downloaded and shared from the Bladder & Bowel UK website at www.bbuk.org.uk/wpcontent/uploads/2019/10/ManagingBowel-and-Bladder-Issues-in-NurseriesSchools-and-Colleges.pdf If you have any comments or suggestions, please do let us know. We will be undertaking a formal review in 2021, but would appreciate feedback to email bbuk@disabledliving.co.uk at any point.

Davina Richardson Children's Specialist Nurse

Paediatric Continence Forum – New Awards for Transition of Care from Children’s to Adult’s services Are you or do you know of a healthcare provider that deserves recognition for their care in transition of young people from children’s to adult’s continence services? The Paediatric Continence Forum has launched a new award to recognise excellence in this area of care and to highlight best practice.

More information, including application forms are available from http://www.paediatriccontinenceforum.org/transition-awards/ Closing Date: Friday 22nd November

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Early Intervention Toilet Training

Toilet training is a significant developmental milestone in early childhood. Most children achieve the physiological, cognitive, and emotional development necessary for toilet training by 18 to 30 months of age.

While most parents will start to think about toilet training when the child is around 2-3 years we have found that many families with children with ‘additional’ needs will delay introducing toilet training until their child is much older in the mistaken belief that their child is ‘not ready’.

helpful or totally incorrect.

Delaying toilet training often results in underlying problems, such as constipation, not being recognised as well as a fixed dependence on nappies and issues around toilet refusal and stool with holding. However, our own clinical experience has shown us that in majority of cases, with the right advice and support, these children can be toilet trained at the same age as their typically developing peers.

The lack of understanding and social awareness is often the reason why many children with DS show no interest in becoming toilet trained and it is this lack of interest which is often mistakenly interpreted as the child ‘not being ready’.

Discussions with families of children with Down syndrome (DS) at a toilet training workshop concluded that many parents were provided with either no advice or support at all or any advice given, such as ‘wait until he is ready’, was not

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Successful toilet training is often a fine balance between the physiological maturation of the bladder and bowel and the child’s understanding and social awareness.

To help give the right information to as many families as possible and promote early toilet training, we linked in with a support network for families of children with DS PADS (Positive about Down syndrome) and developed a closed Facebook Page – Going Potty?! for families and professionals. We now have nearly 1,500 members from across the UK which enables us to reach a wide audience.

Early potty sitting is encouraged from around 6-9 months, once the child is weaned, and this has been found to not only help facilitate toilet training later on, but also reduce the incidence of constipation. The group was started in January this year and we already have had tremendous success with infants as young as 7 months happily pooing on the toilet, with a number becoming toilet trained before their 3rd birthday.

Parents are signposted to their health care professional if any underlying problems, such as constipation, is suspected.

addressed with behavioural interventions utilising social stories, sequencing pictures, motivators and rewards.

The success of the Going Potty?! Facebook page has led to the development of a further Facebook page for children with DS from age 5 years called ‘Toileting issues for children with Down syndrome age 5 years+’ which looks at supporting children with more complex problems with toilet training and other problems such as constipation and bedwetting. Both families and professionals are again encouraged to join. www.facebook.com/groups/2696424470414491/

We should never presume that children are ‘not ready’ to be toilet trained as any lack of awareness or social understanding can be

June Rogers Children's Specialist Nurse

Bladder & Bowel UK's toilet training resources page Most parents and carers worry about toilet training their children, particularly if their child has additional needs and many receive conflicting advice and information from friends, other parents, relatives and professionals.

Visit our website to download a range of useful resources and information sheets about toilet training.

Click here

www.bbuk.org.uk/children-young-people/children-toilet-training/

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Empowering Children and Their Families to Improve Bedwetting

Bladder & Bowel UK, together with ERIC, the children’s bowel and bladder charity, have linked together with Ferring Pharmaceuticals to help inform the non-promotional Stopbedwetting website: https://stopbedwetting.org.

The website has recently been updated with a series of useful tools including helpful checklists to go over with their child, videos to help children understand the problems they are having and to support parents in helping their child get dry. They have recently launched a new blog on the website full of expert vlogs and articles aimed at helping manage bedwetting.

They are also active across social media where a related Facebook page has also

been set up that can be found by clicking the link below or searching for ‘Stopbedwetting’ via Facebook www.facebook.com/stopbedwetting.org/.

You can also follow their recently launched Twitter account @stop_bedwetting for helpful and useful tips for parents and carers on managing their child’s bedwetting.

June Rogers Children's Specialist Nurse

Read our bedwetting blog posts!

Visit: www.bbuk.org.uk/blog/ and search 'bedwetting'

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Incontinence: The Engineering Challenge Conference

Have you have come across the "Incontinence: The Engineering Challenge" conferences that run in London every two years at the Institution of Mechanical Engineers? The 12th event in the series is scheduled for 13th & 14th November 2019 – and there is still availability to book and attend this stimulating, multidisciplinary event.

The aim of the conferences is to help our highly multidisciplinary mix of delegates to come up with better technology to meet the needs of those living with incontinence. And to do this, we have developed a rather unusual format in which - over the two days - we run like a conventional conference for about half the time (short papers on latest research findings) while in the other half we aim to provoke, stimulate and inspire.

For example, we always invite along a panel of people with incontinence who we interview, asking them to tell us their stories, challenges, priorities and dreams.

Something else we do is to ask creative people who (usually) don't know much about incontinence - but who have expertise relevant to the field - to come and share their thoughts. For example, we have had speakers on: (i) How do WCs work aboard space ships?

(No gravity to help the urine and faeces decide which way to go!); (ii) Odour (Incontinent people live in fear of smelling. How does our sense of smell work? What are possible strategies for neutralising / detecting / masking odours?); and (iii) Lessons from origami (eg how do you fold planar material round a complex shape like the body?).

Other speakers - clinicians, academics or industry colleagues experienced in the field provide useful overviews of key topics. Poster sessions, discussion groups and plenty of opportunities for networking complete the programme.

Our conference website contains full details of speakers, the programme, interactive events and how to register!

Visit: www.imeche.org/incontinence

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Bladder & Bowel UK's Bowel Education Day 2019

The Bowel Education Day in September has become a regular, well attended event in BBUK‘s annual educational calendar. With delegates attending from all over the country. The day was well attended and brings together a variety of healthcare professionals, including General Nurses, Specialist Nurses, Pelvic Floor Specialist Physiotherapists.

The aim of the day, was to improve knowledge to support our standards of practice and, continue (through learning and networking), to enhance the care we deliver to the people we all see or come into contact with, who either have, or look after someone with bowel problems.

BBUK are also supported at this event by many companies who exhibit, providing information, advice and updates on their products.

We are very grateful to the companies for supporting Bladder and Bowel UK education events and it allows mutual networking or updating between clinicians and commercial colleagues.

The exhibition and company representatives provide delegates with an opportunity to looking at new products, reviewing current products and

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update knowledge on what is available to help treat and manage people with bowel and skin care problems.

A final thank you goes to all the speakers who support this event and provide informative clinical updates.

Joanne Hoyle, BBUK Specialist Nurse chaired the sessions and welcomed everyone to the day.

The first speaker was Dr Dipesh Vasant, Consultant Gastroenterologist MFT and Honorary Senior Lecturer, University of Manchester.

Dipesh gave delegates an informative lecture on Management of functional colorectal disorders, this included an overview on functional GI disorders, the scale of the problem, making ‘positive’ diagnoses, optimising patient interactions and achieving the positive outcome.

BBUK were thrilled to welcome both Clare Thornber and Jill Harrison- White and from Cauda Equina Syndrome Association.

We were also updated on the novel therapies that are available and research that is currently taking place, with Dipesh also providing an insight to the Specialist IBS Service at Manchester Foundation NHS Trust.

Clare informed us about the work of the association, explaining about Cauda Equina Syndrome (CES), and introduced us to the work undertaken by the association - a patient led non-profit support group which includes services, helpline and website. www.ihavecaudaequina.com

Karen Irwin Service Manager / Specialist Nurse BBUK and RCN Bladder and Bowel forum committee member, informed delegates about the recently published and updated RCN document on Bowel Care.

Bowel care is of great importance for a patient’s quality of life, yet many remain hesitant to discuss such a topic. Karen explained that this updated RCN publication, promotes a positive and proactive approach to care delivery and includes information on best practice. It provides guidance for all nursing staff and incorporates knowledge of bowel function and the essentials of assessment, treatment and management of lower bowel dysfunction. Further information regarding this document can be found on pages 12 and 13.

Mary Hill, Clinical Specialist Physiotherapist East Lancashire Hospitals Trust who delivered a super overview and update on pelvic floor muscle reeducation, which included an overview of pelvic floor structure assessment, bladder control, bowel control and pelvic pain.

•Support group meetings around the UK •Online support group – 24 hours a day •Helpline: 03335 777113 •Product advice and signposting •Awareness/training in the red flags of CES

Jill provided us with a very informative, powerful and thought-provoking talk, sharing her personal story and journey from diagnosis to the current day, her treatment and management of CES and bowel management.

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BBUK’s Specialist Nurse Davina Richardson gave an informative lecture on Transition of Young People into Adult Services, with a focus on increasing delegates awareness and understanding of the importance of improving the experience of young people who require bladder and bowel services. Davina highlighted the impact of incontinence on young people, the reasons young people struggle to engage with services and how we can offer appropriate support and work together during transition, have awareness of national guidance and documentation, education and training that is available.

Sue provided an update, on the work her team continue with, across Manchester Foundation NHS Trust. The team worked collaboratively with the Spinal Injury Association, considering individuals’ experiences when admitted to hospital, identifying gaps in meeting spinal cord injury patient’s bowel care needs when admitted to hospital and developing training for staff across the organisation.

This service provides regular bowel care study days, which are aimed at qualified nursing and medical staff or band 4 assistant practitioners, who regularly perform bowel care procedures in their current role. They also provide bespoke teaching bowel care study days to the local community intermediate care units. Staff receive a competency skill document in bowel care, following an assessed simulation practical assessment. This work has also been shared at a TIME TO SHINE event.

The day evaluated excellently and we would like to thank you all for attending, it was super to see you all and also thanks to the companies for supporting the day.

The final speakers of the day (and this year’s BBUK Bowel Award winners) was the Bladder and Bowel Team at South Manchester, led by Sue Ryder Clinical, Lead Nurse.

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Karen Irwin Service Manager/Specialist Nurse

r ou s r y nt Fo tie pa

BBUK Just Can't Wait Cards

FREE pocket sized plastic card BBUK confidential helpline Available from BBUK - a charitable service Order your supply of cards from: bbuk@disabledliving.co.uk www.bbuk.org.uk

Registered Charity No: 224742

Visit the Continence & Stoma Products Section on the Supplier Directory

There is a section on the Disabled Living Supplier Directory dedicated to continence and stoma products. In addition there are a wide range of categories providing information about companies and organisations that provide equipment, products and services to support disabled children, adults and older people.

You'll find the Supplier Directory on our website homepage: www.bbuk.org.uk

Updated RCN Guidance - Bowel Care

Management of Lower Bowel Dysfunction, including Digital Rectal Examination and Digital Removal of Faeces This document is written primarily for a nursing audience to be used in all care settings, across the UK and refers to ‘nurses’ throughout the publication. However, it can also be used by other health care professionals to support them in undertaking a wide range of activities relating to many aspects of lower bowel dysfunction. Many of the statements contained in this document reflect essential nursing care and are not of an advanced or complex nature.

This document has been produced to support nurses in a wide range of activities related to the assessment, treatment and management of lower bowel dysfunction. Those who may find it of value include health care professionals involved in the management of lower bowel dysfunction and nurses: • delivering lower bowel care as part of their role – from the assessment of bowel dysfunction to the delivery of specific lower bowel care interventions • developing lower bowel dysfunction risk assessment tools • working within any care setting where lower bowel care is provided

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producing guidelines, protocols, policies and procedures related to lower bowel dysfunction before administration of medicine • in management posts who supervise, recruit, develop and appraise staff working within lower bowel dysfunction • developing programmes of learning, teaching and courses which encompass lower bowel dysfunction • developing, using and measuring quality bowel care nursing indicators • undertaking bowel care audit and/or research.

Bowel care is a fundamental area of patient care that is frequently overlooked, yet it is of paramount importance for the quality of life of our patients and residents, many of whom are hesitant to admit to bowel problems or to discuss such issues. The popularity of previous RCN publications relating to digital rectal examination and the manual removal of faeces has demonstrated the strength of interest in the issue of good bowel management and the urgent need for this type of information. Since its first inception in 1995, the publication has developed over the years and remains an invaluable practice and educational resource for nurses. This 2019 edition includes updates on best practice and provides guidance for all nursing staff, plus incorporates knowledge of bowel function and the essentials of assessment, treatment and management of lower bowel dysfunction. The publication promotes a positive/proactive approach to care delivery for the essential and fundamental needs of bowel function and management of bowel disorders. The National Occupational Standards (NOS) relating to lower bowel dysfunction have been incorporated throughout, where relevant, to continue to support delivery of best practice.

For more information and to download the publication click here: www.rcn.org.uk/professional-development/publications/pub-007522 Jane Fenton, Teaching Fellow Keele University, Lead Author

You might also like to read...

Our free adult bladder and bowel resources which are available at: www.bbuk.org.uk/adults/adults-resources/ These leaflets are produced by Specialist Nurses who have a wealth of knowledge in the continence speciality. The information is extremely useful to individuals who are experiencing bladder or bowel problems, their family members and carers and healthcare professionals.

The resources are constantly under review to ensure they are accurate and contain the most up to date information.

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The National Bowel and Bladder Health Project

The National Bowel and Bladder Health (NBBH) Project was developed following a series of workshops held between members of the Excellence in Continence (EICC) board and the All Parliamentary Group (APPG) on continence in 2018. The aim is to align objectives across existing initiatives (EICC, APPG, NHS Supply Chain), in order to support the delivery of the ambitions of the Excellence in Continence Care Programme.

The National Bladder and Bowel Health Project has been established to improve continence care across the whole health and care system. As part of this it will make recommendations about education and information needs, workforce, supply and distribution of continence care products, and data and information requirements through six workstreams. The four clinical workstreams are bladder, bowel, stoma and paediatrics with transition. Alongside is a workstream for data, supply and distribution and one for education and workforce. These will consist of about 10-15 key people and will make recommendations.

It is important that those who are involved in delivering or receiving care get the opportunity to contribute to the development of the NBBH Project, so three stakeholder forums have been established to feedback to the workstreams and inform their discussions.

They are: 1. Health and Care Professionals Forum - for those working in organisations providing continence care.

2. Patient and Carers Forum - for those who have experience of either receiving or caring for those

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who have received continence care.

3. Supplier Forum - for those working for organisations that supply products related to continence care.

If you would like the opportunity to be involved in influencing the outcomes of this exciting project, to receive information and give feedback about the NBBH project as it develops please complete the form available at: http://bit.ly/BladderBowelHealth.

Feedback will mostly be sought through online communication but there will be opportunities to attend consultation events. It is up to you how much you get involved. Thank you for your interest and we look forward to hearing your views.

Bladder & Bowel UK have signed up for the Forums and have been involved with the establishment of the workstreams. We would encourage you to also join the Forums and offer this opportunity to your patients.

Fay Allen Tourist toilets at summit base camp of mount Kilimanjaro at sunset, Africa

Bringing our CPD events near to you!

2 BBUK Symposiums in 2020 Ricoh Arena, Coventry Tuesday 3rd March 2020 & USN Bolton Arena, Horwich, Bolton Wednesday 30th September 2020 Health & Social Care Professionals have travelled from all corners of the UK to attend the BBUK Symposium in Bolton. Each year we are oversubscribed.

You have asked if we can organise a Symposium a little further 'south'. We are delighted this will happen in 2020.

We have gone one better, we are having 2!

Contact bbuk@disabledliving.co.uk for further information or visit: www.bbuk.org.uk/professionals/professionals-training/training-symposium/

Loo of the Month - Toilet Cabin in the Forest

Tourist toilets at summit base camp of mount Kilimanjaro at sunset, Africa

Get in Touch with Us

For more information please visit: www.bbuk.org.uk

Bladder & Bowel UK Head Office - Disabled Living, Burrows House, 10 Priestley Road, Wardley Industrial Estate, Worsley, Manchester M28 2LY Email: bbuk@disabledliving.co.uk Tel: 0161 607 8219

Part of Disabled Living Website: www.disabledliving.co.uk Email: info@disabledliving.co.uk Tel: 0161 607 8200