Integrated Continence Advanced Nurse Practitioner, St Thomas’ Hospital
Bowel health, in particular constipation and incontinence, represent taboo subjects in the UK, with many people failing to access NHS treatments that could transform their quality of life.
At St Thomas’ Hospital, London, continence nurse practitioner Carlene Igbedioh regularly sees patients who have waited five to 10 years before seeking medical help. “Once they’ve experienced soiling outside many, people become too embarrassed to venture out. They give up jobs, avoid socialising and stop going on holiday.” says Igbedioh. “It’s all because as a society we’ve a real taboo about discussing our bowels, even with health professionals.”
Bowel issues represent an epidemic in the UK, with estimates suggesting one in seven adults are affected by constipation. Data from the Bowel Interest Group shows that in 2018 to 2019, 76,929 people in England were hospitalised with constipation, equivalent to 211 a day.
Constipation symptoms include straining, lumpy or hard stools, sensations of incomplete emptying and experiencing fewer than three bowel movements per week. Faecal incontinence, involuntary loss of faeces, is surprisingly common; affecting one in 100 UK adults it can often be triggered by overflow from constipation.
A misconception, says Igbedioh, is that constipation is an inevitable part of ageing. “This isn’t the case. There are usually underlying causes which can be easily treated, dramatically improving quality of life.”
Getting lives back on track
Once any more serious cause has been ruled out (such as bowel cancer or inflammatory bowel disease), treatment is based on a ‘pyramid’ approach. At the base are simple measures like encouraging people to eat regularly, drink adequate fluid, take physical exercise and checking whether any drugs are responsible.
“If these fail, other interventions can be explored such as transanal irrigation or using electrical stimulation to strengthen anal muscles. It’s tragic that so many lives are made a complete misery from letting embarrassment get in the way of wellbeing,” says Igbedioh.
“The first step to getting your life back on track is to talk to a health professional. My patients are always completely surprised to learn how many others are in the same situation.”