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Bladder and Bowel 2021

Why patients must speak up about incontinence

Polly Weston

Chair of Executive Committee for the Association for Continence Advice (ACA)

Incontinence is one of the last health taboos in modern society. Embarrassment stops many people from accessing the NHS services that can help them.


Incontinence is surprisingly common. It’s estimated that one in four of us will have a problem with bladder control at some time and one in 10 will have problems with bowel control. This means that more people have incontinence than asthma, diabetes or epilepsy combined.

The prevalence of bladder and bowel dysfunction has been spoken about many times, most recently colorectal surgeon and lecturer Daren Francis (The Royal Free NHS Trust) spoke at the ACA national conference May 2021 stating that the percentage of postnatal women with pelvic floor injury remains high at 22%.

However, access to the right healthcare advice is hindered due to the embarrassment of the problem. The LeDeR (Learning Disability Mortality Review Programme) shockingly highlighted high incidence of mortality due to constipation, this could have been avoided if early detection and intervention had taken place.

Women often delayed seeking help for their symptoms due to lack of awareness, embarrassment and stigma.

Removing the taboo around incontinence

Doreen McClurg (past ACA Chair, physiotherapist and researcher Glasgow Caledonian University) reminds us that patients find bladder and bowel symptoms too embarrassing to discuss. The issue continues to be the elephant in the room that they ‘didn’t want to bring up’.

Doreen reports that women often delayed seeking help for their symptoms due to lack of awareness, embarrassment and stigma. When presented to a GP, their symptoms were often dismissed and unaddressed until they became more severe.

Therefore, I urge health care professionals to ask open ended questions. Following NHS guidance clinicians should make every contact count, ensuring that clinical assessment is holistic and includes questions on bladder and bowel to encourage early symptom detection and treatment. The pelvic floor report published in April 2021, led by Professor Charles Knowles (consultant colorectal surgeon Barts NHS Heath Trust), supports this and early intervention for clinical consultation can ensure correct diagnosis and treatment.

I would like to encourage patients to have confidence to speak up. In order for a patient to get the best outcomes, an open and honest description of symptoms is needed. Informing their GP of the impact the bothersome bladder or bowel issue is having on their quality of life is a good starting point.

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