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How Continence Problems Can Affect Mental Health

girl looking worried hugging her father

For Stress Awareness Week, BBUK’s Children’s Specialist Nurse, June Rogers, looks at how bladder and/or bowel issues can cause stress and affect a person’s mental health.

Historically, continence problems (wetting and soiling) in childhood were thought to be the result of the child having an underlying psychological or behavioural problem. A journal article written in 1972 stated that …enuresis has long been considered a sign of emotional disturbance… and that most children with soiling have an underlying emotional disorder.

We have thankfully come a long way since then and have a better understanding of both these problems. We now recognize that the majority of wetting and soiling problems in childhood are the result of an underlying medical problem, such as constipation. We are also aware that any behavioural or psychological issues are the result of the wetting and soiling and not the cause of them.

Often parents will report that their child appears to be ‘not bothered’ by the wetting or soiling and will deny they have had a wetting or soiling accident. This obviously increases the overall stress within the household, but parents need to understand that often the denial aspect is a coping mechanism that many children will use to help them manage and cope with the problems they are having.

Many studies have highlighted the affect wetting and soiling problems have on the mental health and well-being of children and so families should always seek medical advice to help resolve the problems. There is often a mistaken belief that children will ‘grow out’ of any wetting or soiling problems and as a result parents may delay seeking help. However, in many cases the problem will get worse not better with time.

A study carried out in 2018 involving interviewing young people with bladder or bowel problems highlighted some of the emotional issues they were going through. Many struggled to hide their problem from their peers and felt constantly embarrassed and frustrated that non one appeared to understand what they were going through. One young man described his problems as “not life threatening, but life ruining” which reflect the emotional impact continence problems can have.

A recent article in the guardian looked at the link between mental health and disabilities with people with spinal cord injuries, often resulting in lack of bladder and bowel control, showing a high degree of mental health problems.

Studies have also looked at the mental well-being and quality of life of informal caregivers involved with looking after a family member with a bladder and bowel problem. They found that in many cases caring for a family member with ongoing problems negatively affected the carers quality of life and mental health. Parents we work with often relate how stressful the problem is and can also cause rifts within family members when they disagree how the problems should be managed.

Incontinence in an elderly relative is often the trigger factor for the relative going into a care home as the stress and day to day issues of caring for an individual with a continence problem is often too much for the family member to bear.

Continence problems can affect individuals of all ages and we need to be mindful of how having an ongoing bladder or bowel problem can have an affect on an individual’s mental health and well-being. As well as treating and managing the underlying bladder or bowel problem it is important that affected individuals are treated holistically so any associated stress and anxiety can be addressed. We must also recognize how caring for an individual with a continence problem can affect some individuals and families should be provided with the appropriate advice and support regarding managing the individual’s problems.

Providing the right information and support and ensuring any wetting and soiling problem has been assessed and the appropriate treatment put in place can go a long way in reducing stress and anxiety. However, it is also important that we create opportunities for affected individuals to discuss any mental health issues, by asking questions in the right way and having a non-judgmental listening ear.

Bladder & Bowel UK have lots of information and resources on the website at www.bbuk.org.uk to support people of all ages with bladder and or bowel difficulties.  These are all free to download and print.

Bladder & Bowel UK also have a confidential helpline staffed by children and adult nurses who are specialists in bladder and bowel care. You can contact them by email at bbuk@disabledliving.co.uk or by telephone on 0161 214 4591.

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