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Continence care is a cornerstone of person-centred nursing, yet it remains one of the most sensitive and often overlooked aspects of practice. Bladder and bowel problems affect millions across the UK, leading to discomfort, loss of independence, and reduced quality of life, while also carrying emotional consequences such as embarrassment and social isolation. Nurses are uniquely placed to make a real difference. Early recognition, accurate assessment, and timely intervention can prevent complications, protect dignity, and promote recovery. Skilled continence care also reduces infection risk, skin damage, and unnecessary catheter use — all essential to improving safety and outcomes. This webinar highlights continence as a fundamental element of safe, compassionate care. Through expert discussion, case studies and practical examples, nurses will explore structured assessment, first-line interventions, and communication techniques that empower patients and enhance quality of life. Register

The Green Nursing Challenge Showcase was held on 20 October 2025 celebrating the outstanding work of teams from hospital and social care settings—an award-winning leadership and engagement programme dedicated to transforming healthcare. One of the teams that competed in the Green Nursing Challenge was the Bladder, Bowel and Pelvic Health community team in Lewisham, London, with their project: ‘Trial without catheter (TWOC) using a structured approach’. The team have shared their project with the hub. The Centre for Sustainable Healthcare supported the Bladder, Bowel and Pelvic Health community team in Lewisham by undertaking a sustainable quality improvement project: a ‘Trial without catheter (TWOC) using a structured approach’. The team (consisting of the clinical lead, catheter lead nurse and a graduate management trainee) worked with the district nursing teams and urgent care service as part of the Green Nursing Challenge to improve care for patients, whilst saving money and carbon emissions. The challenge Indwelling urinary catheters are among the most used invasive medical devices in the UK, and an estimated 90,000 people in community settings require long-term catheter use. Evidence suggests that the longer a catheter remains in place, the higher the risk of infection, and around 2,100 deaths per year are directly attributed to catheter-related infections. The financial burden of catheter-associated urinary tract infections (CaUTIs) is approximately £2,000 per episode and the total annual cost of Foley catheter use estimated between £1 billion and £2.5 billion. A TWOC is conducted when a catheter, which is a tube inserted into the bladder to drain urine, is removed to determine if the patient can urinate normally without it. This procedure is essential for evaluating bladder function and ensuring that the patient can manage without ongoing catheterisation The team found that there was a lack of knowledge around standardised TWOC protocol, and a lack of clear evidence on how to manage the process. They identified problems with repeated catheter use, unnecessary district nurse visits, ambulance callouts and avoidable hospital stays. These inefficiencies not only compromise patient care, comfort and quality of life, but also generate considerable plastic waste from catheters, gloves, aprons and maintenance solutions. Removing catheters as soon as possible has many advantages, but it is vital that removals are planned and effective to prevent adverse events, unnecessary emergency call outs or attendances to the emergency department. Avoiding the cycle of failed TWOC and repeated catheter insertion is key. The Green Nursing Challenge helped the team in the successful implementation and evaluation of a project to develop a structured TWOC process, and measure the impact from a social, financial and environmental perspective. They implemented a classification system for TWOC suitability, together with corresponding TWOC strategies. The project saw the team training staff and evaluating their results across the community of Lewisham and the wider Trust. Results Monthly figures were collected before and after the project and showed clear improvements in the following: Reductions in: Catheter-related ambulance call outs by 25%, suggesting more timely community interventions. Catheter-related hospital stays (bed days) by 32%. Catheter-related hospital admissions by 12.5%, indicating fewer acute deterioration events. No catheter associated urinary tract infections were reported. Environmental sustainability The projected annual saving is 42,156.40 CO2e, equivalent to driving 124,026 miles in an average car. Economic sustainability On average, the initiative contributed to projected net annual savings of £441,708. Social sustainability The reduction in bed days meant that patients spent less time in hospital and more time at home which linked to improved emotional wellbeing. Reduction in staff pressures due to TWOC attempts and urgent visits for catheter-related complications. Increased staff confidence in catheter management contributing to a working environment that was less reactive and more focused on delivering high quality, consistent care. Improved integration, communication and patient pathways helped to ensure accurate referrals, faster and more effective communication. Next steps The team are continuing to develop their project hoping to see further improvements in emergency attendance, hospital stays, CaUTI rates, use of catheter materials and speed of catheter removals. They hope developing more comprehensive guidelines will lead to faster assessment and TWOC, or referral elsewhere, with the net result being a significant reduction in catheter usage overall. For more information please see Green Nursing Challenge Trial without catheter - a structured approach. Do you have a project you would like to share on the hub? We'd love to hear from you. Please email [email protected].

Incontinence is often described as the last medical taboo. Everyone from medics and patient representative groups, researchers and charities, to social scientists, marketeers and psychologists agree that it is a condition cloaked in shame, silence and stigma.[1]   But how does that impact on patient safety? And are there any measures that could prevent potential harm? In this blog, best-selling author Luce Brett explains why it’s so important to shatter the stigma surrounding incontinence, a condition affecting 34% of women in the UK.[2] Drawing on research from her recent book, and her own insight as a patient, Luce highlights how we can improve health outcomes for patients by simply talking about it more.  A dangerous silence Historically, the combination of being a common symptom but also a massive taboo has meant that incontinence has sometimes slipped through the cracks, so to speak. A group of UK charities, working for conditions where the disease or treatment can cause incontinence issues, found that stigma had a negative effect on research funding and investment.[3] There is also a lack of appropriate recognition in policy forums and political public health discussion. Some things are changing, and the NHS recognises continence and pelvic health in its five-year plan, but the stigma is still creating barriers to safe, quality care. We’ve known for some time that incontinence can negatively impact physical and mental health and overall quality of life. A significant percentage of patients with urinary incontinence suffer from depression.[4,5] The situation gets more worrying the deeper the dive into the murky worlds of faecal incontinence, which is perhaps the most smothered in embarrassment, discomfort and taboo. We know faecal incontinence is often under-reported, even amongst communities such as older women where it is relatively common.[6] The condition causes psychological distress in patients and can sometimes have a potentially devastating impact on sexual function. Some studies have suggested healthcare professionals can be reluctant to start investigations and enquiries about faecal incontinence as it can be a complex area to assess and they may not necessarily know a lot about current management.[7] That, combined with patients’ understandable sense of shame and reluctance, means silence wins, again. And when it does, it provides the perfect breeding ground for insidious inequalities and poor quality of life for the incontinent patient. Active screening could surely prevent actual lived misery. Also, ‘urge’ urinary incontinence (when urine leaks as you feel a sudden, intense urge to pee, or soon afterwards) is significantly associated with falls in older patients,[8] depression, urinary tract infections, increased BMI, diabetes and death. So, the safety implications for patients are clear. The most common forms of urinary incontinence can often be cured – sometimes with surgery, but far more often with short, cheap interventions like pelvic floor physiotherapy. However, a society-wide unwillingness to talk about it badly hampers patient-doctor conversations. In the UK, patients take an average of seven years to seek medical help for post-birth incontinence.[9] A long time to suffer the effects in silence. If patients don’t feel able to seek help, their continence issues could potentially worsen or they could develop related conditions and comorbidities. We know that comorbidity is associated with worse health outcomes, more complex clinical management and increased health care costs. When incontinence is a side effect of something more ‘serious’ – part of a neurological disorder, a cancer treatment, the reason for a fall or infection – it never seems to be at the ‘top of the list’ of things to talk about, despite the huge impact it has on a person’s daily life.[10] We have to ensure that incontinence is spoken about in settings beyond those dedicated to maternity, postnatal and pelvic healthcare. If patients with conditions linked to a higher prevalence of incontinence (e.g. COPD in women) are not asked about it, the silence and stigma will continue.[11] I’m a writer, a patient and a lay contributor to healthcare initiatives. I’m not a researcher or a clinician. But I do have insight into incontinence after writing and speaking widely about it. This year I launched my book, an intimate memoir and wider take on being an incontinent woman, PMSL: Or How I Literally Pissed Myself Laughing & Survived The Last Taboo to Tell The Tale. Anecdata from this work has revealed that many women who experienced urine leaking post-birth were brushed off by practitioners or labelled as ‘normal’. Some were told that they were making a fuss or complaining. Sadly, these experiences are not uncommon. The recent Cumberlege Review highlighted similar attitudes towards women who underwent surgical mesh implants. Adopting a safer approach We really have to change the way we approach incontinence. We have to avoid dismissing, ignoring or trivialising it. If incontinent men and women are told their leaking is ‘just’ anything, ‘just’ an oops moment, ‘just’ a brief side effect, ‘just’ an inevitability after a vaginal delivery, ‘just’ a problem for their male partner in sex, ‘just’ a part of aging, then they are less likely to speak up or feel able to get help. They are already conditioned to put up and shut up. And that can make them more susceptible to further harm, both physically and mentally. By speaking about incontinence widely, clinicians will help it to become recognised as a legitimate and non-taboo healthcare conversation. This will mean more patients will be referred for help if incontinence is part of the full burden of their other conditions. It will also set a tone for stepping away from the harmful silence of the past. Good practitioners are also mindful of the safety issue posed by not ensuring that the incontinent patient’s mental health is taken care of. They are prepared to create space for some of the most embarrassing or uncomfortable issues incontinent patient might face – such as sexual dysfunction or leaking during sex. Ignoring incontinence may be less awkward or allow people to avoid difficult conversations. However, like all taboos in medicine, this comes at a cost to patients – leaving them prone to worse health outcomes. We can all do better than that. Get 20% off Luce Brett's book Members of the hub can receive a 20% discount on Luce’s best-selling book, PMSL Or How I Literally Pissed Myself Laughing & Survived The Last Taboo to Tell The Tale. To access the discount, please sign up to the hub and request the code by emailing us at [email protected]. References 1. European Guidelines on Urinary Incontinence. World Federation of Incontinence and Pelvic Problems. 2. Excellence in Continence Care. NHS England. 2018. 3. “My bladder and bowel own my life.” A collaborative workshop addressing the need for continence research. 2018. 4. Steers WD, Lee K-S. Depression and incontinence. World J Urol 2001; 9: 351–357. 5. Incontinence, anxiety and depression. Beyond Blue and the Continence Foundation of Australia. 6. Meyer I, Richter HE. Impact of Fecal Incontinence and Its Treatment on Quality of Life in Women. Womens Health (Lond) 2005; 11(2): 225–238 7. Meyer I, Richter HE. Impact of Fecal Incontinence and Its Treatment on Quality of Life in Women. Womens Health (Lond) 2005; 11(2): 225–238 8. Brown JS, Vittinghoff E, Wyman JF. Urge urinary incontinence was associated with increased risk of falls and non-spinal, non-traumatic fractures in older women. Evidence-Based Nursing 2001; 4 (1): 26. 9. Breaking the taboo of incontinence after childbirth. National Childcare Trust. 2016. 10. “My bladder and bowel own my life.” A collaborative workshop addressing the need for continence research. 2018. 11. Button BM, Holland AE, Sherburn MS et al. Prevalence, impact and specialised treatment of urinary incontinence in women with chronic lung disease. Physiotherapy J 2019 105 (1): 114-119.

In 2015, few people had even heard of pelvic mesh implants, let alone the devastating complications they could cause. Women were told their pain was “normal,” their concerns dismissed, their injuries hidden behind a wall of medical gaslighting. But what began as a small group of women raising their voices against an invisible epidemic turned into one of the UK’s most powerful grassroots campaigns for patient safety and medical justice. As Sling The Mesh marks its 10th anniversary, it celebrates a decade of courage, compassion, and relentless campaigning that has changed lives – and policy – forever. Over the next decade, Sling The Mesh will: Demand proper aftercare and support for all mesh-injured patients. Push for accountability from manufacturers and regulators. Campaign for awareness around hernia and other less-recognised mesh complications. Advocate for safer alternatives and patient-centred decision-making. Empower the next generation of campaigners to keep raising their voices. Push for tougher regulations and oversight of medical devices. Lobby for Sunshine legislation for transparency around funding from industry to the healthcare sector which can bias prescribing and affect research integrity.