THOUSANDS of patients every year have cause to be thankful for the work of Gwent's Continence Service in helping treat what remain for many, hidden and embarrassing problems.
Thankfully, the invaluable work of the nurses who provide the care and support these patients rely on is continuing despite the challenges thrown up by the ongoing Covid-19 pandemic.
And they are now operating under a new name - the Bladder & Bowel Nursing Service - in a move intended to help destigmatise perceptions of the conditions they deal with.
"There has always been a bit of a stigma to the words 'continence' and 'incontinence' and it is important to look at ways of helping to overcome that - and also, they feel a bit old fashioned these days," said Karen Logan, bladder and bowel nurse consultant, who heads the service.
"It is a big step to change the name. We have been known as the continence service for around 20 years, but it feels like the right time to do it."
The service, like many others provided by the NHS, has been hit hard by the Covid-19 pandemic, not least in the area of promotion. Displays in places like public areas and supermarkets have been curtailed, but the Bladder & Bowel Service has now launched a Twitter platform - @BladderBowelABB - to help raise its profile.
Ms Logan (above) has helmed the service in Gwent since the early 2000s and her work and expertise in the field has earned her accolades including a UK Nurse of the Year title, an OBE, and a Lifetime Achievement Award from the Royal College of Nursing.
The service's team of specialist nurses sees patients with a range of bladder and bowel conditions - children and adults - with referrals predominantly through GPs.
Referrals are on the rise - there were 2,238 in 2018/19, and 3,010 last year, split between new and follow-ups - and referrals for provision of continence pads, another aspect of the service's work, rose from 4,618 in 2018/19, to 4,996 last year.
"We are a first point of entry to prevent a referral straight into secondary care. It used to be that patients were referred into urology or gynaecology," said Ms Logan.
"We provide a first assessment, and conservative management, with non-invasive treatment. A lot of patients' conditions are significantly improved.
"For about 15 per cent though, there is a need for further investigation and often surgery."
The service has now launched a Twitter platform
The Bladder & Bowel Service runs nurse-led clinics in hospitals across the Aneurin Bevan University Health Board area, and also provides home visits for the housebound. Since 2015 its nurses have been able to prescribe continence appliances - previously GPs would do this - and a patient database has been developed, with all patients regularly reviewed and re-assessed.
"In the past there was a lot of wastage with these appliances, either they did not work or were not suitable for some patients, but we have now developed a prescribing formulary, where all appliances are carefully chosen to be fit for purpose," said Ms Logan.
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Teaching and training of nurses in continence issues is also a key part of the service, which has links to hospital wards, care homes and district nursing.
"We want to help get people better, and we need to get in early, as we don't want them to have to wait. There is a lot that we can do if we get them early," said Ms Logan.
"Not all patients are incontinent, but they can present with a range of bowel and bladder problems, and we need to care for them to make sure they do not become incontinent.
"A lot of our work is in habit and behaviour training, and we are often trying to help people change the habits of a lifetime.
"These conditions do not kill people, but they can kill quality of life, and for people who live with them day in and day out, those quality of life issues can be catastrophic.
"For instance, I did some research involving spinal injury patients, and for all that they go through, most of them said the worst thing was the loss of bladder and bowel control.
"We can make a huge difference to people's lives, many of which are compromised a great deal by the conditions they have.
"These conditions can affect confidence, social interaction, and where and for how long people feel they can go out. It is all about quality of life."
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