Flushing Away the Stigma: One Nurse’s Mission to Make Care Comfortable

Paediatric Continence Care Interview with Hannah Douglas: Clinical Nurse and Lead Continence Advisor

Today, we are joined by Hannah Douglas, a Clinical Nurse and Lead Continence Advisor for At Home Care. Hannah has over a decade of experience in paediatrics and complex care and has dedicated the last three years to the field of continence care.

To start, can you provide some background on continence care for our audience?

Hannah Douglas: Certainly! Continence care helps people manage bladder or bowel concerns through a comprehensive assessment and management plan tailored to the individual’s needs. An assessment typically includes a relaxed discussion about health history, daily routines, and symptoms, accompanied by a gentle, non-invasive check-up. The goal is to create a personalised plan that includes practical strategies, education, and product recommendations to enhance comfort, independence, and quality of life.

These assessments are particularly beneficial for individuals experiencing incontinence, frequent urges, constipation, or toileting challenges related to disability or medical changes. Under the NDIS, these assessments can also support access to funding for ongoing products and care.

Interviewer: Are there any misconceptions or stigmas surrounding continence care that you frequently encounter?

Hannah: Absolutely. Many people still feel embarrassed to discuss bladder or bowel problems, even though they’re pretty standard. A common misconception is that incontinence is just a normal part of aging or something to accept. In reality, continence issues can be effectively treated and managed with proper support. Early evaluation often results in significant improvements. The more we talk about it, the less stigma there is.

Interviewer: What aspect of continence care tends to surprise people the most?

Hannah: Most don’t realise the holistic nature of continence care. It’s so much more than products and toilet training. We consider diet, fluid intake, mobility, posture, medication, and even emotional wellbeing. Often, minor adjustments, such as timing fluid intake or changing toileting positions, can lead to major improvements in comfort and continence.

Understanding Paediatric Continence Care 

Interviewer: How does continence care differ when it comes to paediatrics?

Hannah: Paediatric continence care is more family-centred. The focus is on establishing routines and strategies that fit naturally into the child’s home and school life, utilising positive reinforcement and gentle habit-building methods. It often addresses issues like delayed toilet training, constipation, daytime wetting, and challenges related to developmental delays or disabilities.

Interviewer: How do you make accommodations for your youngest clients during assessments?

Hannah: Children’s assessments are designed to feel playful and reassuring. I often conduct assessments on the floor of their home or in a familiar environment, making use of visual aids and simple explanations to create a comfortable atmosphere. In-home visits are particularly effective, as they allow us to understand the child’s surroundings and develop realistic routines for the family.

Interviewer: What are some common continence challenges faced in early childhood compared to adolescence?

Hannah: In early childhood, common challenges include delayed toilet training, constipation, and daytime wetting. In contrast, teens and young adults might face bedwetting (nocturnal enuresis), stress-related incontinence, and difficulties managing continence in social settings. As they get older, we place a greater emphasis on building their independence and self-management.

Interviewer: How do continence issues impact a child’s emotional wellbeing or self-esteem?

Hannah: Children experiencing continence issues often feel anxious or embarrassed, which can lead to social withdrawal. Early intervention, encouragement, and a positive approach to the topic are crucial.

When continence care is introduced in a supportive manner, kids and teens typically gain confidence quickly and come to view these challenges as part of learning about their bodies.

Interviewer: What role do parents or caregivers play in supporting continence care at home?

Hannah: Here, education and consistency are essential for success. Parents and caregivers are instrumental in continence care. They help maintain toilet diaries, monitor fluid and bowel patterns, and reinforce routines between nursing visits. As a continence nurse, educating parents/ carers is key; it empowers parents to understand what is normal, what to look for, and how to respond calmly during accidents. What role do parents or carers play in supporting continence care at home?

How Continence Care Changes for Teens and Young Adults

Interviewer: What does the transition from paediatric to teen and young adult continence services typically look like?

Hannah: Transitioning to adult services can be daunting, but it’s a necessary step toward building independence. We focus on encouraging young people to become more engaged in their own care, prompting them to communicate directly with clinicians and understand their management plans. This involvement is essential for building confidence and self-management skills as they grow.

Interviewer: How do you support young adults in taking ownership of their continence care?

Hannah: It starts with a conversation. My focus is on education, confidence-building, and practical skills. This can involve teaching them how to manage products at school discreetly, navigate public toilets, or discuss their continence needs with support workers or partners. We set small, realistic goals that gradually build their independence, such as managing product reordering or setting reminders for bladder emptying using a phone app.

Interviewer: Are there specific challenges that arise during this transition period?

Hannah: Yes, there are emotional and systemic challenges that often emerge. Many young people feel embarrassed discussing continence openly, and some struggle to find adult services that are approachable. Building trust and continuity of care is crucial to overcoming these hurdles.

Interviewer: How do you prepare young adults for managing their own continence care independently?

Hannah: Preparation starts early. I encourage families to involve their children in small tasks, like packing their own supplies or tracking fluid intake. By the time they reach adolescence, we shift our focus towards teaching self-advocacy, including how to explain their needs confidently and access support when necessary. I also collaborate with schools, therapists, and support coordinators to ensure a smooth and consistent transition.

Interviewer: Are there any new technologies or products that have improved continence care for young people?

Hannah: Absolutely! There are now continence tracking apps like Habit Trainer or DryNites Tracker, wearable discreet sensors like Dri Sleeper Eclipse, and stylish product designs such as Modibodi and Night N Day. These products look and feel like regular underwear but provide protection that supports independence and confidence, especially for teens navigating school and social life.

Interviewer: How do hormonal changes during puberty affect continence care?

Hannah: Hormonal changes can influence bladder function and bowel patterns, particularly in girls. It’s often beneficial to re-evaluate continence routines and supports during puberty to adjust to these changes.

Interviewer: Are there different strategies or products recommended for more independent teenagers?

Hannah: For older teens, we place a strong emphasis on discretion, autonomy, and self-management. Options like pull-up style absorbent pants, slimline pads, and odour-control disposal systems make managing their needs much easier. We also encourage using digital reminders, hydration tracking apps, and creating small toiletry kits for travel or school, hence, empowering them to handle their continence privately and confidently.

Managing Continence Care Outside the Home

Interviewer: How do digital tools (e.g., apps or trackers) support continence management for families?

Hannah: Digital tools are a great support, especially for families managing routines. Apps like UroTracker or My Bladder Diary allow users to log toilet times, fluid intake, and accidents, helping to identify patterns. For families, this data can be shared easily with clinicians, making reviews and plan updates significantly more efficient.

Interviewer: How do you work with schools or educators to support children with continence needs?

Hannah: Collaboration is key. I work directly with teachers and school health staff to develop individual continence management plans. These plans specify routines, privacy strategies, and staff responsibilities, ensuring that children are supported discreetly throughout the day. When schools are well-informed, children feel much more comfortable and confident.

Interviewer: What should parents know about advocating for their child’s continence needs in an educational setting?

Hannah: Parents should know that it’s completely acceptable to request reasonable adjustments under school inclusion policies, such as flexible bathroom breaks, discreet storage for supplies, or staff education. Also, having a written plan from a continence nurse helps schools understand exactly what is needed.

Interviewer: How do you approach conversations about continence with children who may feel embarrassed or anxious?

Hannah: Honesty and empathy go a long way. I use simple, age-appropriate language, incorporate humour, and provide reassurance to make the child feel safe and heard. We talk about how bodies work and emphasise that many kids face similar challenges. Normalising these discussions significantly reduces shame and anxiety, creating a space conducive to trust and progress.

Interviewer: Finally, for those seeking continence services, what factors should they consider when choosing a provider?

Hannah: From a clinical perspective, look for a qualified nurse with specific training in continence care and experience working with individuals with disabilities. Look for someone who adopts a collaborative, person-centred approach, involves families and carers in the process, and provides documentation that meets NDIS requirements.

Good communication and empathy are just as important as clinical skill, since continence care is very personal. Feeling heard and respected is vital for effective care.