Bladder and Bowel UK Newsletter
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June 2018
NEW BBUK ENURESIS AWARD Find out how you can enter
SPORT AND CONTINENCE Bladder and bowel issues in men and women who participate in sport
LOOK GOOD, FEEL GOOD AWARD WINNERS 2018 1st, 2nd and 3rd place winners announced
WORLD CONTINENCE WEEK Sharing expertise
Charity number: 224742
Welcome to our June newsletter Welcome to our new look, monthly issue BBUK Newsletter. Please feel free to share with your colleagues. Many of you are familiar with team members here at BBUK and the services that we offer, whilst some of you may be new to the bladder and bowel speciality and would like to know more about our organisation and how we can support you and your patients/clients. We have upcoming training and education days, such as the Bowel Education Day in September and Paediatric Study Day in October. You can also stay connected with us through social media - Facebook and Twitter. We post regular blogs on the BBUK website. It’s always great to hear what you are up to in practice, as well as sharing ideas, connecting and networking to support each other as a wider group. We would love to hear what you are doing for World Continence Week. In this month’s issue, you will find some practical information and tips to share with patients when travelling with a continence problem. The team recently attended the Association for Continence Advice Conference in Bournemouth and jointly with the ACA, BBUK organised and presented the Look Good, Feel Good Award, so do take a look at the winners. This year, we are also proud to offer the first ever Enuresis Award and are looking forward to receiving your applications. We have some new Adult Resources to share with you all and this month we are talking about healthy diet and fibre intake. We have also included a link to new report asking 'Are Failing Hygiene Standards Failing Primary School Children?' You can download the full report on our website. Regular features also include information on the Supplier Directory and the Loo of the Month.
Karen Irwin, Service Manager/Nurse Specialist
Explore our key features Sport and continence....................................................................................................................4 Raising awareness for World Continence Week...........................................................................6 Dates for your diary.......................................................................................................................8 Bladder and Bowel UK's online shop.............................................................................................9 ACA Conference 2018 in Bournemouth.......................................................................................10 Look Good, Feel Good Award Winners.........................................................................................12 Encouraging children to drink more water.....................................................................................14 Bladder and Bowel UK Enuresis Award........................................................................................16 New resources on our website......................................................................................................17 Loo of the Month...........................................................................................................................18
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Sport and continence
The summer is upon us and with it a whole host of national sporting events; The World Cup, Wimbledon and the Open to mention a few. There will be some professionals taking part in these major events who will be experiencing bladder or bowel problems, as these are often a hidden problem and rarely visible to others. Sport is such a brilliant way of maintain physical fitness and well-being alongside, in many cases, having a pleasurable and social aspect. However, how many people experience bladder and bowel problems that affect their participation in sport? Some people, especially ladies but some gents, experience stress incontinence during exercise which can affect their motivation for taking part due to embarrassment and discomfort. It is, also, true that many who never experience incontinence but may experience for example urinary urgency or constipation are restricted by their bladder and bowel conditions when considering participation in sporting activities. It is essential as part of an overall holistic continence assessment to ask about lifestyle activities, current and any that maybe the individual does not feel able to be part of any
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longer. It may be a post natal lady who has stopped her aerobics class due to stress incontinence. Through proactive management, advice and support individuals can get back to sports and hobbies they like or seek alternatives when functionality of the bladder, bowel and pelvic floor are explained. It is advisable for anyone experiencing pelvic floor muscle weakness to switch from a high impact sport to a low impact sport.
Advice should, also, be given on how to prepare for sporting activities to prevent discomfort, leakage etc during the activity. Maybe some individuals prefer to be spectators of sport and this activity can, also, be affected by bladder and bowel problems as it may mean not been close to a toilet or lack of public toilets and facilities. BBUK has produced a Just Can’t Wait card that is available to individuals who feel they need to access toilets urgently, frequently in the absence of the availability of public toilets.
We need to be as proactive as possible as continence professionals in promoting support and advice as much as possible to enable continuation of positive involvement in sport for those who want to take part and those who enjoy watching sport. Encourage individuals to seek help to enhance quality of life to continue and return to a sport they enjoy! Let’s hope the sportsmen and women from the UK do us proud! Joanne Hoyle, Continence Specialist Nurse
World Continence Week Monday 18th June - Sunday 24th June 2018
We have a team of dedicated Specialist Nurses and knowledgeable Continence Product Information staff, who can be contacted on the National Confidential Helpline: 0161 607 8219 or via email: bladderandboweluk@disabledliving.co.uk
#WCW18
Raising Awareness for World Continence Week 2018
Bladder and bowel problems among adults are not uncommon, affecting both males and females of all ages. Some common bladder problems may include bladder leakage (incontinence), bed wetting or difficulties emptying the bladder. Some common bowel problems may include leakage (faecal incontinence), constipation and difficulties emptying the bowel. Having a bladder or bowel problem (or both), can cause embarrassment, anxiety and distress, often having a major impact on an individuals quality of life. Often people are reluctant to discuss their symptoms with anyone, but it is important to know that much can be done to treat, manage and improve symptoms. It is important to discuss any problems with local healthcare professionals to ease the taboo around this subject; Continence Awareness Week 2018 gives everyone an insight into seeking help, talking more openly about problems and raising the profile of services that can help.
Here at Bladder and Bowel UK, we can offer advice, support and practical help to individuals who are experiencing problems alongside their families, carers and healthcare professionals. Advice is available from adult and child specialist nurses.
Experiencing bladder and bowel problems can affect an individual in many ways including social, psychological and financial. Many feel that they can take part in hobbies and sport any longer whilst some will avoid social occasions due to self esteem issues and embarrassment.
Other bladder problems that do not involve leakage can include the need to pass urine frequently, urgently and an increase need to pass urine during the night.
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There are several types of urinary incontinence, but the most common types include stress incontinence, (leaking on coughing, exercise or sneezing), urgency or dashing to the toilet, urge incontinence, mixed incontinence, overflow incontinence, difficulties emptying the bladder and functional incontinence.
Bladder and bowel problems in childhood and young people are very common. Problems
including difficulties with toilet training, wetting, constipation and/or soiling affect up to 28% of all children and adolescents at any one time. Younger children are affected more often than older children, but problems can happen at any age. Parents or carers often feel as if their child is the only one suffering, as nobody talks about it. We can also suggest how to approach your child`s GP, health visitor, school nurse, or other healthcare professional for treatment if appropriate. They should be able to offer individual assessment and treatment or refer you to a specialist for this, if necessary. Bladder problems are common in children and young people of all ages. The commonest problem is night time wetting. However, children and adolescents can also be affected by wetting during the day, having to rush to get to the toilet (urgency), or having to go to the toilet more often than is normal (frequency) or a combination of any or all of these. Less common problems include urinary tract infections (UTI). Initially it can be difficult to understand why a child or young person has a problem with their bladder and sometimes parents or carers might think it is a behavioural problem, or that their child is being lazy. Most children are dry in the day by the time they are three years old and at night by the time they are five. If a child has additional needs, it may be thought any delays in achieving dryness are related to the disability. However, all children with daytime wetting, frequency, urgency or any bladder difficulty should be offered an assessment and treatment if appropriate. How can BBUK help? Helpline services including signposting to local specialist services, product advice, generic clinical advice and support.
How can we be contacted? The helpline is available Monday to Friday, 9am – 4pm. We are also contactable by email. So who contacts us? Anyone concerned by a bladder or bowel problem may contact us for help and advice. This includes the general public, relatives, carers, health and social care professionals and other groups such as teachers or organisations such as charities and support groups. Duration of calls we receive We receive a large number of calls, each day to both the helpline or via our email service. Enquires range from a quick question being answered, but more often are more detailed, requiring us to dedicate time with the caller, to go through their concerns or query. Why do people contact us? We are contacted for a number of reasons. Some request information on continence products, aids and appliances. Some are looking for local bladder and bowel services and are surprised when we inform them that things can be done to treat, improve or better manage their situation. We always try to suggest that people present for continence assessment and to signpost or put people in touch with their local services, so they can access the help they need locally. We may also signpost to other charities or organisations. Health and social care professionals may be looking for information or training, which we also provide. We always try to ensure that people accessing our services are informed and directed to other appropriate services, such as NHS specialist bladder and bowel services for further help. We always encourage an individual or family member to speak to someone, GP, Continence Specialist Nurse, District Nurse or other health care professional.
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Dates for your diary Adult Bowel Education Day Date: Tuesday 25th September 2018 Venue: Redbank House, 4 St Chads Street, Cheetham, Manchester, M8 8QA Price: £25 Topics include: Physiotherapy Led Healthy Bowel Clinic (BBUK Bowel Care Award Winner 2018) RCN Guidance on Management of Lower Bowel Dysfunction including DRE and MRF - update Constipation Treatment and Management Spinal Injury Bowel Management Expert Patient Experience
Paediatric Continence Promotion Day Date: Tuesday 16th October 2018 Venue: Redbank House, 4 St Chads Street, Cheetham, Manchester, M8 8QA Price: £25 Topics include: • Constipation • The Psychological impact of incontinence • Working with schools in Durham • Enuresis Award winners • Using data to support service development
UK National Annual Symposium 2019 Date: Wednesday 6th March 2019 Venue: USN Bolton Arena, Arena Approach, Horwich, Bolton, BL6 6LB Price: £30 This day has three concurrent education streams: Adult Bowel, Adult Bladder and Paediatric. The Symposium offers an extensive company exhibition. Booking is essential, as it will get sold out!
For further details on any of the study days please contact us on Tel: 0161 607 8219 or email bladderandboweluk@disabledliving.co.uk or see our website: http://www.bladderandboweluk.co.uk/professionals/professionals-training/
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Visit Bladder and Bowel UK's Online Shop
Visit: www.bladderandboweluk.co.uk/online-shop/ or call: 0161 607 8219
We are delighted to be working in partnership with Complete Care Shop to provide you with a comprehensive online shopping facility for equipment and products to make life easier. Complete Care Shop has over 250,000 in stock items at competitive prices offering you choice from a wide range of manufacturers including disposable pads, pants, urinals, bedding protection, disposal and reusable bed and chair pads, wipes, gloves and a whole lot more. In addition, Complete Care Shop has a reputation for excellent customer service which made the decision to enter into this partnership an easy decision to make! The main advantage of purchasing via the Bladder and Bowel UK website, is the opportunity for you or your clients to speak to Continence Specialists for free impartial help and advice, ensuring unnecessary purchases are not made.
Inadequate Toilet Facilities
Download the full report on our resources page here underneath the 'Other Useful Resources' section.
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ACA Conference 2018 - Bournemouth
Bladder and Bowel UK attended the Association of Continence Advice (ACA) conference in Bournemouth on 21st and 22nd May. The theme this year was ‘The Seven Ages of Continence’, with the programme focusing on the impact of incontinence at different points through life and including a paediatric workshop on the first day and a care homes workshop on the second.
Don't miss out on... The company exhibition was, yet again, a
The educational programme included a wide range of topics, with eminent speakers from diverse backgrounds and continence sub specialties. The conference was launched with an outstanding keynote talk from Professor Christine Norton on ‘How far have we come with continence care’, which was followed by Wendy Gray, Head of Nursing at NHS England South, with a talk that reflected the conference theme. Other speakers covered continence within topics as diverse as challenging public attitudes, male pelvic pain, childbirth, menopause, diabetes, constipation and dementia, to name but a few. The educational content also included free papers, posters and company symposium. ACA members are now able to access presentations (where speakers have given permission) on the ACA website.
great success with a diverse range of continence products, pharmaceuticals, devices, equipment, charities and organisations. This provided an excellent opportunity to update knowledge, gain new information, discuss innovative products, medications and devices with company representatives, forge links and develop ideas for improving continence care. The Bladder and Bowel UK stand was busy with healthcare professionals and company representatives visiting us to find out about our role. We provided information on our helpline, online resources and training. It was also an opportunity for us to meet new people as well as catch up with friends and colleagues from both industry and clinical backgrounds. The ACA conference provides valuable networking opportunities, in a warm
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welcoming and friendly environment. It allows opportunity for discussion with others who share enthusiasm for continence care and promotion, which stimulates ideas and innovation to improve practice. We would encourage those working in all areas of continence to consider joining this wonderful organisation, which brings the benefits of local group support, local and national education to drive excellence in continence care.
Care Homes Workshop – ACA Conference 2018
Paediatric Continence Workshop – ACA Conference 2018
The first session of the day was delivered by Paul Edwards (Head of Practice Development at Bupa UK Care Services). He spoke eloquently on the challenges in the care home environment and was followed by Wendy Ness, Colrectal Nurse Specialist and member of the ACA executive who talked about bowel dysfunction in the elderly. In the afternoon session Prof Jo Booth, Chair of the ACA Education Committee, highlighted new treatments available to the care home environment while Sharon Eustice, Nurse Consultant from Cornwall discussed appropriate assessment for continence products.
For the fourth consecutive year there was a separate workshop on paediatric continence. However, for the first time this was run across late morning into the afternoon, which gave delegates time to travel, as well as an extended opportunity to visit the exhibition; something that was appreciated by all. The day started with a talk about constipation, from Davina Richardson, one of the BBUK nurses and this was followed by Helen Ripper and Sandra Hanson, from Dartford and Gravesham Trust, talking about their Nursing Times Award winning resource to support families of children with constipation. The video they developed to provide information on how to use macrogol laxatives has been used internationally by clinicians treating adults as well as children and is available at http://www.thepoonurses.uk/
It is a number of years since the ACA last ran a care homes workshop, but this was reintroduced this year with a similar format to the paediatric workshop. This event took place on the second day of conference. Delegates from the main conference were able to attend any of the workshop sessions.
Don't miss out on...
Claire Lindsay and Debbie Richards talked about the impact on later toilet training on service provision and Dr Hannah Cottis spoke on the assessment and management of daytime wetting. June Rogers completed an interesting and stimulating programme with a talk about the serious impact of night time wetting on a child’s health and well being. It is hoped that these workshops are now an established part of the wider conference and will be run again at next year's event which is scheduled for 10th and 11th June in Harrogate.
For further information about ACA membership, contact Fitwise: ACA@Fitwise.co.uk The Association for Continence Advice is the association for any continence professionals who wish to sustain their professional development, share skills and ideas with peers, network, remain aware of specialist educational opportunities and receive regular newsletters, and receive information about local branch activities and national awards.
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The 21st ‘Look Good, Feel Good’ Award 2018
The Association for Continence Advice (ACA) Conference at the International Conference Centre, Bournemouth, was the venue for the presentation of the 21st Annual ‘Look Good, Feel Good’ (LGFG) Award. This joint ACA/Bladder and Bowel UK Award highlights products that contribute to improving quality of life for people with bladder and/or bowel problems. It aims to encourage designers to also consider reliability discretion and ease of use, as well as quality and innovation at an early stage in the development of new products. Judges came from a varied background of Specialist Nurses, Allied Health Professionals (both adult and pediatric clinicians) and charity representation. Only products exhibited at the ACA Conference, that have been launched or significantly improved in the last year, are eligible to enter for the award. Look Good, Feel Good Award 2018: 1st place MAPle, a biofeedback machine, produced by Novuqare and distributed in the UK by Medtronic.
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Look Good, Feel Good Award 2018: 2nd Place Aloe Meatal Plus - Hunter Urology
Judges comments on the winning product were: "Compact, looks good, innovative, discrete; extremely good product, would like to trial; discreet and innovative; a plus that it can help with lots of conditions and good that it can be operated with an iPad." The MAPLe High Definition technology enables a patient’s individual pelvic floor muscle EMG activity to be seen at a glance, allowing accurate diagnosis and provision of a targeted treatment.
The Aloe Meatal Plus is a dilatation catheter with a flexible tip. Dilatation catheters are designed to reduce the risk of urethral strictures by preventing narrowing of the urethra from occurring. The natural water based coating of this catheter contains Aloe Vera for a smooth and slippery feel. The flexible tip is tapered for easy insertion. For more information please call: 01404 44088 or visit: www.hunterurology.com
Look Good, Feel Good Award 2018: 3rd place Kesvir Boy’s and Men’s Jellyfish Board shorts – Incy Wincy
The MAPLe uses high definition technology and is the first system able to precisely identify individual muscle activity on different sides and depths of the pelvic floor. This allows accurate diagnosis and targeted treatment. The MAPLe can be used to reduce or resolve the symptoms of pelvic floor dysfunction, so improving quality of life. The unique design of the probe with 24 electrodes, means the MAPLe is suitable for rectal and vaginal use. For more information on this product please call: 0192 321 2213 or visit: www.medtronic.co.uk
These new swim shorts have an attractive, vibrant colour are in a chlorine resistant fabric, while adjustable leg and waist cuffs on the integrated briefs provide extra security for the wearer. Available in seven sizes for boys and fives sizes for men. For further information please call: 0844 875 4645 / 01189560295 or visit: www.incywincy.net
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Encouraging Children to Drink More Water
Adequate fluid intake is important for maintaining health and well-being. Most school age children should have about one and a half liters of water per day with half of this during the school day. Children will need more than this if they are physically active, if the weather or classroom is hot, or if they are overweight. Older children may also need more. However, many parents complain that their children are reluctant to drink and say they do not feel thirsty. Not drinking enough can cause or exacerbate continence problems, as well as being the reason for headaches, feeling tired and struggling to concentrate. What should my child be drinking? Plain water is the best drink, as it does not contain any sugar or other additives. However, some children refuse to drink water. If this is the case for your child, you could try the following: • Offer them water from the fridge or add ice cubes to it • Use very dilute sugar-free fruit squashes as an alternative
causing the child to have to rush to the toilet or go to the toilet more often • Do not give your child drinks with caffeine in them. Caffeine can irritate the bladder. Tea, coffee, hot chocolate, cola and some energy drinks contain caffeine. • Do not let your child have more than 500mls (one pint) of milk per day. This can exacerbate or cause constipation and may contribute to excessive weight gain. How can I encourage my child to drink more?
Are there any drinks my child should avoid? • Do not offer your child fizzy drinks, except as a rare treat. Fizzy drinks can upset the bladder 14
Encouraging children to drink may be difficult, especially if they don’t feel thirsty. However, thirst is quite a late sign of needing fluids, so children should be drinking
regularly – about six to eight drinks spread evenly throughout the day.
• Build drink times into your family’s routine. • Make drink times fun: sitting together with a book or game and only read the next page or have your turn at the game when your child has had a few more sips. If your child won’t drink then put away the book or game until the next drink time. • Let your child chose their glass, cup or straw. • Start by expecting your child to drink only slightly more than they currently are and then gradually increase the amount you expect them to have until they are having about 1.5 litres per day. • Some children manage better if given half a glass and told to drink it all; some do better if given a full glass and are asked to drink half of it. • Measure out your child’s water in to a clean jug or plastic bottle each day, so they can see what they should be drinking. Pour all their drinks from that so they can see how well they are doing and offer them a small reward if they manage to drink it all. • Do not have battles over drinks.
bring the bottle home at the end of the day and offer them a small reward for drinking most or all of it. • If your child enjoys cold drinks, almost fill the water bottle and put it in the freezer overnight. The water will stay cold as it melts at school the next day. • Ask the teacher to build drink times into the day, or to allow the children to have their water bottles on their desks. • Ask the teacher to allow the children to use the toilet when they need to. If your child thinks they will not be allowed to go to the toilet, they might not drink at school.
Other things to consider Do not encourage your child to drink in the hour before they go to bed as this may cause bedwetting or make it worse. If your child has a bladder or bowel problem, making sure they drink well during the day can help. Ask your child’s GP, school nurse or health visitor for more advice or visit: www.bladderandboweluk.co.uk for more information.
How can I encourage my child to drink more when at school? • Ensure your child always has a sports bottle of water for school each day. Make sure they
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Bladder and Bowel UK Enuresis Award
Sponsored by:
Bladder and Bowel UK are delighted to have received support from Slater and Gordon LLP to be able to launch the first ever Enuresis Award with a £500 prize. In addition the prize includes expenses to attend and speak at the Bladder and Bowel UK Children’s Education Day on 16th October 2018. Why have an Enuresis Award? Enuresis used to be considered a benign condition that was self-limiting. However, we now know that children and young people, do not always outgrow the problem and those who are most severely affected are least likely to spontaneously recover. In addition, it causes reduced self-esteem and self-confidence; may be associated with other bladder and bowel problems; disturbs sleep which has a knock-on effect on daytime behaviour and learning; and negatively affects social opportunities, such as sleepovers and school trips. To raise awareness of bedwetting the International Children’s Continence Society and the European Society for Paediatric Urology launched World Bedwetting Day in 2015. Bladder and Bowel UK have worked with others to promote this event and disseminate information. 16
However, we felt that an award would not only help to further the aims of World Bedwetting Day, but would help to recognise the work of those children’s healthcare professionals who work tirelessly to support children, young people and their families with this condition. Why apply for an Award? Working in the field of healthcare today is difficult and demanding. Barely a day goes past without a headline about the lack of resources or some failure in health services. We feel it is time to celebrate all the hard work that is going on, particularly in an area that is associated with significant stigma and embarrassment for patients. Winning an award, not only brings the immediate benefits of the prize – in this case money to spend any way you would like, but also is an opportunity to validate achievements, share good practice, inspire others and positively
promote and advertise services. Decision makers are often more supportive of service development when external assessors have recognised exceptional practice. So there are many less apparent benefits! What about the Enuresis Award? The Bladder and Bowel UK Enuresis Award 2018, aims to recognise an individual or team, working within the NHS, or independent sector, who is able to demonstrate that they have made a difference to the care of children or young people with bedwetting. It is designed to highlight good practice and disseminate this to other health care professionals to enhance patient care. The work submitted needs to either be linked with World Bedwetting Day, or demonstrate how outcomes for children or young people with bedwetting have been improved.
How to apply Send your competed application form and 500 word summary of the work you have undertaken by email to: bladderandboweluk@disabledliving.co.uk or post to: Bladder and Bowel UK, Disabled Living, Burrows House, 10 Priestley Road, Worsley, Manchester M28 2LY. Entry forms and more detailed information are available here. Closing date 30th July 2018 For more information about Bladder and Bowel UK and Disabled Living’s services and resources go to: www.bladderandboweluk.co.uk www.disabledliving.co.uk
New Resources on Our Website BBUK have produced a number of new resources, which are free to downloadable on our website and can be found under Adult Resources. This month we have added a guide to a healthy diet and dietary fibre. All our other BBUK resources are also free to download for adults, children and young people which can also be accessed via the BBUK website. 17
Loo of the Month Canadian Outside Toilet A latrine toilet, outside, dry, wooden, toilet cabin in the heart of Canadian wilderness with spectacular views. And it's great for relaxing during cloudy summer weather.
Connect with us on social media As you know Bladder and Bowel UK is active on the Twitter, LinkedIn and Facebook social media networks, if you have anything that you wish us to share for you just get in touch, or tag us in. Please follow us, like us and connect with us!
@Bladder-and-Bowel-UK
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@BladderBowelUK
Bladder and Bowel UK
Disabled Living Services
Watch Our Donkeys to Innovators Film
Bladder and Bowel UK is a service of the charity, Disabled Living a charity which provides impartial information and advice about products, equipment (assistive technology) and services for disabled children, adults, older people, carers and the professionals who support them. We have a range of services which you can access via our helpline, through the website or at our Kidz to Adultz Exhibitions. Equipz The team comprise occupational therapists, trusted assessors, moving and handling specialists, physiotherapists, nurses, continence specialists who together with knowledgeable information co-ordinators offer practical solutions to what may seem like unmanageable problems. The staff, respond to enquiries throughout the UK, primarily via our helpline and website, with some people opting to make an appointment to visit the Disabled Living Centre based in Manchester for a free equipment assessment. Helpline: 0161 607 8200 Bladder and Bowel UK The team provide information and advice for children, young people and adults with Bladder and Bowel problems. We provide a confidential helpline managed by a team of specialist nurses and knowledgeable information staff. In addition, the website offers a wide range of downloadable free resources. Helpline: 0161 607 8219 Kidz to Adultz Exhibitions Disabled Living organise the largest FREE UK exhibitions totally dedicated to disabled children, young adults, their families, carers and the professionals who support them. With over 100 exhibitors at each event, offering a ’One Stop Shop’ for equipment products and services to enhance the quality of life. We deliver 5 events throughout the UK in: Farnborough, Bristol, Coventry, Manchester and Edinburgh. Training Disabled Living provides a comprehensive training programme for professionals and carers. Most of our courses are accredited by Open Awards and others provide CPD opportunities. Our training courses can be ‘tailor made’ to suit your organisations requirements and can be delivered throughout the UK for more detailed information on the courses we provide please visit the Disabled Living website.
www.disabledliving.co.uk
0161 607 8200
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Get in touch with us
For more information please visit: www.bladderandboweluk.co.uk
Bladder and Bowel UK Head Office - Disabled Living, Burrows House, 10 Priestley Road, Wardley Industrial Estate, Worsley, Manchester M28 2LY Helpline Tel: 0161 607 8219 Email: bladderandboweluk@disabledliving.co.uk Website: www.bladderandboweluk.co.uk