I beg to move,
That this House has considered the matter of incontinence.
I thank the Backbench Business Committee and its Chair, the hon. Member for Harrow East (Bob Blackman), who helped secure this debate. I am delighted that we are debating this vital but often ignored issue during World Continence Week.
The definition of a taboo is a subject so difficult, repulsive or offensive that it cannot be mentioned in polite conversation and can be articulated only in hushed, embarrassed tones. Once, menstruation was a taboo and we were not supposed to talk about it. Once, cancer was a taboo, and in some communities it still is. Once, mental health was a taboo and people covered it up. We can now discuss those things more openly without embarrassment, we can seek the right medical advice and treatment, and we can offer support to one another and fight for decent healthcare for every aspect of the human body.
How did I get here, in this Chamber, talking about human bodily functions? This has been a journey for me. I spoke in the Westminster Hall debate on women’s health in February. As a physiotherapist, I talked about pelvic health and the importance of rehabilitation and pelvic floor exercises. My words seemed to have struck a chord. Colleagues, residents and professionals all emailed me to thank me for speaking out and to share their experiences. It started to snowball, and I asked myself, “Why aren’t we talking about this more?” I am advised that this is the first ever general debate on this topic in the Chamber, so I congratulate the House.
What are we actually talking about? We are talking about the involuntary loss of faeces and urine, which can be caused by pregnancy, neurological conditions, multiple sclerosis, spinal cord surgery, musculoskeletal conditions, disabilities, menopause, prostrate-related conditions and many more reasons. The crippling fear for patients is that it might happen at work, in public or in social settings. Patients have told me that they feel like a prisoner in their own homes, caught by a condition that means people avoid others, do not go out, cannot go to work, do not have relationships and feel a crushing sense of shame. People’s mental health suffers to the point of serious illness.
Our language reflects society’s attitudes: “wetting your knickers”, “peeing your pants”, or ruder variants that I will not say. Yet we are talking about a range of conditions that affect millions of our residents. Did you know, Madam Deputy Speaker, that bladder and bowel incontinence is more common than hay fever? The NHS estimates that 14 million people live with bladder problems—one in five of the population—and it is men as well as women. The NHS says that 2 million men experience involuntary loss of urine. A third of women live with these conditions right now—that’s right: a third. Yet this is another aspect of health that is woefully unsupported and pushed off the agenda. It affects 1.5 million children and young people. One in 12 children across the UK battle these debilitating symptoms, including bed wetting, chronic constipation and soiling. Half a million adults have bowel conditions that lead to the involuntary loss of faeces.
We have a population that is getting older and surviving complex conditions, such as cancer, and that will increase the prevalence of bladder and bowel dysfunction. When it comes to bowel conditions, we are talking about the involuntary loss of faecal matter, which can be because of irritable bowel syndrome, Crohn’s disease or other conditions, such as bowel cancer. I have not even touched on what people suffer when they are doubly incontinent. Our NHS collects data on anything and everything. The number of patients with continence care needs to be routinely published, and it is not. My first ask of the Minister —and I have several—is, why not?
The House will note—notwithstanding the title of the debate—that I avoid the terms “incontinence” and “continence”. I have spoken to so many people with bladder and bowel conditions, and my feeling is they are the wrong words to use and they carry too much stigma.
To give justice to the debate, I have conducted roundtables with experts and patients and have shared anonymous surveys. Dawn shared her story with me. She noticed some urinary leakage 10 years ago, when she was 50. Now, at the age of 60, she spoke to me about her journey. She did not go to the GP because she felt ashamed. It got worse and she began to see the gynaecologist. She got the strength to speak to the GP, who gave her tablets. Three rounds of tablets did not work. Her symptoms got worse, and she was unable to leave the House. The gynaecologist referred her to a physiotherapist and specialist nurses. I asked what went wrong here: it was the lack of prevention.
Prevention, prevention, prevention is key. Physiotherapy is recommended as an integral part of women’s health, especially with pelvic floor dysfunction. According to the 2019 NHS long-term plan,
“Physiotherapy is by far the most cost-effective intervention for preventing and treating mild to moderate incontinence and prolapse”.
Insufficient physiotherapist numbers mean that women who experience pelvic floor dysfunction or prolapse wait months or years, or miss out on treatment entirely. Women often end up needing surgery that could have been avoided with earlier intervention. Dawn eventually received specialist care, and her symptoms have vastly improved. She only gets the odd leakage here and there. Her advice to others is
“see your GP… don’t leave it and ask for a referral to see a specialist”.
I had the privilege of seeing one such specialist service in my constituency—Dudley adult bladder and bowel service, known as DABBS—where I met patients and practitioners like Ola Rawlins, team lead and clinical pelvic health physiotherapist, who shared her story, which was eye-opening. Patients told me how GPs ask about bowels but seldom bladders. A patient—Leanne—said she felt ignored, fobbed of and misdirected. One felt like a “prisoner”. Ola’s patients felt like a ball bouncing around different parts of the system. Men, especially those with prostate cancer, were reluctant to take part in self-help groups, and many men did not even know they had a pelvic floor and thought only women did.
Yet symptoms can be easily treated with the right interventions, treatments and course of rehabilitation. Research shows that for every £1 spent on women’s health services, there is a return of £13, thanks to a reduction in emergency admissions, fewer missed days at work and better long-term health outcomes. I know the Department of Health and Social Care is consulting on the men’s health strategy, and I trust that the Minister will ensure that this aspect of men’s health is front and centre.
The DABB service calls itself a “Cinderella service”. The testimonies of patients and professionals is humbling to hear, but it makes me so angry. We are letting too many people down. So what must change? We need to talk about the taboo, and we need action. We need a renaissance of public toilets: to maintain the ones we have, open the ones that are closed and build new ones. I want to see bins in both men’s and women’s toilets, so people can throw these products in the bin. I support the Boys Need Bins campaign by Prostate Cancer UK, and I congratulate the all-party parliamentary group for bladder and bowel continence care for its work. I ask that this place be a pioneer in this space by placing bins in all men’s toilets.
We also need better food labelling, so that fibre is listed on products and people can understand how they can get better bowel health. We need to ensure that the AI and robotics revolution in healthcare does not miss bladder and bowel care. We need a joined-up service between GPs, hospitals, clinics and patient groups. Perhaps we could have more sympathetic and subtle signage in healthcare settings. Products provided outside healthcare settings could have simple labels on shelves, such as “body care” instead of “incontinence products”. That tackles the embarrassment of being seen by a friend or neighbour buying them in the shops.
I urge the Minister, as the 10-year plan nears publication, to ensure that bladder and bowel care is included. Much needs to change, but today I have five concrete asks for the Minister. First, we need a public information campaign to raise awareness and smash the stigma, as recommended by Dr Sara Webb of the Royal College of Midwives. The NHS rightly spends millions on campaigns, such as cancer screenings, the use of 111 and sepsis awareness. Will the Minister commit to a campaign on bladder and bowel care?