Challenges and risks

Let's look at some specific challenges you might encounter and the risks they pose... 

1. Infections...

Smelly urine can be a sign that something is wrong.

If there are other symptoms alongside the smell, for example, a burning sensation or needing to go more regularly than normal, it could be due to something like an infection, kidney stones or a sexually transmitted disease (STI). Many cases of acute urinary incontinence are caused by urine infections which can be avoided by better hydration.

If urine smells abnormally sweet (and it is not a one-off or due to eating something that makes urine smell), it could be due to being thirstier than normal or feeling tired. However, it could also be due to dehydration or diabetes. The NHS recommend that you do not self-diagnose and the individual should see a doctor.

2. Urinary catheters...

Catheters are flexible tubes used to empty the bladder and collect urine in a drainage bag. 

They are often associated with infections because bacteria can enter the body. This can lead to a hospital admission and even death if not correctly treated. People living with a long term catheter can find them distressing, uncomfortable and undignified. Although for some people, they can provide independence and prevent kidney damage.

Catheters should be:

Catheters should not stop people from living a normal life.

People can still exercise, swim, go to work, take holidays and have sex. Individuals will need to learn how to remove and replace the catheter, particularly to have sex. If you are required to change catheters as part of your role, you will need to be shown this and have your competence checked. 

Medical advice should be sought if any of the following happen:

3. Stoma...

A stoma is an opening in the abdomen

It can be connected to the digestive or urinary system to allow urine or faeces to be diverted out of the body. These are some of the challenges that people might sometimes experience with a stoma:

4. Diarrhoea... 

If staying at home is not an option for the individual...

...a pharmacist will be able to help with over-the-counter medication to stop the diarrhoea and also with oral rehydration sachets. Ensure the individual washes their hands with soap and water frequently. Wash any clothing and bedding that is soiled. Take extra care to clean toilet seats, handles, taps, surfaces and door handles every day.

If you are suffering from diarrhoea, you should not go to work to prevent infecting other people. You will need to check your employer's policy for when you can return to work. If no policy exists, you would normally need to wait until at least 48 hours after the last episode of diarrhoea before returning to work, providing you feel well enough.

5. Constipation... 

The International Longevity Centre-UK report looks at the burden of constipation in the ageing population. It states that for older adults in the community and in care settings, the risk of developing constipation may be increased by the following: 

Muscular weakness

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Muscular weakness can limit general movement and the possibility of physical exercise.

Mobility challenges

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Less mobile patients who experience a loss of sensation, or those who ignore the signal to empty their bowels to avoid inconveniencing a carer or because the toilets are inaccessible. 

In care settings, they may be offered a bed pan or commode and be unable to empty their bowels due to poor positioning or lack of privacy.

Diet

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Changes in diet, including a reduction in fluid and fibre intake for fear of incontinence.

Difficulty swallowing

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Which can result in requirement for modified consistency diets. This can restrict consumption of adequate fibre and fluids.

Poor dentition

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This is about the condition of a person's teeth which can impact on dietary intake, including fibre-containing foods. 

Limited assistance

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Limited care assistance available at mealtimes for dependent individuals, to ensure appropriate diet and fluid provision.

Medication

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Development of co-morbid medical conditions and resulting poly-pharmacy (multiple medications) including, in particular, analgesics and psychotropic drugs.

Using a number of medicines that induce constipation, including antacids, calcium and iron supplements, as well as radiotherapy and opioid pain relief for cancer treatment.

Mental health

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 Such as depression, anxiety, dementia and cognitive impairment.

Socio-environmental factors

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Including hospitalisation and institutionalisation.