Episode 40 – Helping and Supporting Baby Boomers Living with Incontinence

Incontinence is often an embarrassing problem that affects many baby boomers. It is the lack of voluntary control over urination and/or defecation. The severity of a person’s incontinence ranges from occasionally leaking urine to having a sudden, strong urge to urinate and you don’t get to a toilet in time. In this Boomsday Prepping episode, Baby Boomers talk about their experiences and struggles with incontinence and how they face it as they age.   

The Boom - Incontinence

Transcript

Wayne Bucklar: You’re listening to Boomsday Prepping, the Baby Boomer podcast, our regular chat with Baby Boomers about being a Baby Boomer. Despite all the things that come with age, including for me difficulty getting my words out, remembering who’s who and getting organized in time, it’s time for us to talk to you. As usual on our panel today, we have Glenn Capelli, Brian Hinselwood, Bron Williams, here’s our host Dr Drew Dwyer.

Dr Drew Dwyer: Hello everybody, welcome. Thank you, I don’t know whether it’s a tough subject today or a horrible subject. It’s a subject I’m quite used to talking about, it’s a subject I talk about regularly, probably more regularly than people would think but we’re talking about the subject matter of incontinence against continence. And basically to get it clear for the Baby Boomer listeners that incontinence is the term that we use for involuntary or accidental loss of urine from the bladder, which is urinary incontinence and bowel motions or feces or opening your bowels accidentally or involuntary which is fecal or bowel incontinence and it’s a widespread condition. It really affects a lot of people at different ages for different reasons, but when we focus that into the aging aspect of it, I’m going to try and quickly clear up and answer any of the panel questions, you might be interested to ask some questions but clear up some of their reasons and rationales or why it takes a prevalence in aging studies and aging environmental issues, aging welfare issues is because it has such a huge impact on the individual human being who lives with it. So it ranges in severity, it can be a small leak. A lot of people notice it when they have a cough, they might have a bit of a leak. A lot of men notice it because they’ll start to get up at night and want to go to the toilet or have an urge to go to the toilet and that’s called urge incontinence. And of course women, it affects immensely because women in the studies that we do and we look at it, women have a very fierce need to control continence and in general and I will generalize here but in general, it is associated to dignity and self-respect but also in many women it’s associated to control of bladder control, of vaginal muscles control of that area of the reproductive organs and the urinary tract because it’s a major concern to women. Women of course, their parts are on the inside if I can say that simply and  men’s parts are on the outside. Women sit down to pee, men stand up to pee. These types of things play a very big sociological and psych-social aspect to men and women when it comes to dealing with the issue and the questions we ask around helping and supporting somebody who does live with incontinence. So people maybe thinking to the question now “Do I have a problem with my bladder or bowels? And I’m not really sure if I should seek help and this is a really private part of my life.” Because of course the toilet is a private area but there’s some very simple questions about continence to ask and it is do you feel you’re not completely emptying  your bladder? Is the first thing, when you go to the toilet have a wee, does your all your wee come out? Do you have to rush to the toilet sometimes because you think you’re not going to make it in time? Are you frequently nervous about it, worry about it? Do you sometimes leak at exercise or sport or walking? Do you have stains in your underwear that you’re noticing more regularly? Do you soil yourself when you perhaps you might break wind or flatulate, fart? And do you plan routines where you always go to the toilet at particular times? These are interesting questions that get stuck in your head as a Baby Boomer because, interestingly enough as a nurse we’d learn so much about our patients through their bowel and their urine. We are able to tell a lot about a human being’s activity of daily living and their homeostasis which is the balance of fluid in the body through examining their toileting issues, their continence or their ability to toilet in the urine and feces or excrement or excretion that comes from the body. So question to the panel first, do you think about this issue? Is that something as you age, you have concern about it? Do other friends talk about it around you? Is it a conversation you’re having? And I’ll start with Brian

Brian Hinselwood: Yeah, okay. Yes of course, it’s at your age it’s something to think about. I think you almost cannot think about it and certainly for me, I go to the toilet far more often than I used to. Yes, sometimes it’s “Oh my god I’ve got to run quickly and get there.” Most often it’s not, but I do make sure or I try to make sure that if I’m going on any sort of a car journey for more than whatever a couple of hours, I have got to make sure I go to the bathroom before we leave rather than sort of stopping somewhere halfway.

Dr Drew: Brian, can I ask is this noticeable for you in your seventies? Now did you notice when it came on to be more of an issue or did it just all of a sudden progress?

Brian: No, it did not all of a sudden progress. It progressed very gradually in fact and it’s probably only the last, I don’t know two years maybe that I’ve started for example getting up during the night to go to the bathroom but no, it’s been a gradual thing and it’s not something that the worries me particularly. It’s just a fact of getting older and and there’s not an awful lot you can do about that. Well there is, but you don’t want the alternative.

Dr Drew: Alright. A female perspective, if we don’t mind. Bron, you’re listening into the conversation sitting there, where do you sit as an older woman and with the issue of continence and incontinence? Of course continence means the ability to use it and incontinence is the lack of or involuntary aspect of it. As a woman do you think about this? Do other women talk about it? Because I know men don’t talk about it as much as they should. But do women talk about it? I do know and feel and something women do share amongst each other.

Bronwyn Williams:  I have to be honest, it’s not part of my conversation with my friends. We discuss out the things which I think we probably find a whole lot more interesting. However, I have had my own issues with it particularly in my early 50s, I had a huge issue with a prolapsed womb and that was causing a whole lot of incontinence issues for me and so I had some pelvic repairs done.

Dr Drew: Very common now and let me say the most common surgery undertaken by women in the last five years and growing is the surgical replacement, the netting, the fixing, the tightening of that area. Very, very, very common for plastic surgeons and utero surgeons to do now and the figures are quite staggering, how many women are getting this done to assist them with the issue of continence and of course prolapse and of course post pregnancy, post childhood, post menopause condition.

Bron: Yeah. And so certainly, that that made a huge difference because prior to that, I couldn’t get out, do anything for more than a very gentle jog and I have issues. So that has made a huge Difference to my life. I had, interestingly, I was thinking about the other day maybe the whole thing of incontinence has been on my mind. I did used to have some issues with urge incontinence, particularly at the end of the day after work and I wouldn’t feel as though my bladder was particularly full but then literally the moment I stepped through the front door, it would be like ‘whoooosshhh!’ If I made the toilet, I was going to be lucky.

Dr Drew: Let me tell you, as a nurse very environmentally driven funnily enough but just for the listeners, urge incontinence is one of the five types of incontinence that we experience in the urine. And it’s a sudden urge or strong need to urinate and you may also hear it as unstable or overactive bladder, but it is an instability in the bladder, generally nerve driven, muscle driven. The detrusor muscles contract very quickly and then of course you have to quickly use the toilet or open your bladder. It means the bladder contracts faster and contracts early even when your bladder is not full, you might have only just had a bit of fluid in your bladder filling it up and all of a sudden, the nerve endings are relaxed or tensed and the bladder contracts and you have to go. So that is urge incontinence and it has really caused from an understanding that it’s linked to things that bring symptoms in the body or stress, caffeine, drugs, personal physical muscle strength, it’s linked to things like stroke, Parkinson’s, age, sclerosis, a lot of things that happen as we get older and get chronic so urge incontinence is probably the most common because as people age, they feel that need to be frequently urinating so that they don’t have an accident.

Bron: It was just an interesting thing because that was just for a particular period of my life when I was living in a particular place and I haven’t had it ever again.

Dr Drew: Alright. So stress for those who are interested though but to listeners but stress incontinence is another one. It’s leaking small amounts of urine generally because the bladder is stressed, the abdomen pushes down and the bladder then it leaks out a bit of urine, comes out of stress incontinence, comes out of coughing, sneezing, bouncing on a trampoline, any sport, riding a horse, things bicycle things like that that cause stress to that lower part of the abdomen put stress on the bladder and of course we then live with stress incontinence. Functional incontinence is a functional of incontinence and threat around the way that the anatomy and physiology of the body works so very functional around the kidneys, the liver and the way the body does its ADME process or the way it filters things through the body. A lot associated to hormones and nerves and of course incontinence associated with chronic retention and that is people who hold on to their bladder all the time and not urinating enough and waiting until they get full, they end up with incontinence associated to chronic retention issues which is very common in people as well. I’ll move to Glenn, your thoughts so far Glenn on the subject matter of continence and aging and do you think about? Is it a conversation you’ve had with many people?

Glenn Capelli: It’s wonderful that it can be so interesting and engrossing this topic. I think there’s a number of things that I’m thankful for in my life that have prepared me for perhaps aging and for future incontinence issues. One is a lot of travel, if you’ve done a lot of Continents and you’ve traveled pretty rough, then you probably have kind of like incontinence moment. So I can remember in Kenya, the stomach upset was amazing. And I traveled with a mate of mine Dave Lawson a guy who’d backpack the world for 14 years and at one stage, David was pooping and vomiting at the same time and in between pooping and vomiting he was laughing. He was just pissing himself laughing, shitting himself laughing.

Dr Drew: So this is where the term comes from, ‘pissing yourself laughing.’

Glenn: And the other thing and I didn’t know I had incontinence but because I spent a lot of years being a runner and a long-distance runner and a marathon runner. It’s amazing how fast some of that final kilometer actually was. You’ve been on the road running and in 20 clicks and and then that last kilometer you suddenly speed up and you’re with clenched buttocks heading for a loo and “Don’t talk to me.”

Dr Drew: Yes, I can imagine.

Glenn: And I want to put this to Brian. A lot of us on this panel, we’re professional speakers, we’re on stage maybe for 90 minutes sometimes in half a day and in breaks, you don’t get a break people come up and talk. And I’m amazed sometimes, I’m on stage, I do what I do, finish and everything’s fine and then once you’ve finished, a minute later you realized how you just have to go to the toilet. Brian, you’re on stage as sometimes in live theater, I mean is that the same for you? What do you do? Do you have a secret hidden bottle?

Brian: It’s the obvious thing for me. I am currently doing a play which finishes this coming weekend. And five minutes before I’m due to go on, I have to go to the bathroom. And it’s been like that for 40 years.

Dr Drew:  So you schedule yourself Brian?

Brian: Well it’s not so much schedule as you so think “Oh I’m now doing ready to go on.Oh my god I’m going to go to the toilet.” So I don’t think there’s an awful lot of scheduling in it.

Dr Drew: So do you think it’s a nerve thing, nervous thing?

Brian: Yeah, very much so but for me it is. So once I come off, I can then go another whatever X hours 16 whatever hours without going to the bathroom.

Dr Drew: The Australian facts that sit around the statistics in this is basically and they’re quite prominent and people don’t realize and I do get surprised that it’s not such a talked-about issue when we do deal with clients or patients as we do call them when we deal with this, it’s quite a  therapeutic approach because it’s quite invasive to a person to be talking about how they wee and poo. But 65% of women and 35% men visit their GP over this issue and urinary incontinence affects up to 20% of men in Australia and 40% of women so it shows you a variance of how this works and 70% of people with urinary leakage do not seek any advice or treatment with the problem. So out of all those people and statistics, 70% of those people are not seeking out help and it becomes a problem but I’ll move across to that to let you know very clearly that the market for adult diapers, as they call them which I think is a revolting term or adult nappies is growing at 60% at the moment and they’re planning on a massive massive industry boom or market share boom as the aging Baby Boomers age and they will require more of these support aides to assist them and I make this comment because you think about if 70% of the people with the issue and not getting treatment or care or help, they’re going to self-diagnose, self-treat through Dr. Google of course and they’ll be running off just to get pads and again we’ll have a discussion soon about management but I just warn everybody that is the wrong way to deal with this subject around your health. When it comes to fecal incontinence, it affects 20% of Australian men and only 12% of Australian women. So men get fecal incontinence more than and women get urinary incontinence more than men. And as I said before, you could hypothesize that’s associated to the anatomy and physiology but really it’s a terrible thought to think that men shit themselves more often than women do. So you can put it into that aspect if you like but the fact is men are more fecally incontinent than women are fecal incontinent. The admittance into residential aged care for the incontinence basis is extremely prevalent for men in fecal incontinence and that is a general concern for when people do admit their elderly males into care. It’s one of the reasons is because of their fecal incontinence issues that need more support because you can imagine if you’ve got grandpa at home and he becomes fecally incontinent, the care level around that gentlemen will raise significantly and not a lot of members in the family are prepared to put up with that type of intimacy and the care. With women, you don’t get it as much although the fear with the women is that they become urinary incontinent and that’s a large fear for women. More than 80% of people in a nursing home in Australia are affected by this issue and of course more probably 50-60% people who are in nursing homes will wet themselves or become incontinent at least through urinary incontinence at some stage in their stay in the home so it’s a very prevalent issue. I’d like as a gerontologist and the panel of course to begin the conversation because we need to understand some basic things around what causes it for people. But more importantly, the importance about how to manage it because as I said if people are just not killing anyone and running off and getting nappies or pads, you can actually be making this process worse. Bron?

Bron:  There’s a little saying that an older male friend gave to me years ago was that ‘Once you turn 60, never waste an erection and never trust a fart.’

Dr Drew: That’s right. I had a gentleman tell me the other day “I’m multi-skilled Doc.” He said “I can cough, sneeze, laugh and piss myself all at the same time.”

Bron: Yeah, look I think it’s good to laugh about these things and I think what we’re doing as much as talking about incontinence, either it doesn’t feel very classy it doesn’t feel like earth-shattering. The reality is it affects all of us and I think it’s helpful if we can sort of bring it out and normalize it there and whether we use humor or whether we use education, just to sort of normalize it say “Actually this happens to everybody.” And it’s actually it’s okay in that sense that you know there’s nothing wrong with you because as you get older you have these issues, it’s part of the aging process and yeah, I agree with you about I think we probably don’t go to the doctor about these things.

Dr Drew: Yeah, very much so.

Bron: Because it’s just normal. Like going to the toilet, like that’s a normal thing that we do and we don’t see, unless we’ve got pain. We don’t sort of think that there actually might be anything wrong more of than the novel stuff.

Dr Drew: I think most human beings will just adjust their activity of daily living around toileting so they’ll find another way to compensate any issue they’re having. And I want listeners to understand in the panel of course too that the conversation needs to be de-stereotyped because it is something we all do. My mum used to say this to me, she comes from a very socio-economic deprived family, very poor family, grew up extremely poor my mum but she will always used to say to me “They all wipe their ass the same way.” She used to say that to me and I’d say “What Mum, what do you mean? She says “They all go to the toilet. We all go to the toilet the same way.” So in her opinion is it’s one factor of being human that we all do the same, whether or not we can have the conversation, whether do you fold or scrunch your paper, but it’s a clear point. We all do it it happens to everybody, we all go to the toilet and it should be something that particularly as we age, we should share the experience or ask each other  whether or not you’re experiencing any changes in the way that you use the bathroom. Now I’m asking that question because it’s something I wanted to discuss but remember something very clearly as human beings, we are taught to toilet. It’s something that’s taught to us when we get up into geriatric atrophy and looking up the very frail and older and sick people, it’s one of the first things that they lose because particularly with memory and dementia and cognitive abilities, it’s one of the things they forget how to do is to use a toilet. So therefore, it’s something that a conversation needs to be had. Your thoughts Glenn?

Glenn:  So much in thinking there Drew. My dad is ringing in my head. Jack, he held on for weeks after he didn’t want to hold on, if he could have ended his life earlier, he would have. But at one stage towards the final times of dad’s life, Jack’s life, the nurse said that they were going to give him some more different drugs and that he wouldn’t come back to consciousness from where he was and she also said that when they give him these drugs, this medication, they’ll put him into a nappy and he’s going to lose control of his functions. And she said “I’m telling you this because it’s going to happen pretty soon and you still may be here and witness it.” And he will, I imagine, if he’s like other people he will actually rally against this. And dad could barely get himself off the bed but when this moment came where obviously his systems were becoming incontinent in a sudden rush, he lifted himself off that bed and the fear in his eyes that he was doing something wrong was amazing.

Dr Drew: Yes. You see this every day as nurses.

Glenn: Yeah. Well she said actually that that’s nowhere near as strong as what some reactions are and so it really, it was an incredible learning for me because yes, we all do come full circle at some stage and as strong as what we are and I do believe these issues need to be, talking about normalization and you’re mentioning humor Bron. One of my favorite jokes is ‘every morning like clockwork at 5:00 a.m. I go to the toilet. The only trouble is I don’t wake up till 6:00.’ Getting the timing right. But I don’t know, something in me that and I did radio for years and on ABC. I used to have a weekly segment called Thinking Caps and every now and again, I touched on topics, I did one about urination and tried to explain that it should be a sport and that men sometimes when we’re urinating, the difficulty is we don’t know whether we’re on stream or spray. We don’t know what nozzle, so it’s difficult but the topic and I did urination, I did farting, the love puff when a man shares his wind, it’s an intimacy. Yeah, but the one that got the most complaint and people ringing the talk and they having fun and it becomes serious but the one that got the most complaint Drew was poo. And I started and just the first few sentences were some words have a good ring to them, poo is one such word – psychologists often talk about people going through an anal stage, my belief is some folks particularly those spoke with a y-chromosome never leave this stage. It’s not just a phase for them , it’s a fascination.

Dr Drew: Yeah. You look at any young boy and I’ve got a young son, he’s 16 and for a long period of time now watch and notice, we’ve all had a laugh and other and women and mothers will comment when you’re in groups, ‘Our boys, everything’s poo and poo and pee and wee and poo.’ And all the men of course chuckle and laugh and the women will shake their head. They just don’t get that chromosome space that says ‘poo and wee and poo is a funny stuff.’

Glenn: I laughed out loud to Pooh Bear. I just thought Pooh Bear was great, not just because of his name.

Dr Drew: It can’t be that bad. We have a poo emoji.

Glenn: It went under some pretty serious stuff but people rang in and were agitated that we were talking about poo. And it’s this thing, I think it is like your mum said, everyone wipes their ass and it’s the great equalizer. It’s the great bottom line if you like. We fart, it doesn’t matter how good-looking we are, no matter how much money we’ve got, that’s what we do and it’s one of those things. By talking about it more, we all do it we all poo it and if by taking some of the stigma away from these things, we may be healthier human beings.

Dr Drew: Brian, you’re looking a bit complex or perplexed there on screen.

Brian:  I’m trying to visualize Glenn and/or anybody else talking about this on radio and the people ringing in to complain or to comment or whatever and it just seems to me that it’s such a relatively simple act. And yes, we all will do it. How do you discuss this in terms of this is what we do? “Well I got this pair of trousers and I undo the top button.” I mean there’s only so much conversation you can have about going to the toilet.

Dr Drew: Well of course we have the Bristol Stool Chart if anybody wants to examine that. Yes, I love it. I love the new one for children, my son has a t-shirt with it on the front. It associates the shapes of poos to bananas and sausages and vomit and things like that but of course as nurses we use a thing called the Bristol stool chart and it identifies whether you’re having a number one, two, three, four, five, six or seven and the consistency of your poo and what it means about your bowel. So of course, it’s a good team of Boomers to have a look at, a Bristol Stool Chart. You can download them off the internet, you can get one from your doctor.

Bron: I’m glad you said a Bristol Stool Chart rather than a bacilli stool chart.

Dr Drew: No it’s a Bristol stool chart, Bristol is a company that researched it and invented it and makes products in it and of course it helps us to identify whether or not we have got healthy bowel motions by looking into the bowl or looking at our bowel outcome and seeing what shape, form and what color it looks like. So it has a big impact on fecal incontinence because we’re able to determine as nurses or people that care for older clients that whether they have high impaction, low impaction, fibre issues, diarrhea, infection, things like that so it’s very important to look at you poo to see what type of poo is coming out of your body. It will tell you lots about your health.

Brian: I don’t know if anybody remembers some years ago now on Australian television, there with one of these health programs where they’re talking about all sorts of problems and I think it was an English Program because there was a Scottish lady on there that took samples of people’s stools, people’s poo and it was wonderful to watch because she had this lovely little Scottish accent “Oh yeah this one’s a bit soft, a bit hard, a bit brown.” And it just went on and on and on and I thought ‘How can one talk about something like poo for this length of time?’ And she was on every week because it was one of those things where they put ‘This is what you eat in a month’ and there’s groaning tables of coca-cola and pizzas and all sorts of crap, sorry no pun intended. She would talk about poo for minutes on end.

Dr Drew: It’s wonderful. You get a group of nurses around a table and having a meal or something, it won’t take long before the conversation moves into the poo zone.

Brian: I think that’s another reason I did not got into nursing.

Dr Drew: That’s because we learned so much about the human beings around their poo so Baby Boomers who are listening and probably cringing at the moment but in actual fact, many people probably thinking ‘What type of who do I have? What do I do?’ I teach my kids very early to look at their poos and tell me what type of who’s or they might go to the toilet and I go ‘Stop, let me have a look.’ And of course working with the elderly, the very much older people in their late eighties, we very much get into the same synch with them and letting me ‘Have a look at your poo so I can tell what type it is so I know on a general basis that you’re travelling along pretty healthily and I can maintain what I’m doing with you.’ But from an incontinence perspective, it’s a conversation as Glenn points out it should be had and it should be talked about, not necessarily over the dinner table but I think it’s important for men because men don’t look under the bonnet as much as they do in their own cars. But men should be having conversations with other men around and they’ll make jokes. I mean you guys are a little bit older than me but I hang around blokes, they’ll make jokes about getting up and peeing in the night or having a leaky bladder or blah blah blah. Now with this, I also warn men, incontinence for urinary comes from the aspect of them maybe having a prostate issue and I know that cancer and women’s cancer breast cancer and so forth is very prevalent in our lives at the moment, advertising and not-for-profits and raising money and so forth. But here’s an interesting fact, more men die of prostate cancer and more men are diagnosed daily of prostate cancer than women are a breast cancer and yet we hear nothing in the news about it. And that’s a really interesting social aspect for me because again, men will not under like this conversation being put on a public table and I would like to see that changed myself. But an enlarged prostate is something all men need to be conscious of after 50 and it’s something you need to have regularly tested every year. It’s a simple blood test and sometimes it’s a simple finger up a bottom and of course a lot of men are very resistant and resilient to going and having that done particularly if you come across a nurse or a doctor like me who has very large hands.

Bron: Can I just interrupt here. Women have their body bits poked, prodded. From the moment that you’re sexually active, women have their body bit prodded and poked at.

Dr Drew: I’m glad I’m a boy, I’ve got to say.

Bron: So guys, just get over it

Brian: Drew, can I just point out that you started off that last a little bit of the conversation talking by a finger up the bottom and ‘They don’t like me because I’ve got big hands.’ I’m thinking ‘Hello, what’s going on here?’

Dr Drew: Well most men in general go “No one’s sticking a finger up my bottom.” And I think ‘Well if you want me to have a little feel around in there and feel your prostate, that’s what I need to do to see if it’s enlarged so I’m going to stick my finger in your rectum.’

Brian: Yeah. Well many years ago, I used to do public talks about prostate cancer for the Queensland Cancer Council and one of the things I mean, they teach you what to say. You’re basically learning a script, you go out and talk to the Lions group or the whoever, different companies. And one of the things that they used to say was that ‘If every man will live long enough, they will all die of prostate cancer.’

Dr Drew: Oh yes, absolutely. Funnily enough Brian, on that comment is in most autopsies, it’s discovered that nearly and I think the figure is, I have to be corrected but it’s over 80% of men when they die have an enlarged prostate. The examiner finds it and says ‘This man had an enlarged prostate.’

Brian: Enlarged does not necessarily mean you’ve got cancer.

Dr Drew: No but what I’m saying is that the very limited examination, understanding and the diving into this space for men it’s quite a controversial subject for men so of course when we look at urinary incontinence, I know from examining and talking and researching my own male clients, when I get to the point of dealing with urinary incontinence and we then find out there’s also associated prostate enlargement or prostate cancer, it’s been going on for some time and they have not been getting it addressed. And I warn all men, the moment you feel anything, the urge, the runny the leaky bladder, anything around there, go and get yourself fully checked out because it is quickly reversible, fixable and whether it’s surgery or whether it’s medication, something’s going to occur but can be addressed quite rapidly if caught early.

Brian: I think the other thing that maybe puts men off Drew and I’m in totally agreement with what you are saying is that I think it’s reasonably common knowledge and I’m assuming it’s right because it’s common knowledge that prostate cancer as such is one of the slowest growing cancers that people can get so it’s kind of if you were 80 years of age or even 70 and you’re diagnosed with prostate cancer, the chances are they’re probably not going to operate. They can certainly do treatment but they’re not going to operate.

Dr Drew: No, they probably won’t, not at that age. The thing is that the person, a human being has to live with incontinence or the signs and symptoms of these conditions. So let’s have a look at diabetes for example, many many people live with diabetes. Diabetes has a massive impact on urinary incontinence because of it of its chronic conditioning to the human body and its impact to the human body so if you’re a diabetic and you probably have no problems at the moment with your bladder, please make it on your checklist with your doctor, that that conversation comes up, that the doctor does routine checks around your aging and actually investigates the connection between your diabetes and your urinary continence. Glenn?

Glenn: I’m thankful I’ve got a couple of friends, men, who have different degrees for cerebral palsy so they’ve lived with the challenge of going to the toilet and hoe you go to the toilet and when it comes on you suddenly for a long period of time and they talk quite openly about it and maybe it’s one of the reasons why I have tried in the public sector and like Brian, to get people to be thinking about these things and talking about these things. But there’s a lovely quick story, for some reason when I was 17, me and my mates of high school, we wrote a song based on, it sounded a lot like The Turtles singing happy together but the chorus of the song went “It’s a great big poo poo poo poo poo” so it was a poo song and we’d sing this song. And a guy by the name of Terry Hardy.

Dr Drew: We’re back here again Brian.

Glenn: So Terry Hardy, a mate of ours, loved this song and whenever we were around he would come up, sing the song to us and get us to join in and we’d sing it on stage and all sorts of stuff. But anyway, I went traveling, Terry moved out of my life, I get back to Australia and I bumped into Terry Hardy and he says “Cap, I saw you in a pub a couple of years ago and I put my hand on your shoulder and I started singing poo-poo-poo-poo and you turned around and it wasn’t you.” He probably has done us service on spreading poo.

Dr Drew: Well there you go. Spreading poo was poo was one of the issues I won’t discuss today, but I want to just spend the last few moments of our podcast today, I want to talk about the management of incontinence because for many Baby Boomers they often when they get to a space to be therapeutically discussing it with people like myself, it’s really about “I’ve just been diagnosed Drew and I’m nervous and I’m anxious.” Or “I’m worried about what’s going to  happen.” And I often reassure them first and foremost, that it’s not a normal part of aging but in some aspects, it’s a normal part of the activity of daily living so the foundations that we look at is working with incontinence, health and promotion of good health around it. So you’ll have to live with this issue whether you get it and can get it surgically fixed is another thing. I always immediately begin with diet on under management and diet and control and understanding yourself, so your emotional intelligence of course has to be enacted and we always advise our patients to think about themselves. To really look at themselves, reflect on themselves and understand how they need to consider changes to life so that they can deal with and manage any form of incontinence that they have been diagnosed with. One of those issues straight and foremost for me is medication, polypharmacy, the overuse of medicines is very big in the elderly and the older people, people over 50. Too many people over 50 taking too many drugs and you need to find your avenue about removing, less is best, change your diets, exercise, all the things we often discuss on this panel, but it’s very important because you would be surprised how you may be in the early stages of or have developed a diagnosis of incontinence of urine per se, but how quickly you can manage it by making small and routine adjustments to your diet, your home life, your work life, your outings and how you do what you do, succession or excessive alcohol and substance abuse, medication use and of course particularly if you are a diabetic, diet. So management is a huge issue and I’m wondering, you can use aids, aids are what they are to help us. I have many males that will move to EuroDome catheters, that is a like a condom sheath that goes over the penis, attached to a tube into a bag. It doesn’t go into the penis and then they can quite happily relieve themselves. It goes into a bag and they empty that bag during the day. Some people opt for surgical and other catheterization. I wouldn’t recommend it if it’s not needed. And with fecal incontinence some people may have to move to surgery to fix nerve endings in the rectum or perhaps go to a colostomy in worst cases and severe cases where they can manage the use of bowel through the colostomy opening in the stomach which empties the bowel into a pouch. That of course dramatically changes the way you live your normal life. So I ask the panel in thinking about management, do you have any questions and what would you think about how ‘Goodness me, how would I manage?’ And we heard Brian before saying he gets nervous and goes to the toilet. But I could tell you scheduled toileting and reflecting on yourself when you go is extremely important because I know my body, as soon as I’ve eaten my peristalsis kicks in, I have to use the toilet nine times out of ten. Once I’ve had a meal, I have to go and have a poo, that’s just my body and it’s been like that since I was a child. So when I’m reporting if I get incontinent, so I have continence issues, I will be reporting to my health professionals my normal daily routines and how I do them. Bron?

Bron: I just think, I’m taking note, like I’ve noticed that particularly my bowel motions have changed as I’ve got older. That different foods impact how my bowel responds in ways they didn’t.

Dr Drew: Diverticulitis is a big issue, particularly for women your age Bran and that’s for everybody listening is the slowing down of peristalsis which builds up in a little like the vacuum cleaner tubes or hoses, have those ripples. Nuts and fiber and things build up inside those little culverts and then they cause irritation, inflammation and bleeding to the bowel. So of course a lot of people notice that all of a sudden, their bowel habits change as they get older. It may be because peristalsis is slowing down.

Bron: Yeah. I could only say for myself, I’ve noticed this probably over the last 15 years since I’ve got sort of got towards midlife, just things changed and they’ve changed slowly, it hasn’t been a quick change whereas as a young person I do a poo once a day, now I probably go three or four times. Do a big one and then a whole lot of little ones. But it’s about knowing that this is my body and this is what it’s changed to and it’s then if something from that then changes like quite dramatically, that’s when I know things are not normal. And for me, that’s an indication that I have to go to the doctor and say “Look, my body is not doing what it used to do and it’s changed pretty quickly and I don’t understand or I’m getting more pain or whatever.” I agree with you about the emotional intelligence and I’ve talked a lot about my mum and she’s just continuing to age more and more rapidly and her body is changing and shutting down and all of those things and that whole thing of watching how she’s not dealing emotionally with her body changes, I’m trying to watch that and go “Okay, I want to be aware. I want that self-awareness.” I’m self aware now and I’m sure that will continue, but how important that self-awareness and the emotional intelligence around our body.

Dr Drew: You have got to get to know yourself as your age because as you age, we cannot prevent I’ll stop the aging process. We can slow it down and ameliorate it as I’ve said, we can soften it but the earlier you begin to do that, the better it is for your body. Glenn?

Glenn: I guess some of the most important data we can keep is of our own self and the shifts and changes of things. Probably because of my running and early years in playing Australian football and taking it very seriously, I actually always kept track of what I ate and then what came out the other end. So in between diarrhea and constipation, we have flow and flow is where we want to be and I guess just paying some attention to how we do what we do. As you say whether it’s colours or whether it’s texture, Brian’s five minutes Scottish woman doing the poo sample, we try to own it sometimes. All our life’s a circle and at some stage we will come back to how we started and the flow of the poo and the wee. My uncle at the moment has got a bag and it’s amazing how he’s become used to it and we do adapt and that’s one of the things as human beings if we flow, we can adapt, we can integrate things into our life. But for me, the finishing thing is the marvelous Google of poo, the rhyme, the chimes our bottomline, the base of you and me, no matter the size of your house, car, mortgage, we have, we are those of goo and wee. We fart, and feel and breathe, no pedestals please. So no matter what we’ve done in life, it’s the great thing that takes the pedestal away and just keeps us pretty grounded. We are people of fluid.

Dr Drew: Well I think as we age, that’s the point. We’ve got to understand what we call ‘homeostasis’ and that is fluid balance in the body. It is one of the biggest issues that has an impact on aging and that is where as we age, we drink less fluid, consume less fluid therefore our body dehydrates faster. So I would like to see all people drinking a minimum of 1,500 mills a day, 2 liters is best, 6 to 8 glasses of water a day. The bladder will hold up to 500 mils of urine in it on a normal basis, 800 mils in a good extended bladder but you’ve got to remember when you’re drinking a lot of fluid you need, to be peeing a lot otherwise you get retentive bladder or retention in the bladder which causes urinary infection in the bladder. So there is a lot, so the more you talk about confidence and incontinence the more we probably start to realize as we age, we have to be focused on it. So 1,500 mills a day minimum for everybody who’s a Baby Boomer and above and you need to push that through your body mainly because the large intestine absorbs fluid very quickly and that’s what hardens up your poo. If it gets too hard, too dry it becomes impacted and won’t come out causing lots of other problems. If you’re not flushing water through your kidneys and through your bladder, you’ll get infections – very common in the older person. And you don’t need those infections because they can lead to sepsis in the body because other organs in the body that rely on your filtering will then get toxic because your body’s not filtering enough. So of course I explained this in my book ‘Ageing in the New Age’ very simply for people to understand, Boomers to understand what your body does naturally is what you have to study and understand. It’s not hard to learn and it’s not hard to manage but good bladder training, keeping a bladder diary if you do have bladder issues and bowel management. Learning when and training your body to actually go when it needs to go. It works, it’ll take a few weeks to get used to but once you’re there, you’re there. Bron?

Bron: It’s just a question that’s coming from Dianne. She said “Is it true that older men get prostate cancer because they’re not sexually active?”

Dr Drew: No. Straight off the bat without looking at the evidence, I would not agree with that as an empirical answer. I would say that it’s not the case that men are not sexually active because I can honestly tell you, men are probably more sexually active as they age than women are because of what we’ve discussed before as we’ve had discussions around sex and sexuality. If Amanda was with us today, she’d be able to answer this very quickly. But men continue to get erections and continue to develop and build sperm right up until death whereas women have the certain amount of eggs. Once they stop, they stop, menopause goes, dryness. Women have a lot more issues around this than men. The prostate cancer is a change in body homeostasis, chemical alkaline of the body so it’s about a chemical process or hormonal process in the body. That’s what it’s more about. As we age and we atrophy our bodies change, the prostate gland is

one of those glands in the body as part of the endocrine system and it’s one of those glands that will change or let’s say present with a sign and symptom quicker than others. It’s unfortunately for men, one of those glands and signs and symptoms that they will ignore.

Glenn: It might actually have been started by some men, this idea that if we’re not sexually active, we might be getting prostate cancer. It’s like “Listen, I’ve got to have some sexual activity or else I’m going to get cancer.”

Dr Drew: Yeah, I’m sure that’s a good avenue.

Brian: I might try that on my wife.

Glenn: I’m not sure if it’s going to work but it’s worth a try.

Dr Drew: I don’t think it’s going to stand up much long before the wife turns around says “You’ve got a hand, masturbate.” So Bron, you can’t. And Dianne listening in on the conversation, I’d say “No, it’s not true because of course we self stimulate, we can masturbate.” If men need to have ejaculation process or sexual stimulation, it can be done in many ways so the fact that they need to have intercourse because intercourse is only a part of sexual activity. It’s more about hormones, chemicals and imbalances in the body that are not homeostasis or balanced so and with men it’s one of those glands like women when you look at their ovaries, it’s one of those glands that needs to be a focus and understood and have regular checks. I get checked regularly. Men are more prone to kidney stones which will also be very quickly connected and have a congruence with prostate issues because these are all around the urinary tract functions or the urinary tract has got a number of organs, a number of tubes, a number of different functions it plays. Once we start to have problems here, of course this is the filtering system of the body for the excretion component and it plays a significant role. All the organs in that area play a particular role and we’ve got to manage them and watch them and know what they are.

Brian: Well I have to say Drew, listening to you I have learned quite a bit. I think I’ve actually been very lucky because up until probably a couple of years ago, I would go to the toilet to do a poo almost like clockwork. You can almost set your watch by it. I still just go, by and large I go once a day but it’s not like clockwork anymore. It can be at any time during the day so I think I’m being in fact very lucky to have last this long as I have with the regularity that I have but I really don’t drink anywhere near that much water and I’m assuming you’re talking about water.

Dr Drew: Just water, yeah.

Brian:  And I have cut down on teeth because I find if I have a cup of tea say at nine o’clock at night or something then I’m up three hours later. Tea and coffee apparently are notoriously bad for making people go to the toilet.

Dr Drew: Yeah, that’s right and they also dehydrate you. But in the essence of understanding that for many people listening it’s to understand as again yourselves and what your normal routines are and how they’re changing. But in the end, if you could get a litre of water into yourselves a day would be great because you’ll pick up 500 mills out of food, out of drink, out of coffee, out of milk, out of the fluid that exists with inside food. But let’s look at the bowel specifically, we eat food it goes to the stomach the stomach does a process. It goes down into the small intestine which is a couple of kilometres long per se, I’m joking, but it’s very long and small, it has a particular function of the villi and those stomach tubes do a particularly thing, absorb things out of your food and your bowels then it enters the large intestine where we have an ascending colon goes up, a transcending colon across the middle of your stomach and a descending colon down. As food transfers through there, water is taken in, water is taken out, the last bit of nutrients from your food is used and absorbed and of course other things are  placed back in as waste which develops your poo and the fact is most of these issues sit down in the rectum which is the pouch inside your bum which holds a certain amount of poo and then once that’s rectum becomes full, nerve endings are triggered, the bottom of the rectum opens up and it empties a certain amount of poo. And a lot of the problems around incontinence is that area, it’s right near the rectum, it’s a little pouch that sits inside your bum that hold a certain amount of poo that when it’s filled, it then releases and that’s where a lot of issues are in either the rectum itself which is your bum hole or the little valve, the next valve up into the descending colon which allows for the bowel to move into the rectum, it might be a nerve ending in there that needs adjustment. For many people, these can be quickly surgically fixed. Dor some people, they can’t. Of course for our LGBTI people listening and particularly our gay men listening in the way that they conduct themselves in their sexual activities, they will probably experience other issues as much as other people who do use the anus as a sexual form of sexual intercourse but at the end of the day it’s about what you’re doing, how you’ve been, the nerve endings, the chemicals, the fluid balance, it’s a whole system that is moves through the body. We must know our system because that system is what from the time we put food in to the time it comes out the other end, from the time we put water in and it comes out the other end, your body is using that substance, cleaning that substance and then eliminating them. It’s called ADME – absorption, distribution, metabolism and excretion – as I said, it’s in my book. People can go read it and study it on Google. It’s a fascinating easy bit of science to understand and once you do understand it, you start to control your body a little differently particularly as you get older. Sugar is the biggest killer on the planet if you ask me. I eat far too much of it myself, but sugar will kill you as you age, so watch the sugar. And always anybody, CAM therapy – complimentary alternative medicines – are really good for managing this type of issue in your body. Glenn?

Glenn: I love the fact that when I was at high school I actually did human biology study human bio and I had a fascinating teacher Miss Shepard and yet others who studied human bio, somehow it was really boring to them. It should never be boring we should all be students of human biology, we should love it. When we understand human biology we understand systems and systems thinking and we understand that we should love words like ‘endocrine.’ So it’s a joy to hear you speak about it Drew in such a way that is captivating and that’s what we should be. We should all become captivated students of our own bodies and their systems and part of that is to understand how we poo and wee or how we don’t poo and wee or how we sometimes may lose restraint over our poo and wee.

Dr Drew: And my final comment on it is ‘don’t panic.’ If you start to experience any form of incontinence or continence issues, race yourself off to your GP, find yourself a good continence link nurse, there are many of them and let them therapeutically guide you. These are expert nurses our deal specifically with this issue. They will teach you everything you need to know, set up your planning, guide you through exercises and strengthening and the use of aids and services that we use to assist and support people who live with incontinence. It’s not that bad, it can be reversible and managed. It’s up to you to identify and pick up on it and it’s also up to you to prevent it so don’t have a fear over incontinence.

Wayne:  You’ve been listening to Boomsday Prepping, the Baby Boomer show. We’ve been talking to our panel Brian Hinselwood, Bron Williams, Glenn Capelli and out co-host Dr Drew Dwyer. My name is Wayne Bucklar, this is Boomsday Prepping, the Baby Boomer podcast.

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