Children’s Bladder and Bowel Nursing Team

Who are we

We are a team of registered nurses with specialist knowledge to support and advise children and young people with ongoing bladder and bowel difficulties, if first line intervention is unsuccessful. We are supported by our administrative team. 

We see children who suffer from chronic constipation, soiling difficulties, and day time wetting. Or those with more complex bladder and bowel conditions such as neuropathic bladder or bowel under a paediatrician or tertiary hospital for local support.

We offer a service in Ashford, Canterbury and Coastal, South Kent Coast, Thanet and Swale.

Our aim is it to help children/young people and their families to become confident in managing their bladder and bowel difficulties independently.

What we do

We seek to promote healthy bladders and bowels by providing assessment, education and suggest appropriate interventions and advice for children and young people with bladder and/or bowel difficulties.

Following an initial assessment, we agree a treatment plan with the family and young person for them to work on at home and school and when they will be reviewed. The initial assessment and subsequent reviews will be either phone contacts or seen face to face in clinic. All children will be offered at least one face to face appointment in clinic.

We encourage you to contact us between appointments if you have any concern or queries about the plan, or medication, for the duration of the package of care.

You and your child will be expected to follow the plan at home/school/college and to complete any charts that you may be given to record progress and success. Engagement from the child/young person and family and the ability to apply the interventions advised are crucial to the success of the treatment plan.

We offer a six-month (five contact) package of care. Once a treatment plan is established you will be discharged back to your GP or added onto our dormant case load to continue with the plans independently with your child.

The dormant case load means that you can contact us for advice or further appointments if needed within a period of six months, if no contact during this period you will be discharged.

If there is no improvement for at least six months of working on the plan after discharge they can be rereferred.

As part of the assessment the nurse may perform/request

• Urinalysis
  This is where we test the child’s urine to make sure there are no problems that might be causing the bladder problems such as infection or diabetes.
• Bladder scan
  This is an ultrasound scan of the bladder to make sure that it is emptying properly. It is useful if they have a good drink before the appointment.
• Bladder diary
  This is important to assess how much the child is drinking, how often they pass urine and to get an accurate measure of how much their bladder can hold, which can help the nurse advise the most appropriate treatment plan. Please fill this out before the appointment and bring it with you, or you can email it to the team. It is suggested you complete at least two to three days to get the most accurate information.  This will need to be completed at home.

Tip: Buy a plastic measuring jug and encourage the child to urinate into this. Record this on the diary. Also measure their favourite cup or drinks bottle, then you won’t have to keep measuring drinks

• Bowel diary

This needs to be completed at home but any stools passed at school will need to be added to it when at home. This needs to be completed for at least a two week period to assess the child’s normal bowel pattern.

Tip: If child unable to say if bowels were opened at school, request a home school contact book, especially if school staff are performing personal care.

• Abdominal examination
  This is feeling the abdomen to assess for constipation.

• Request the child attends a bladder assessment day
  Information leaflet available on website

• Attend a different clinic for an ultrasound of the rectum
  Provided by the nurses. Usually used to assess if any soiling is due to constipation if not responding to treatment

How do you use this service

We accept referrals from health care professionals for children and young people who have a registered GP in Ashford, South Kent Coast, Thanet, Canterbury and Coastal and Swale.
For children two years and over with Constipation and or soiling difficulties

Children five years and over with day time wetting.

Birth onwards if under a paediatrician/tertiary care for local support.

We do not accept referrals for toilet training, bed wetting alone or behavioural management around toileting eg children refusing to sit on the toilet unless they have underlying constipation.

All children will need an initial assessment and intervention from a tier one service. This can be:

• Their GP to exclude and/or treat constipation and exclude/treat urine infections or other medical reasons.
• The healthy child programme, comprising of Health Visitors and School Nurses, who offer early intervention information and advice to help promote healthy bladders and bowels. This can reduce the risk of longer-term problems such as ongoing constipation and wetting.
• The parents and child will be offered a package of care and they will then need to work on the advice given following completion and discharge. Following this if the continence issues remain with no improvement made for three months for bowels - six months for bladders; a referral can then be made to CBBNT.

Related services

• Childrens Continence Product Service
• Health Visiting Service
• School Health (Kent)