Incontinence

Jodie Gosling Excerpts

Thursday 19th June 2025 Commons Chamber

[Jodie Gosling (Nuneaton) (Lab)]

I congratulate my hon. Friend the Member for Dudley (Sonia Kumar) on securing today’s important debate. I have recently become the chair of the APPG for bladder and bowel continence care, and there is much to be done. As someone with a background in early years, I am sure that any parent of a young child will confirm that we are probably the people who talk about wee and poo the most in this world. They tell us vital health information—from the earliest days of having a baby, it is crucial. Bladder function is one of the signs of good health, and maintaining that through adulthood leads to the prevention of incontinence.

The importance of talking about wee and poo cannot be overstated. As any three-year-old will tell you, that is because it is funny. Wee and poo is the funniest topic in nursery classrooms up and down the country—and it is funny, right up until the point that it is not. When wee and poo stop being funny, it is devastating. It impacts on people’s mental and physical health, their dignity and their very independence. In some cases, it can prove fatal. It is also entirely preventable.

Sadly, poo and wee is not funny for around 14 million people who have continence and incontinence issues. That figure alone hides some of the issues of dealing with the enormous range of health conditions in the field of continence. The figure of 14 million is based on data gathered in 2018, and no recent data is available. Continence status data is not recorded as standard on entering the NHS. The scale of the problem is simply unquantifiable. The NICE guidelines have not been reviewed, and the findings of the 2017 report “Excellence in Continence Care” have not been fully implemented. We need a stronger mandate and a greater focus on training for incontinence needs across midwifery, dementia, cancer care and health visiting teams—literally from cradle to grave—and we need to provide that care in our communities to avoid the need for crisis interventions in A&E.

Today, I will highlight just a couple of the complications from failing to provide a robust continence service. Despite spending a large amount of my time surrounded by, and occasionally covered in, poo and wee, I did not arrive in Parliament intending to take on this role. I have been made aware for many years of the woeful lack of help for those with continence issues, the poverty caused by buying continence products, and the rationing of four pads a day. I have faced the frustration of parents who had no continence service in Warwickshire at all until May 2024. I have been aware of the trauma faced by parents, especially those whose children have special educational needs and disabilities, attending A&E with their child’s constipation, which had reached agonising and dangerous levels.

It was, however, Elissa and Ivan’s story that motivated me to take on my role, and campaign for more humane, systemic changes to prevent the worst impact of continence issues. So many simple things can be done to protect the dignity and independence, and improve the quality of life, of these 14 million people. When Ivan arrived at A&E, he was screaming and in pain. His stomach was distended and he was severely underweight for his age. He had spent months in pain, attending A&E around four times a week. He was discharged without treatment, but Elissa did not leave. She did not accept the shocking assessment from consultants that disabled children just scream. She pushed back and, with sheer luck, one of Ivan’s other consultants happened to see them and gave instructions for an X-ray. On the final day, they evacuated nearly 2 kg of stool from a 10 kg three-year-old child.

Elissa believes that that day saved Ivan’s life. Others have not been so lucky. In 2019, 19 people with learning difficulties died from constipation when under continence care. Out of all the deaths of people with learning difficulties, more than a quarter were also suffering from constipation and bowel issues that would be worthy of note. Unsurprisingly, we do not even hold the data for the wider population on these issues.

Continence and constipation issues are increasing in our younger population at a worrying rate, with a strong correlation between constipation, continence issues and neurodiversity. One in four of our children who start school is not yet ready to use a toilet independently, and on average, 2.4 hours of learning time is lost every day in supporting children going to the toilet. Toileting issues, even in nursery, cause embarrassment and anxiety, which often leads to functional constipation, damaging the bowel and causing lifelong continence issues.

Getting it right from the start is hugely important. Children with continence issues are often excluded from school activities and parents are required to take time off work. Consequently, ERIC, a charity that specialises in supporting children with continence issues, whose representatives are, coincidentally, here today to celebrate and draw attention to World Continence Week, note that in the 1980s, 83% of babies were out of nappies by 18 months. New research identifies the benefits of children who start potty training earlier and are out of nappies by 30 months, but the health visiting team numbers are at a disgraceful all-time low. That is a national shame, as are the outdated NICE guidelines.

The message is not getting through, and parents simply do not know where to turn for the right support, especially in places like Warwickshire where continence care was simply unavailable. Hospital admissions for childhood continence issues and constipation have increased by 60% in over a decade, with 44,000 children admitted this year alone. The decimation of health visitor numbers and school nurses, and the demolition of institutions such as Sure Start, leave carers and families without the infrastructure and support needed to train children to toilet independently, and for constipation to be recognised before it becomes life-threatening.

Increased data collection is essential, and the NICE guidelines need to be heavily reviewed and mandated in healthcare so that we can make savings in crisis teams. If we intend to move care to the community, and move from crisis to prevention, continence care has to be a central focus of that mission.