Plumbing the depths of continence with Sheena Lagat

Michele Ong

We have to get past this stigma over talking about wee, poo, and other toileting activities. It's something that we do every day, and if you're not, you really should be speaking to someone about that. Because continence is something we should all be proactive about, regardless of age or gender.

Sheena Lagat is a wee wee nurse, specifically a continence and urogynecology clinical nurse consultant. Join us as we speak to Sheena about her journey to continence in urology nursing, why we should care more about our plumbing, and the personal, economic, and environmental impact of incontinence.

I'm Michele Ong, and this is STEAM Powered.

Welcome to STEAM Powered, Sheena, I'm really looking forward to speaking with you about your journey today. And today we'll be talking about urology and incontinence nursing and all the cool stuff – well, cool for us, but maybe not for everyone else, just yet – about your career and what that involves.

So we'll just go straight to the beginning and talk about what led you to the field of nursing.

When your family hosts an intervention about your choice of career.

Sheena Lagat

Firstly, thanks Michele for inviting me and for the opportunity to be on your podcast.

So how did I get into nursing? It wasn't by choice, even though my mum is a nurse, she gave us the free will to make the decision to choose whatever profession me and my sister wanted to pursue. I initially started doing my Bachelor of Science, but then my uncles actually did an intervention.

One day, I came home university, and I found three of my uncles' cars parked in the driveway. We didn't have any family gathering that I knew of, and I thought oh, something was wrong because even mum and my sister weren't home.

When I walked in, my uncles were in the living room and they're like, Oh, we need to have a chat with you. And I'm like, did I do anything wrong? And they're like, no, we just wanted to talk about your career. And I've just started in my first year of Bachelor of Science. And, one of my uncles said, we don't think you've chosen the right career. Because he actually teaches in a university in the science area and he said that unless I was really passionate about being in a lab environment, then maybe.

But he said, you talk too much. So I think, we think that you should consider nursing. And it's a joke, like, you know, a lot of Filipinos, that's my background, pursue nursing as a specialty. So they're like, Oh, maybe you should consider nursing. Um, I said, Oh, I don't think I can. They said, Oh, you'll be able to credit your science subjects, so just try it and if it doesn't work, at least we've tried.

Now, the reason why I didn't want to pursue nursing is where I- I lost my dad to colorectal cancer when I was 12. And the thought of being in that hospital environment, I didn't think I would manage emotionally. And I just couldn't see myself as a nurse.

But I followed their suggestion anyway, and the transition was actually natural. I think I just tried to remember what it felt like to be on the other side, and it was weird because I actually worked alongside the nurses that looked after my dad. My first hospital placement was in the same hospital where my dad passed away.

So I was really anxious. I said, Oh, this is, I can't do this. I was sweating. I wanted to back out from the clinical placement, but my mum just said, Just remember what you felt when you saw a good nurse versus a bad nurse and you obviously want to look after the person the way you want to be treated.

The transition to urology nursing.

Sheena Lagat

So I just went with that mentality and I survived and then I finished and then I'm here 17 years later, but not realising that I was going to pursue to become a wee wee nurse. I initially thought that I was going to pursue cardiac nursing because that's where most of my placements were, but something clicked in my new grad year when I was in the urology ward.

I didn't know much about it when I was doing my Bachelor of Nursing, I thought it was just all emptying that dreaded catheter bag, the task that most nurses dread. But when I started to understand more about the surgical procedures and how it relates to the bladder function, I became intrigued and when I did my placement in the community as well, I realised how much of a Cinderella subject it is and I tend to vouch for underdog stuff and urology and continence nursing is one of them.

So I said, I'm just one person, but if I could make a difference in patients' and the carers' lives, this is something that I want to do. And I haven't looked back since.

Michele Ong

That's an amazing journey. And especially because your family just took such a proactive approach in trying to guide your career path, like, that's super intense.

Sheena Lagat

I know, I know. At first you're like, okay, did I do something wrong? So a lot of things were happening, were running in my mind, but when they finally managed to address what they wanted to speak about, I was like, okay, it's not too bad. I'll try it.

How experiences and perspectives support different ways to care in healthcare.

Sheena Lagat

Yeah. So when you did that placement where it was in the same place where your dad was being cared for, did you tell the people ahead of time that that was going to be a problem or you just kind of kept it to yourself and hoped for the best?

I just kept it to myself. Uh, they recognised who I was and the ones who I considered as the good nurse who provided that palliative care, dignified care. They're like, we,we were hoping to ask you what you were planning to do when you grow up and it's good to see you and we're glad that you've chosen nursing as a specialty because we need nursing staff who has that experience because they provide a different kind of perspective and a different way of caring as well. And nursing is,is an art of science and care.

So it's a striking a balance of both. But I think if you have the experience of losing a family either to cancer or having medical conditions, you just have a different appreciation for life and how-

Michele Ong

How people want be cared for when they're in those sorts of situations.

Sheena Lagat

Exactly. Yeah. You see how fragile life is as well as their vulnerability as well. So similar to a hotel, you know, you try to be hospitable. I think we have that opportunity as a healthcare professional, because people are coming in through the doors, whether it's from emergency, whether it's elective, regardless of that circumstance or the situation, no one wants to be on a bed, not knowing what's going to happen because nobody has that crystal ball.

But if you know that someone is there to look after you, that they anticipate your need before you even say something. Like a lot of things can be, um, communicated just by facial expressions without them having to press the buzzer.

We do have the clinical calling system for medical review, but I think before you even activate that call, you should know your patient's baseline so that you can detect that smallest change and intervene or even flag it with a team before it gets to the point. Okay. We're hitting this arrest button because sometimes that arrest button may mean that it's going to change their outcome.

Michele Ong

And that's a stressful situation as well. So even if before that button is hit it's stressful, and having someone you know is there to provide compassionate care, and looking out for you, medically as well as, you know, psychologically as well, you're getting that emotional support even before it gets to a situation where you are considering alternate outcomes.

Sheena Lagat

That's right. And we are as humans as the patients we look after, so you want to be treated the way you want to be treated.

Michele Ong

Yeah. Absolutely. It's such an important part of healthcare that I think people do underrate wrongly.

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The need for advocacy in certain areas of healthcare.

Michele Ong

So when you started moving towards urology and incontinence, where did you see yourself as a nurse specialising in this area?

Sheena Lagat

I didn't want to have the title for the status quo. It's not about specialising just so that you can have those credential. I think it was more of advocating that continence nursing has a part in all of the other specialties. Some people think of us as like a plumber's assistant for the human body because we don't do surgeries, um, there's a urologist for that, or you're a gynecologist in terms of women's health. But for me, instead of viewing my role as fixing leaky pipes, tackling, you know, the, the wee wee woes and ensuring that the plumbing is running smoothly, I see myself as being more of a patient advocate as well as, providing an innovative perspective to bridge key stakeholders and just humanising the problem as well, because we all have to fight for budgets, funding, in order to run a service. And unless you advocate and provide a voice to the problem, they won't know that this is an issue. And continence is one of those specialties that requires advocacy, a nursing voice.

Michele Ong

Absolutely. And, you know, I love that you have in your headline, Wee Wee Nurse, because it's straightforward, it's to the point. It does simplify what you do, but it is the kind of tag that will prompt the curious to ask you more questions, because there's so many stereotypes around urology and continence and incontinence, as we briefly spoke about before, and the distinction as to what that is.

The stereotypes and stigma around urology and continence care.

Michele Ong

So, what are the stereotypes that you've encountered around this area of care? We've already heard a little bit about how it's just about the plumbing.

Sheena Lagat

Well, I was inspired to introduce myself as a wee wee nurse, mainly to simplify my role. When I speak to patients, when you introduce yourself, when you say urology, they may not pick that up. They may think it's neuro, neurology. So when I explained it, I deal more with the bottom part area. It triggers that, Oh yes, I do understand where you're coming from.

And you use humour as well to break the ice, because nobody would just open up about their bladder and bowel issues or sexual issues to you unless you have an icebreaker. And I think it's up to me as the clinician to provide that safe environment for the patients or their carers so that they open up and they give that trust and that rapport when we establish that therapeutic relationship.

Michele Ong

Yeah, and it's a difficult one as well because we have stigmatised in society all the stuff to do with the plumbing. And I mean, we still use euphemisms and other terms to work around, you know, going to the, like, number ones, number twos, and kind of masking what is a natural bodily function that, yes, we do in private, but that we shouldn't be afraid to discuss because it is about our health and it is about the way that we can advocate for our own care and if we can't be comfortable talking about our wee issues and our gynecological problems, we can't expect to get an adequate standard of care back.

Sheena Lagat

And it's a private issue as well. We go to the toilet individually. We flush it. We don't look, as well. We just want to go in and get out. So, and there's also that debunking the myth, I should say, that it's part of aging.

There's an assumption that it should just be accepted. There's no services around as well, so I'll just accept it as the way it is, but no, you shouldn't because it's abnormal.

And there are support services available. We do exist and we just need to make sure that we intervene as early as possible, and this goes with my fellow colleagues who may be listening, timely referrals is very important in order to achieve a great outcome for the patient and their carer as well.

Michele Ong

Yeah, absolutely. And there's so many things that come up, especially in this space, where you find out about it by accident, or you're only told about it because the person you spoke to happens by accident to know about it.

Sheena Lagat

Yeah.

Michele Ong

So, you almost stumble into care, but there's no direct path to it and even from personal experience, I haven't got continence issues, but I have had to see people about pelvic health issues and all the information that I seem to learn was in passing or just happened to have heard about it and that happened to get passed on to me.

But when I shared it with other people I knew who had experienced this in my friends groups, a lot of them would say, Oh, I didn't know that was a thing. I didn't know you this. I didn't know that there was care that you could receive that was not hospital specific around preventative or proactive care for your health in this way. And yeah, it's become another thing where it's like, it's so frustrating because you don't know what you don't know.

Sheena Lagat

Exactly. And it's a bit of a double edged sword having social media and the worldwide web at our fingertips. The information is there, but it's knowing whether those are reputable resources, and with AI now in healthcare and also at people's disposal, there's actually research studies on how patients are using ChatGPT to provide them with the information rather than seeking professional advice.

It's quite scary. So watch that space.

Michele Ong

It is quite scary, but it also depends on the type of person because, you know, I am actually for AI, depending on how you use and whether you know what you're doing with it. Because, you know, AI can give you tools to say, Oh, so this thing I didn't know about exists. Let's find out more. And then you approach the appropriate channels for that. But you can't just take it all at face value.

Don't limit your healthcare by thinking "I'm just getting old".

Michele Ong

And you also mentioned about how people treat incontinence and continence as, Oh, I'm just getting old. I'm just gonna have to deal with it at this point.

And there's so many issues that we treat that way. It's like, Oh, it's just a matter of aging. Or, I've had kids. Or, you know, I just have to expect this. Without realising that a lot of this can be corrected or fixed.

The state of preventative and rehabilitative treatment.

Michele Ong

So, what sort of things as part of the work that you do in urology nursing isn't just about the output, but about the preventative and proactive stuff?

Sheena Lagat

So, I'm not sure whether I've mentioned that my role is not just about pads, nappies, also catheters. There's also innovative technology that we can use to help. revive or to support continence care, for example, neuromodulation.

A lot of people, when you ask them, so how does the bladder work?

They forget that you need the brain, spinal cord, the nerve pathways running through that spinal cord, in particular, the S2 and S3, which are the sacral nerves that innervates the bladder, the bowel area, because if you don't have that intact communication that's when things can go wrong. You either can be incontinent of bladder or bowel or even both.

So in those cases, when you remove those nerves or those nerves become damaged, then it's a permanent issue. It's a debilitating problem. But if none of those are affected, then there's a chance for patients to trial or even look into neuromodulation, which basically it's like bladder acupuncture.

We use an electrode needle, place it around a tibial nerve and it's a treatment provided by Medicare, funded by Medicare. It's a 30 minute session. There's three phases. Phase one, 12 weeks, weekly sessions for 30 minutes, then phase two, five session in three months, and then monthly maintenance if it works. That's a less invasive procedure.

There's the much more invasive procedure that's implanted by, obviously a surgeon, a consultant, and it basically works the same way as a heart pacemaker. But yeah, we just help revive those nerve communications to allow the patient to improve their sense of awareness to pee or to poo and or to do both.

Personal training for your pelvic area.

Sheena Lagat

In terms of other things, we also do pelvic floor training, there are gadgets that will help assist us to provide that biofeedback for the patient. We can teach the patients to do it at home. So we're there sort of like a coach. Here's how you're going to use the machine. We're also the cheerleaders on the side to make sure that they're compliant with the care plan, because you can't just say, here's a sheet of paper with the instructions, figure it out.

With bladder and bowel training, I think most people who have gone through some issue, will include Patience as their middle name. Because it's not just gonna sort itself out after a couple of sessions. You need patience and determination to get you to that long term outcome and to also make sure that we're not just reversing it for the here and now, but also for the future and they have a better appreciation of their pelvic floor, bladder and bowels, and how it relates to their overall function, their general health and wellbeing. Once they understand the anatomy as well as the physiological side of things, 'cause you don't know howthings are broken, unless you understand the structure of it from the very beginning.

So I think it's very important to know continence versus incontinence and the surrounding organs and the systems that works together in collaboration to make the system work more efficiently.

Michele Ong

Yeah. Because all the work that you've described, it's basically personal training in a different set of muscles. You're having to learn how that feels and what the correct feeling of that muscle is when you use it or you contract it or you relax it. And all of that, some people are more attuned their body in that way, and they're able to recognise these signals a lot more easily.

But for other people, or if people haven't known what the correct feel of that is, it takes time to get reattuned and to understand what your body should feel like under certain circumstances. So yeah, it's a lot of work, and you guys are basically the trainers, as you said.

Sheena Lagat

Yeah. And people don't look when they flush as well. I tell my patients that speaks volumes. The colour of your urine, what your poo looks like. It's a reflection of your general health and well-being. So you need to know before you flush because a concentrated urine, something that's more darker in colour can signify dehydration, for example.

And some people may get migraines or headaches because of that dehydration. And when you have dehydration, usually the back passage also is playing up. Because they're constipated because they don't have enough water. So people need to understand that the bladder and the bowel are neighbours and in order to be in a happy medium, you need to also work on healthy bladder and bowel habits.

If one is playing up, usually it interferes with the other as well.

Michele Ong

And it's all indicators about, you know, What goes in, does come out.

So yeah it's a clear visual indicator for you, even if you don't know the science behind it. You can tell when things aren't right, or when things are not running the way they normally are.

Sheena Lagat

Yes, yes.

Michele Ong

Super important. And I think, you know, a bunch of people really underestimate how important it is to be able to understand these things, because we're taught to be fearful of talking about it or observing it or it's dirty and we don't want to be able to get to know it better when we really should. ​

The economic and environmental impact of continence and incontinence.

Michele Ong

So you've mentioned briefly that it has a lot of impact not just for the individual but that it has economic and environmental impact to care about continence and incontinence. So I'd love to hear more about what you mean by that.

Sheena Lagat

Recently, the Continence Foundation of Australia, which is the national peak body, that promotes continence awareness on a multidisciplinary level, they have released their economic report, and astoundingly, incontinence alone in Australia is, um, predicted to top 100 billion and affect about 34.1 percent of the population nationally within 2032. Contributing to that cost is the use of absorbent hygiene products, aka nappies, pads. These are considered as waste and they have a carbon footprint. So, if we look at the market, in terms of the nappy market, they're doing very well because we have a lot of incontinent patients out there.

They may look normal from the outside because that's also the misconception. You have to be disabled. You have to be elderly. You need to be the postpartum lady who's just recovering after multiple childbirth. But as we know, one in three women who ever had a baby is expected to wet themselves. So it's not just that postpartum lady who's had multiple childbirth.

It can be that first pregnancy or first childbirth delivery. So we just don't know what the outcome is going to be. And we can't put a face to incontinence, because it can be multifactorial it can be different nationalities as well. So waste products is something that a lot of people need to consider in terms of continence.

And this is going to affect the economy if we don't do anything about it. If we don't promote that we need to provide alternatives and a dignified giving of care as well.

Michele Ong

Yeah, absolutely. And the nappy thing, because it's fascinating, because when I had a child, we were talking about disposable nappies and the first thing that seemed to get hammered into you is about how many nappies you need and disposables versus washable and all of that.

And you end up going through this rabbit hole of nappies, continence, period care, and all the disposables, how much that ends up being over the course of a woman's lifetime.

And the fact that none of them are biodegradable, even the ones that say they are, because as soon as you've got plastic lining to make it waterproof, that already ruins that particular aspect. The ones that are meant to be compostable are only compostable on an industrial level, so you need to have high heat, and not all councils support industrial composting as part of their waste management. So, you know, massive rabbit hole.

But completely understandable that when you think about the number of I guess countries with aging populations, the increase in continence or incontinence issues, as well as, you know, all those other things relating to it because you don't just need those products when you have incontinence.

Sometimes it's relating to other surgical issues that might require that as, you know, comfort or care or convenience. But the amount of waste that comes through all of this is phenomenal.

Sheena Lagat

Yeah. And there's also different gradings. If you have Louis Vuitton, you know, there's also that in terms of high quality medical grade products. So the cost of living, as you know, is very high at the moment and people are not getting their pay rises. So it's going to really put a hole in people's pockets.

If imagine being dependent on pads where, because you have no control whatsoever and you need to change it six to 10 times a day because some people will have a large, massive output. Some people, because they can't afford pads will improvise and that can have negative implications if we have incontinence associated dermatitis, it's sort of like nappy rash, but for adults, that can cause infections and that can cause hospitalisation.

The psychological and social impact of continence and incontinence.

Michele Ong

And it's just general quality of life. Like, just the fact that you have to maintain whatever it you're doing whether it's using the regular stuff or improvising. It's a lot of mental load and cognitive load to have to manage these symptoms and conditions. So, you know, it's not just wasteful in that capacity, it's wasteful for you, for as a human being trying to function like a regular person, because you have to look after all these things as well deal with any side effects, as you said, with the skin conditions, or even social implications for that. Because of the stigma. All of that adds up.

Sheena Lagat

Yeah. And you mentioned about cognitive function. So if you have someone who's cognitively intact and their senses are all in working order, the smell of whether you're fecally or doubly incontinent, so that's fecal and urine, that gets to someone. So they'll try and change or wash often, just to make sure that nobody can detect that there's an issue as well.

Michele Ong

Very stressful.

The social inequity and accessibility issues of continence and incontinence.

Sheena Lagat

it is quite stressful and there's a gender difference. We have sanitary napkins, disposable bins in the female toilet. But for men, they don't have that. The Continence Foundation of Australia has a really good initiative called Bins for Blokes, but this is not widespread.

It's only shopping centres or organisation in some healthcare facilities have taken this on board.

I'm hoping that this will be standard in all public areas because men, men and boys, needs to be part of that social inclusion. They also have problems and they also need to have access to disposable bins.

Michele Ong

It's an entire infrastructure problem at that point because, you know, public toilets also, we're getting fewer of them, they're starting to shut down because they're expensive to maintain.

So when you want to have them available, the facilities may not be entirely what you need. As you said, you're missing bins or you're missing things that make things easier for people to be out and about and do things normally.

Sheena Lagat

Yeah. And that's the other side of the coin, Michele. You've got incontinence, where you have no control, but someone who can't pee, who's in retention, who needs to self-catheterise, our public toilets doesn't give them that clean environment to do that, especially in the female toilets. Most of the time we have the line outside. Imagine having to insert a catheter and, you know, trying to do things as efficiently as possible-

Michele Ong

In a crowded environment where everybody's waiting and you're feeling the pressure.

Sheena Lagat

Yeah. And we have obviously anatomy difference to a male. So we can't just insert and see you- the hole. Some women who are starting off will require a mirror to know where they're going. But you don't have a cubicle that allows you to place that mirror or to use the back of the door to accommodate her needs.

Michele Ong

So it's a form of disability and it's the way you want to define disability. Yeah. And because it is an invisible disability as well, you end up with people feeling trapped at home because they don't feel supported to be out in society, especially when they do need to do their care-related activities.

Sheena Lagat

Orgo to work. It's one of the things that affects the economy. When you have that loss of productivity, because either that workplace cannot provide that support and if you feel embarrassed and shameful of your condition.

Michele Ong

It also impacts your quality of work as well, so even if you are able to get a job, if you don't feel that you are able to support your needs, that impacts all other areas of your life, too.

Sheena Lagat

Yes. That's right.

Michele Ong

All, all these wide ranging and ripple out effects of medical conditions and invisible disabilities that a lot of people aren't aware of because they are invisible.

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Redefining continence nursing.

Michele Ong

So, this leads into your other big advocacy work in terms of working towards career pathways for nurses in this area and redefining what continence nursing involves. So how does one go about redefining continence nursing?

Sheena Lagat

I think, well, nursing in general is 100% a STEM field, and it's such an integral part of the clinical workforce. We work alongside scientists, researchers. doctors, and other healthcare professionals. So that means we do use the science, the technology, the engineering, and the math every day.

We're not just there with a clipboard, and an obs machine. We're actually putting critical thinking into play in our daily task and also applying evidence-based clinical practice. So, in order to look after complex care, I think the general public needs to understand that we do have that professional insight in how we do go about our things and how we look after patients as well.

So nursing is such a technical expertise that I feel is unique because you've got compassionate care as well as that technicality, and I think that's what makes us impactful if done well.

Michele Ong

So what's the state of career pathways at the moment in terms of the access to information to be able to enter the urology field for nursing?

Sheena Lagat

Similar to the other specialties, here in New South Wales Health anyway, you need to be practicing in the area of specialty that you're pursuing for at least three to five years, then you can apply for your clinical nurse specialist, uh, role. And usually you need to complement that with some form of post-grad qualifications.

When I was starting out, there wasn't much out there. So I did everything. Basically everything that has continence in it, even doing a grad certificate in advanced nursing through the College of Nursing. It had a little module, a small module on continence, but I did it anyway, just so that I can start progressing.

But now La Trobe University is providing a urological and continence nursing Master's. From my understanding, that's the only university that offers this, but once you've accomplished your CNC and you want to progress even more, obviously there's the Advanced Nursing Practice or Nurse Practitioner pathway.

Each local health district and each state has their own criteria and universities also provide more information on this, but yeah, there is that stepping stone from an RN, CNS, CNC, and even advanced practitioner to work at that with more advanced skills.

The doors are very open. It's just that we need to recruit more, more people to be interested in urology and continence and I'm hoping that I'm doing it justice with this conversation to appeal to people's interest in the specialty, especially for the new grads or those who are doing their student nursing. You may not learn it from your Bachelor of Nursing, but you will learn it when you're in the real world, when that umbilical cord is cut you'll see it because urology and continence transcends any specialty.

Most patients will be coming in or will either have that transient issue of incontinence or bowel issues and catheters as well. But it's not just a urology specialty. It's a medical device that follows everybody around the hospital and in the community setting as well.

Michele Ong

And as you said like because it's neurological, muscular, plumbing, there's so many interconnected parts of the anatomy which can have an impact on your pelvic health. And you can't get away from that. There's always going to be something that touches or overlaps with that kind of area.

Whenever you have to do anything surgical, whenever there's anything to do with spines or neural, like, it's, it's something that everyone needs to have at least some knowledge of. If only to understand that this is how this part of your body works. So, it is a supply and demand issue where you need to have more nurses to be interested in this field and if we are starting to get to an increase in population where incontinence issues is becoming a major part of our public health issues, like you said, one in three women, was it?

It's more common in women than men. I don't have the specific, but it's mainly one in three.

That's still a large amount of the population who encounter incontinence issues at some point.

Sheena Lagat

Yes.

Healthy habits to look after your bladder and bowel.

Michele Ong

And you know, the more people we have with these issues, the more care we're going to need. So what can we do? Like, a lot of this work for nurses is at the point where you have to intervene.

Sheena Lagat

So what can individuals do to, I guess, avoid getting to the point where it does need hospitalisation or it does need medical intervention?

I think people need to understand that unlike the heart, bladders can't be transplanted. You can get a stoma for both bladder and bowel, but to physically put a new bladder in is impossible because of the intricate details of the innovation, the brain coordination with the organ.

Because the bladder is just a storage. It's just there until we are able to empty at a socially acceptable time. But if coordination doesn't work, then the bladder is basically useless. We can take it out, for example, bladder cancer, and they can make neobladders using the digestive tract, but unlike the heart, you can't put a new one in or put a dead person's bladder into somebody else.

So I think, we need to value healthy bladder and bowel habits at a young age, starting from bladder training at a young age and promote that at every stage or milestone. Teenage years, premenopausal, postmenopausal, during pregnancy and post-childbirth, and also for males as well.

They may not go through childbirth, but they can go through prostate issues and other issues as well that can obviously impact on their bladder and bowel capabilities. And also pelvic floor, it's not just supporting those organs, pelvic organs, it's bladder, bowel, and sexual function.

So if you can imagine a boat docked at the harbour. If there's not enough water and if that rope that's holding it in place, if it's not well anchored, then that boat will sink.

We all go through the aging process. So that muscle tone will eventually diminish, but it's up to us to exercise it, to help maintain its structure, so that it supports those healthy bladder and bowels.

So I can't emphasise enough the importance of water intake as the main source of fluid, not soft drinks, not coffee. You know, we call those rubbish fluids because they don't hydrate, they dehydrate, and that's why it can irritate the bladder even more, makes it overactive.

But obviously, I'm not a fun police. I do have my coffee as well. This is my coffee from this morning.

Michele Ong

But that's in addition to your water.

Sheena Lagat

Yeah, it's in addition. So you can have those, um, naughty beverages, but everything should be in moderation. If your bladder and bowel habits are being pressured, then obviously you want to look into fluid management and the types of drinks that you're having so that it doesn't exacerbate the problem or the issue as well. But water is the main source for the body where it's made out of water predominantly. So that's what we need to help fuel and flush out the waste from the body as well.

I think I'll also mention that putting pads on patients who are not incontinent can have a psychological impact and can actually cause the incontinence as well.

I know that hospital wide and across different states that we are pressured as a profession because of short staffing. But this is not a solution to make our jobs easy because-

Michele Ong

It can create other side-effects.

Sheena Lagat

Yeah, and for caregivers as well. So if we can, we need to make sure that it's individualised the way we assess patients and we provide a holistic patient-centred care, so that may include a toileting program. Even someone who's got dementia, even for someone who's not familiar with the environment, just needs to know, okay, that white door in front of me is the toilet. So it's just helping that patient to find their bearings.

I know some areas, for example, here at our hospital, in our aged care ward, we've painted the toilet seat black just to help visually for someone who's got dementia to recognise Okay, it's not being washed out in the clinical white surrounding and also help promote safety, as well.

So scheduling patients and offering them to go to the toilet after a meal or before a meal, before they go to bed can be enough to help maintain their continence.

Michele Ong

And it creates routine as well, which means that they're more able to pick up signals when they need to.

Sheena Lagat

Yes. And it will minimise falls as well, and just being mindful of the person's intake. If they're drinking every hour, then they will be going to the toilet every hour. So it's just also guiding patients on fluid management, when they should stop drinking not just close to bedtime, but during the day, that's when they should have the bulk of their fluids.

Michele Ong

And I guess also being more in connection with your own toileting habits so that you know when things change and you know when things are abnormal, and if they stay abnormal, to have the confidence to talk to your healthcare professionals about the issue and not being afraid of it.

Because they're there. They've heard it before. You don't have to be delicate about the problems.

Sheena Lagat

Because most people, and even the general materials out there on the web, would suggest two to three litres or 10 glasses of water every day. But your glass and my glass may be different. So it's seeing who's in front of you before you prescribe fluid intake, because an 80 year old can't drink three litres. It's unfair, you know, and someone who's just delivered a baby day one, well, it's also undesirable them to be pushing fluids in when they don't have any urge sensation. And plus, even if they're breastfeeding, the newborn baby's bladder is very tiny. So there's no need to be replacing that fluid without a proper clinical indication.

Michele Ong

Yeah. All very useful information in making sure that we can be more aware about our own care in this way, and to try and prevent having to get to the point where we need more serious interventions, because it's like you said, some of those are very invasive, and I don't think a lot of us would really want anywhere near that if we don't have to.

Sheena Lagat

No.

Michele Ong

So thank you so much, Sheena, for speaking with me today. It's been absolutely wonderful speaking with you about your journey.

Thank you. Thank you so much for having me.

It's an absolute pleasure. And if people would like to learn more about continence nursing and urological care, where can they go?

Sheena Lagat

There's a lot of reputable resources and organisations out there. The main one for Australia and New Zealand is the Australia and New Zealand Urological Nurses Society, the Continence Foundation of Australia, the Jean Hailes for Women's Health in general, and the International Continence Society, and also the Australasian Menopause Society.

But access those resources. The membership is available to anyone if they want to participate because we want to be encompassing and also representing, you know, the patients that we look after. So we would welcome, consumer involvement and students as well, because we're hoping to mold and shape and to also give back the experience by contributing to the profession.

Michele Ong

Absolutely. And I'll add those to the show notes below.

Sheena Lagat

Yes.

Michele Ong

Cool. And one last thing before you go,

What advice would you give someone who would like to do what you do, and what advice should they ignore?

Michele Ong

and we've covered a little bit of this already, but if someone would like to do what you do, what advice would you give them and what advice should they ignore?

Sheena Lagat

Go for it. If you find your passion you won't be dragging your feet in, because this is what's going to motivate you to do your job. And as nurses, and as a healthcare professional, the underlying prerequisite in choosing nursing or healthcare profession is that you have to care. We have to bring back care in our healthcare system, regardless of what's happening out there.

And continence, it's everyone's business. So even though you don't want to specialise in continence, that's fine, but it's something that you should know and be aware about.

Michele Ong

Because as we've discussed, it doesn't matter what specialisation you're in, it's going to have an impact or your patients are going to be impacted by it.

Yeah, we all share the same basic needs.

Yes. Okay. So thank you again, Sheena. This has been absolutely wonderful speaking with you today.

Sheena Lagat

Thank you Michele. Thank you. And I'm happy to be contacted as well if anybody wants to ask more questions.

Michele Ong

That's wonderful. Thank you so much for that generous offer and yeah, hope you have an amazing rest of your evening.

Sheena Lagat

Thank you.

Michele Ong

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