For people living with any kind of incontinence the thought of planning a swimming trip may provoke fear and anxiety, rather than excited anticipation of an invigorating or relaxing dip. It is not surprising then that an excursion to the local pool is low on the list of fun things to do for people with urinary, faecal and mixed continence problems. With the correct support and advice, however, patients may be encouraged to actively enjoy water-based activities with confidence. A wide range of products is now available to suit each person's individual needs and requirements, which means that all the benefits of water exercise can now be accessible to everyone.
This article aims to increase awareness of the swimwear, pads and accessories available. In doing so, it is hoped that a dialogue may begin to encourage people with incontinence to consider swimming as an enjoyable, stress-free activity.
It is widely documented that incontinence can lead to loss of self-esteem, loneliness, isolation and may lead to reduced physical activity and opportunities to socialise. If a person is assisted to take up swimming regularly, however, each of these negative effects may be reversed. It may be argued therefore that swimming may provide the answer to many of the problems posed by incontinence.
Impact on lives
Whatever our nursing background, we will care for people with incontinence throughout their life span.
Children struggling to deal with bladder and bowel leakage may be required to visit the swimming pool as a social or school activity. This means that those who were previously just about coping with the concealed shame and embarrassment of their bladder and/or bowel problems find themselves suddenly plunged into an environment where they may feel that their secret is on display. Unfortunately, school teachers are all too often ill equipped to support children with bladder and bowel issues in the classroom, let alone in the changing rooms and swimming pool. The resulting effect may be that the child either does not take part in the activity—and therefore misses out—or risks an embarrassing scenario if their difficulty is revealed.
Postnatal stress incontinence affects many women. Evidence shows that swimming can help women recover from childbirth and make big improvements in pelvic muscle tone and nerve regeneration (Darnowski et al, 2019). Regular socialisation with their baby can also reduce feelings of loneliness and isolation and promote the wellbeing of both mother and baby.
Older people and people with disabilities will often experience the negative emotional effects of social isolation. If you add the need to daily manage incontinence to the picture, it is easy to see how going for a swim may not seem worth the stress. Gentle, weightless exercise in water, however, has been shown to improve physical strength and emotional wellbeing (Naysmith et al, 2015) and also provides opportunities to socialise and connect with other people.
For everyone, whatever their age and health issues, swimming can help reduce blood pressure and ease joint pain, improve circulation, general wellbeing and aid sleep (Naysmith et al, 2015). Consequently, if we can encourage patients to get out there and take part in such activities, we should (Swimming and Health Commission, 2017).
Incidentally, many people think that indicator dye is sometimes added to chlorinated water, so that those too lazy to get out to go to the toilet can be exposed by a growing cloud of purple shame. The use of this dye, thankfully, remains a myth. However, it is true that a small stray stool that escapes a toddler's swim nappy at Center Parcs will result in a loud klaxon urgently evacuating all swimmers in the Subtropical Swimming Paradise. Fear of this alone is, therefore, enough to strike terror into the heart of anyone who does not have full bowel control.
So what can we do to help patients to overcome this risk and their very real fears?
Overcoming barriers
Opportunities to raise the question of exercise are manifold within the healthcare paradigm. During formal and informal conversations with patients about incontinence, discussions about the impact that is has on the person's life often bring forth comments such as ‘I haven't been able to go out much’ and ‘I feel unclean and ashamed of myself’.
Along with questioning patients about daily activities, work and general wellbeing, health professionals may wish to consider opening a dialogue about physical exercise. Person-centred discussion (relating to ability and access to resources) may encourage patients to think about water-based activities as a solution rather than a barrier to improving their continence problems.
What is available
Little leaks of urine can go unnoticed in the pool, but wearing swimwear does not always mean swimming. Dealing effectively with incontinence on the beach or during a spa day can help people take part in a wider range of enjoyable and healthy activities. The range of products available for people with continence problems includes internal devices and external, wearable products. Unfortunately, none of these are available on prescription and so will require private purchase. Box 1 provides a selection of products available, but is not an exhaustive list.
| Product type | Selection of products and costs* |
|---|---|
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Disposable briefs to wear beneath any swimwear
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Swim-sters Disposable Swim Pants: £7.99 each |
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Swimwear with integrated washable continence control
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Vivactive Unisex Incontinence Swim Pants: £16.99 |
|
Secure containment reusable briefs worn under swimwear
|
£11.45 for 3 vinyl waterproof pants from CompleteCareShop |
|
Penile compression devices
|
Dribblestop Male Urinary incontinence Clamp: upwards of |
|
Vaginally worn urethral support pessaries
|
BBRAUN Diveen starter pack (includes one small and one medium). Twice-use, vaginally worn urethral supports with an applicator to assist sizing (not available for private purchase, but available on prescription in February 2020): £8.10 IMEDicare Uresta starter pack for women (includes three sizes of vaginally worn urethral supports). Manufacturer says reusable for up to 1 year or as soon as any damage to product occurs: £179, reduced to £139 with NHS discount code iMEDUresta |
The products are available from the manufacturers and outlets, such as the websites included in Box 3
* Prices correct at the time of going to press. Other products are available
Internal products
These include vaginal pessaries for women and penile clamps or cuffs for men. In the case of the latter products, it is important to follow instructions carefully because there is a risk of tissue damage if these are not used correctly; they must also be worn for short periods only.
Other products include:
External products
In terms of clothing, the range includes swimwear and undergarments that can be worn underneath (Box 1). These can be disposable or washable. Box 2 lists the benefits:
| Disposable |
|
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| Washable |
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In the case of pads, it is important to use those specially designed for water because standard pads may swell up, leak and/or disintegrate.
Supporting patients
As nurses, it is our responsibility as part of every continence assessment to ask our patients about exercise. Furthermore, by explaining which products are available for people to use, we can promote swimming and other activities that take place in water as the answer to many of the problems caused by the incontinence itself.
Each person should be advised to consider which product is likely to be right for them, and what they are going to feel most comfortable using. A period of practice with the chosen product before it is needed will further aid confidence. Some manufacturers offer a starter pack to trial the product and sometimes provide different sizes.
Swimming in the sea can offer an ideal opportunity to get used to using some of these products because a small leak would be of no consequence. If possible, swimming with a trusted friend or family member for support can also offer the reassurance that there is no sign that the person is wearing anything out of the ordinary.
Websites and online shops such as AGEUKincontinence and Incywincy are a useful resource for people of all ages needing such products and more advice (Box 3).