Disabilities: talking to your GP about incontinence

According to the Australian Bureau of Statistics, 1 in 5 people in Australia have a disability. We talk to Dr John Crimmins, GP in Sydney Basin and Chair of RACGP Specific Interests Disability about how a general practitioner (GP) can help manage your care.

What do you see as the role of the GP for people with a disability?

The GP’s role is central in providing long-term access to affordable whole person healthcare for a patient with a disability. Whole person care means the GP looks after a person’s physical, psychological, social and vocational health, which includes the impacts of a disability on quality of life. Another equally important role of the GP is that of patient advocate so the person with a disability can access the best supports and care.

“Research shows that having a GP, or a GP practice, will result in the best health outcomes for any person with a chronic condition,” Dr Crimmins tells Bridge.

What makes a good GP for someone with a disability?

The term ‘good GP’ usually is more about a personality match than expertise. Any GP with an FRACGP after their name is a qualified specialist, and like other medical specialties has sat a rigorous fellowship exam to gain their specialist qualifications.

Most GPs actually refer less than 5% of issues to another non-GP specialist and handle most health issues in their consultations. A tip to get the best from any consultation either with a GP or a non-GP specialist is to not leave that consultation until you are well informed and agree on the management plan.

Are there any disabilities that are typically associated with experiencing loss of bladder or bowel control?

Loss of bladder or bowel control can be seen as mild (an occasional small leak) to severe (complete loss of bladder and/or bowel control). This is usually termed incontinence and occurs commonly in all people, not just those with a disability.

However, any disability that affects nerve function can cause incontinence such as a spinal injury, a neurodegenerative condition, eg multiple sclerosis (MS) or a stroke. More commonly incontinence is not associated with a disability and can have many causes from medication to local bowel and bladder issues.

How can incontinence impact quality of life in patients with disabilities?

The impact depends on severity and the need to access continence aids. Socially, incontinence at all severities impacts on how a person can access normal activities and so needs to be assessed and managed early.

If the incontinence symptoms are assessed by a non-medical support person, it can result in inadequate levels of care being provided and lead to poorer quality of life and inadequate funding from NDIS or CAPS. Depending on the severity, a patient may manage incontinence with or without continence aids. I find that after a GP assessment I sometimes refer the patient to a nurse continence specialist to fine tune a bladder or bowel management plan.

How can readers ensure that doctors don’t assume their continence problems are due to disability and actually that they run tests to check there is no underlying separate cause for the continence symptoms?

The assessment for incontinence is the same for a person seeing a GP whether they have a disability or not, and in most cases the incontinence is usually unrelated to the disability. Make sure you feel informed and agree with the management plan your GP has suggested and always follow up with your GP if things are not going to plan or things change.

What does an initial appointment discussing continence symptoms with your GP typically involve?

A GP will ask about type of incontinence-bowel and/or bladder. Frequency of symptoms and severity. Are aids such as pads used. Most importantly, how this impacts your quality of life.

Are there any treatments for symptoms of certain disabilities that can cause incontinence as a side effect?

Yes, the list is quite long, but generally a major cause of incontinence is medication.

A GP can refer you for a Medication Review (often funded by Medicare) with a pharmacist to check medication interactions.

I do a yearly medication review for all my patients with a disability who are on multiple medications.

What sort of information should readers take with them to a GP appointment when discussing their incontinence symptoms?

You should have a diary that records when and how often the incontinence occurs, how severe it is and how much urine or faeces you pass. Additionally some idea of what this is stopping you doing is very helpful. Severity and impact on a person sets off all the alarms in a GP’s mind.

Download our bladder diary and bowel diary to take to your appointment

Do you have any tips for parents or carers of disabled teens/young adults who are transitioning from paediatric care to adult care?

As they move from paediatric specialists to adult specialists your child may also (depending on decision-making capacity and support needs) transition from having someone else, such as a parent or carer, making medical decisions to making their own decisions.

This means that they must understand health professionals need their consent for any investigations and treatment plans and know where to go for help if they don’t feel informed enough to give consent.

This is why it is important to have a regular GP (regardless of your age) who can help guide you to ensure you are part of how you are cared for. In my long experience having a GP to discuss issues or another non-GP specialist’s opinion will give you the best in healthcare.

Another important consideration is also to ensure you are well informed by your NDIS team who might have minimal training in disability care and not know what is required. Your GP should be the first port of call for any health related issues as they are the medical expert in whole person health.

For help with managing continence symptoms call the National Continence Helpline on 1800 33 00 66, open Mon to Fri 8am to 8pm AEST.

Also in this edition

• Carer of the Year
• Mad about materials
• Finding a group to support you
• A day in the life of someone with neurogenic urinary retention
• What is neurogenic urinary retention?
• Looking after your bowels in hospital
• Is health advice from TikTok or ChatGPT better?
• Alcohol and incontinence – what’s the connection?