Jo Booth

Jo Booth

Professor of Rehabilitation Nursing at Glasgow Caledonian University and the Education and Research Lead for the Association for Continence Advice.

Location UK, Scotland


  • @FionaFraser I agree there is a great need for more recognition of continence issues and their potential impact on so many other aspects of a persons life, especially falls risk and sleep. There is a well-recognised association between incontinence and falls in older people but why this happens is not clearly understood - there is evidence that it is not...

  • I completely agree! Its never too early to think bladder and bowel health

  • Jo Booth made a comment

    I'm not totally convinced by the autofiction approach and the stream of conciousness in some if the extracts makes me question her mental health at times. I found it hard work to read and quite frustrating trying to understand it.

  • Jo Booth made a comment

    The sentence structure certainly slows it down and adds a 'disjointedness' to the narrative. It almost seems to shut it down.

  • I agree, perhaps there is the odd narrator who deliberately seeks to mislead, or at the very least control our understanding by revealing what and when they decide, but I suggest this is the minority. What we get with any narrator is their individual interpretation, which is usually an interpretation of another's thoughts or behaviours. As we are all unique as...

  • Yes I agree, he is really quite slippery and untrustworthy

  • Mine too

  • So interesting to hear views from authors themselves. I guess we tend to think it's all decided before you start writing but judging by what you have written here that is probably not the case

  • Flashbacks and flash-forwards add context and dimension to the character. They can highlight particular aspects of the character the author might want to portray and provide explanations for characteristics and behaviours that are interpreted by the reader.

  • Jo Booth made a comment

    Hello. My name is Jo and my favorite hobby is reading novels. I would love to learn more about how to critically review what I read so that I can improve on the comments I make about what I read in my book journal. I have never kept a proper diary, but over the years have recorded the books I read and some brief thoughts about them.

  • Yes you are right. Internal sphincter automatic and we have no control, but external sphincter we can control voluntarily.

  • Both sphincters should be closed to best maintain continence. The external sphincter can be kept closed by us - it is voluntary and under our control. We have no voluntary control of the internal sphincter - it functions automatically.

  • @hilaryhughes They drive all healthcare professional who promote continence nuts. Not just womens health physios. I have to be restrained when I see one, as do most of my colleagues!

  • You are right Gary. It is common practice (although not right) to automatically put pads on in some hospital wards. The problem is that the person then loses their ability to control their bladder. This happens very quickly, even in a few days. It is then a real challenge for them to regain bladder control and many give in, finding it easier to continue with...

  • @JEANBENTON later in the course we discuss whether it is acceptable to ask a person to use their pad, rather than a toilet. It is a very difficult, and unfortunately common, issue. I think you can best answer it by imagining if it was you being told to do that.

  • @VeronicaBlanco-Gutierrez what an interesting study! Thanks for sharing it. I recommend that others read it too. It confirms what we were discussing before about a general low priority for continence care for peri and post-partum women. This does need to change if we want to prevent these women developing continence problems in the future.

  • Hi Stephen,
    Thanks for sharing your situation and you are right to mention wetting the bed as a boy because there is a recognised link between bed wetting in children and continence problems in later life, although we don't understand fully why it happens.

  • Interesting discussion. Yes we often think there is overprescribing of antibiotics in older adults but you may be interested in a recent BMJ study (2019, 364:1922) which shows delayed Ab use for UTI in over 65s is associated with increased risk of sepsis and death. Lots to think about for practice here!

  • That's why those definitions are outdated now and have been superceded by ones that do not judge. Recent definitions eg ICS are much less contentious

  • That's a good point. It's important people are not blamed for an unruly body organ! Instead they should be supported to manage it where possible (it is not always possible) - mind over bladder or mind over bowel

  • We know anxiety affects the bladder and we also know that bladder habits such as frequent voiding are easily learned and hard to break. What part our minds play in bladder problems needs a lot more research for us to fully understand what is going on and how best to help people to gain control over their bladders - it's a case of 'mind over bladder'

  • That is so good to hear! So many midwives don't have interest (or time?) to promote continence but have such great opportunities to learn do it.

  • That is a bladder dysfunction is the bladder is not functioning as it should, even though there is no bladder leakage.

  • Absolutely!!

  • This is such a good point about developing the skills to recognise continence issues - and the skills development is needed by people with a continence issue AND the people caring for them (if needed)

  • That is very encouraging to hear because many women have said that they were not asked about their bladder and/or bowel in the perinatal and post-partum period and that other aspects were seen as much more important eg breast feeding.

  • Jo Booth made a comment

    There's a lot to think about and comment on in this final week. We really don't have all the answers to the bladder and bowel problems that are so common yet so hidden and we are in danger of losing the treatment versus containment battle. Many continence services are changing as specialists retire, continence posts are regraded or lost as cost savings. There...

  • Very true - there is really good evidence that pelvic floor muscle exercises work and given that pads are uncomfortable and can cause lots of problems for the person its surprising that more people don't do them. Perhaps its because they don't know about PFME or don't feel confident to do them? There are lots of apps available to help as well as written...

  • I agree and the number who will benefit is likely to be huge, if we can get the message out and support people.

  • Understandably so but wherever possible we do want people to (re)develop confidence that they can control their bladder and bowel.

  • I agree that bladder and bowel problems often lead to anxiety and that this can have a huge impact on many peoples' lives. I often think this is not recognised to the extent it should be and that there is more we can, and should do.

  • Jo Booth made a comment

    Rosie this is such a good illustration of why it is so important to communicate clearly. I firmly believe that 'keeping it simple' it the key - and don't use euphemisms - try to find out the words the person uses and use those words when communicating wherever possible.

  • There is no way to know how much fluid is in food, other than liquid foods such as soups, smoothies and ice-cream. It is widely known that the majority of vegetables and fruit is water but there is also fluid in almost all food.

  • This is more of a specialist level intervention. In my experience it would not usually be expected of general continence services. However it would be useful additional information to assist with the diagnosis and future management.

  • But huge bladders are unusual! Sometimes there are other underlying conditions eg connective tissue disorders.

  • Hi Sarah, your 500+ and 800+ figures are quite high. Is this your local policy? Shows how varied practice is!

  • @PhilCollis Hi Phil, I think the difficulty is putting a standard figure on what might be a very individual issue. But I agree it would be very useful to have some good research to guide us and there is a lot of information out there. I think one of the challenges would be collating the information is who could do it because it would need to be funded. In the...

  • @RosieL thanks for your comment Rosie. I agree! We will try and do that for the next run

  • For some people it is entirely possible to regain continence.

  • Very good point Steve. I don't know why. Any thoughts?

  • Good point. If only citrus fruit this might acidify (lower) pH slightly, but vegetarians usually eat a mix of all types of fruit and veg.

  • Not sure why you think the episiotomy influenced OAB? This might worsen stress UI, so maybe you think she has a mixed UI?

  • Could be several reasons. That's why a comprehensive assessment is needed to work it out. I suggest you look at her F/V chart, daytime activities and mental state in particular.

  • I agree assessment is essential and is the foundation of all continence care. We need to complete a thorough assessment to get the right diagnosis and identify what we can do to help the person recover bladder and/or bowel function but there is no 'set' way to do the assessment and we can use our clinical knowledge and skills to adapt our assessment to the...

  • This is when a small 'sample' of rectal contents enters the upper anal canal and is detected as wind (flatus) or stool. The IAS can detect the difference and allow the passage of flatus while containing stool until a suitable time and place is found to defeacate.

  • Jo Booth made a comment

    Hi All,
    Welcome to week four. I cant believe we are here already! I hope you are all finding the course helpful so far and you are ready for a more detailed look at how a person's bowel functions and what can go wrong. Although more common than most people would imagine, bowel problems are rarely the subject of general conversation. I hope this week will shed...

  • Yes it is recommended as the best position for successful defaecation as it allows the 'easiest' passage.

  • Hi All, The purpose for this question was to get you all to THINK about residual urine volumes. There are no absolute rules for PVRU ie there is no set figure above which you could say a retention definitely exists and there is no good quality research evidence we can refer you to that would give you an exact answer. Probably for this reason clinical...

  • Rosie, products in my experience urinary and faecal incontinence can often happen at the same time however it does not ALWAYS occur together and it is not an absolute rule. If the person wears absorbent products it can be difficult to tell the order in which they occur. Dementia is an area where we need a lot more good information and where there is not as...

  • Thrush, or to give its full name of candida albicans, is a fungal infection, not a bacterial infection. It usually is a vaginal infection and not one of the most common causes of UTI, but it can be associated with bladder problems, particularly for people with long-term catheters or those whose immune system is impaired.

  • Hi Terry, I'm sorry but we are unable to cover specific conditions.

  • Jo Booth made a comment

    Its often the case particularly for older people, that drugs are not always considered as a cause or trigger for incontinence. Although a lot of single drugs can contribute, its also the polypharmacy that so many older people experience, that needs to be thought about - eg a diuretic plus an ACE inhibitor are common and can seriously challenge a person's...

  • Thanks for posting these Terry - they are all excellent resources which explain interventions clearly in simple terms. I'm sure a lot of people will find them helpful