Seeing it from both sides, a personal story from urology consultant Mo Belal



On February 17th 2021 I went cycling with a friend in the countryside. A dry cold day with no wind. A tree fell at the exact moment I was cycling by. This resulted in a life changing spinal cord injury and broken ribs and scapula.

I remember waking up and trying to move and realising that I was paralysed. I was admitted to the closest trauma unit and underwent emergency surgery that night. After two weeks I was then transferred to the London Spinal Unit and underwent further spinal surgery and several months in hospital. Several months of inpatient stints were required for rehabilitation.

I was fortunate to transit back to work as a surgeon in the NHS after intensive rehabilitation and with a drive to return to help those in need. It took over 1000 hours of rehabilitation and a willing NHS employer who provided the adaptations necessary to allow me to return back to surgery. Experiencing significant issues with my bladder and bowels while an inpatient intensified my passion for helping those with incontinence and gave me a different perspective on incontinence and its treatment.

My specialist interest in urinary incontinence could not prepare me for the real impact of this experience. Having an indwelling catheter for 6 weeks, commencing intermittent clean catheterisation, having video urodynamics and suffering from urinary tract infections made me understand the true burden that patients suffer from urinary issues.

Living in the Spinal Unit I found that for many the loss of bladder and bowel function could be more impactful and harder to come to terms with than even mobility issues.  Physically, incontinence causes skin irritation, catheterisation can be painful and has significant long term health implications, especially if not taught or practiced carefully. Practically, patients limit themselves because of the constraints of this condition. Some limit their social lives or don’t return to work.

The largest impact is to self esteem and body image. Stigma and shame are significant and likely to significantly impact on mood, especially if patients don’t feel able to openly discuss these concerns. Having to catheterise or manage difficulty with bladder and bowel is a constant reminder of their difficulties and loss of function. The psychological fear of being wet can be overwhelming and curtailing social and travels plans.

However, there is light at the end of the tunnel. Open discussions between patients and medics can have an impact on the health and wellbeing of sufferers. Normalising and informing patients, as well as offering practical care ideas to manage their difficulties, are simple and effective interventions.  With the appropriate treatment incontinence can be managed so that patients can have a good quality of life and escape the significant medical and psychological impacts of the condition.