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Looking after Number One

Tuesday 1st July

Losing command of your bladder may be upsetting, but this common condition is rarely untreatable – and some simple lifestyle changes, including pelvic floor exercises, can help many patients avoid surgery.

When you’re talking to your doctor about sensitive topics, it can be hard not to feel embarrassed, even when you know that they must have heard – and seen – it all before. It’s a common enough problem, yet incontinence is simply one of those things we find difficult to discuss.

The new continence care clinic at benenden hospital in Kent, which officially opened in April last year, provides a nurse-led service designed to ease those embarrassing moments – and the advice that it offers may also make it less likely for a patient with bladder problems to require an operation.

“One of the benefits of a nurse-led clinic is that your first appointment here is an hour long, compared with the 20 minutes you’d get with a consultant,” says Janet Chaseley, the gynae and urology sister who manages the clinic. “During that time we take down the patient’s general history, find out about their symptoms and learn what’s bothering them. We also test their urine and scan their bladders to ensure that they’re emptying OK.”

The team sees a range of problems, including stress incontinence (where urine leaks out if the patient coughs, laughs or sneezes), which is common among women after childbirth.

They also treat patients with overactive bladder syndrome. “This is when people feel a lot of urgency and the need to go frequently,” Chaseley explains. “Often they will go to the toilet every hour, when every three to four hours is ideal, and have to keep getting up at night to go.”

Mild prolapses (of the womb, rectum or bladder owing to muscle weakness) are another common problem for women. A fairly large prolapse is likely to need surgery, but the continence team can help people to manage milder cases themselves.

“We advise patients on how simple lifestyle changes can help. Reducing the amount of caffeine and fizzy drinks you have makes a difference, for instance,” Chaseley says. “Bladder retraining is important: if patients are emptying their bladder every hour, we get them to increase the amount of time between toilet visits. This means that their bladders start to hold more urine, putting them more in control.”

Pelvic-floor exercises are a crucial part of bladder retraining. Women are advised to try these after they’ve given birth, but they tend to do them for a while and then forget about it, she says. “But these are really important exercises that you should be doing regularly. They could prevent a lot of the bladder problems of the type we see. You can get good symptom improvement simply by following our advice.”

Men needn’t feel left out – they also have a pelvic floor and these exercises are for them, too. Bladder problems generally affect one in five men and one in three women.

“We do have more middle-aged people coming in,” Chaseley reports. “Women, especially around the menopause, start to develop some of these urinary problems at this point. But we also see women who’ve developed bladder problems after childbirth and elderly people whose problems have developed with age. I’ve got people on my books in their twenties and in their eighties. I think the message here is that bladder problems can affect anybody at any age and there are positive things that you can do to manage these yourselves.”

Having bladder problems won’t necessarily mean surgery, Chaseley stresses, highlighting the success rates being achieved by the service. “Sometimes you simply need some good advice about how to manage your symptoms,” she says. “Since we started seeing patients who would normally have gone straight to a consultant, our statistics show that one-third of those patients who just came to the clinic were treated here and then discharged.”

This article first appeared in issue 23 of benhealth in Summer 2013

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