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Content Article
Women's incontinence is thought to affect millions in the UK. TV personality Gemma Collins is fronting a campaign that aims to help women overcome embarrassment and tackle the taboo. The NHS says there are several types and people should always speak to a GP about their symptoms. 5 Live listeners share their experiences with Nicky Campbell. -
News Article
‘No doctor in the country will touch you’: how the NHS is failing FGM survivors
Patient Safety Learning posted a news article in News
At least 137,000 women in the UK live with the painful and traumatic consequences of cutting, but there is no provision for reconstructive surgery. In May 2023, Shamsa Araweelo was in the A&E department of a London hospital in excruciating pain. It wasn’t the first time she had sought urgent treatment for the gynaecological damage caused by the female genital mutilation (FGM), or cutting, forced on her as a six-year-old. In fact, this was one of many such visits to emergency departments that Araweelo had made in her desperate attempt to find a surgeon who could help undo the damage done to her as a child and which has caused her so much pain and trauma as an adult. Araweelo says that in A&E she was told that she had severe nerve damage and that it could be reversed through reconstructive surgery. But not in the UK. “No doctor in the country will touch you, because you are an FGM survivor,” Araweelo says she was told. “I felt no compassion, no respect. Only in London did they tell me they wished they had the appropriate training to help me, and it breaks my heart. We are not valued in the UK.” Current NHS rules state that if a health practitioner suspects a patient has been cut, they must report the case to the police and complete a safeguarding risk assessment to determine whether a social care referral is required. Guidance for GPs also recommends referrals for mental health issues related to FGM or referrals to uro-gynaecological specialist clinics. Araweelo says that in all the years she has sought help she has never been offered any kind of support from medical professionals. Read full story Source: The Guardian, 21 December 2023- Posted
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- Medicine - Genitourinary
- Womens health
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Content Article
Continence is an important component in a person’s health and well-being at any stage of life. This guidance from NHS England and NHS Improvement is intended to assist commissioning discussions for those developing high quality community continence services while also providing practice guidance for providers and health and social care staff to help ensure people receive excellent continence care consideration. -
Content Article
While COVID-19 has worsened patient waiting times across the NHS, patients with pelvic disorders have long been an under-served population experiencing unacceptable delays in care. Pelvic floor disorders are varied and can be complex, but treatment is available. However, patients, particularly those requiring surgery, can wait years from presentation before receiving the treatment they need. The report from the Pelvic Floor Society proposes changes in six key areas: Empowering and educating patients and beyond. Making use of technology. Integrating expertise. Looking again at surgical procedures. Making the most of our teams. Considering collaborations. Each area is addressed with its own chapter in the report.- Posted
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- Medicine - Genitourinary
- Sexual and reproductive health
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Content Article
Luce Brett's blog: When you ARE that woman
PatientSafetyLearning Team posted an article in Women's health
This blog by best-selling author Luce Brett, focuses largely on the impact of incontinence and depression, and the weird and wonderful, distressing and often hilarious worlds these stigmatised conditions can lead you into. -
Content Article
This health seminar, from Wellbeing of Women, focuses on one of the most taboo issues in women’s health, incontinence. An estimated 7 million women suffer urinary incontinence which can affect all areas of life, yet it is rarely spoken about and regarded as an issue that only affects older women. In this video, we hear from Luce Brett, author of PMSL: Or How I Literally Pissed Myself Laughing and Survived the Last Taboo to Tell the Tale and Elaine Miller a women’s health physiotherapist, for what is an open but also vital conversation about living with incontinence and what we can do.- Posted
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Content Article
Incontinence is often described as the last medical taboo. Everyone from medics and patient representative groups, researchers and charities, to social scientists, marketeers and psychologists agree that it is a condition cloaked in shame, silence and stigma.[1] But how does that impact on patient safety? And are there any measures that could prevent potential harm? In this blog, best-selling author Luce Brett explains why it’s so important to shatter the stigma surrounding incontinence, a condition affecting 34% of women in the UK.[2] Drawing on research from her recent book, and her own insight as a patient, Luce highlights how we can improve health outcomes for patients by simply talking about it more. A dangerous silence Historically, the combination of being a common symptom but also a massive taboo has meant that incontinence has sometimes slipped through the cracks, so to speak. A group of UK charities, working for conditions where the disease or treatment can cause incontinence issues, found that stigma had a negative effect on research funding and investment.[3] There is also a lack of appropriate recognition in policy forums and political public health discussion. Some things are changing, and the NHS recognises continence and pelvic health in its five-year plan, but the stigma is still creating barriers to safe, quality care. We’ve known for some time that incontinence can negatively impact physical and mental health and overall quality of life. A significant percentage of patients with urinary incontinence suffer from depression.[4,5] The situation gets more worrying the deeper the dive into the murky worlds of faecal incontinence, which is perhaps the most smothered in embarrassment, discomfort and taboo. We know faecal incontinence is often under-reported, even amongst communities such as older women where it is relatively common.[6] The condition causes psychological distress in patients and can sometimes have a potentially devastating impact on sexual function. Some studies have suggested healthcare professionals can be reluctant to start investigations and enquiries about faecal incontinence as it can be a complex area to assess and they may not necessarily know a lot about current management.[7] That, combined with patients’ understandable sense of shame and reluctance, means silence wins, again. And when it does, it provides the perfect breeding ground for insidious inequalities and poor quality of life for the incontinent patient. Active screening could surely prevent actual lived misery. Also, ‘urge’ urinary incontinence (when urine leaks as you feel a sudden, intense urge to pee, or soon afterwards) is significantly associated with falls in older patients,[8] depression, urinary tract infections, increased BMI, diabetes and death. So, the safety implications for patients are clear. The most common forms of urinary incontinence can often be cured – sometimes with surgery, but far more often with short, cheap interventions like pelvic floor physiotherapy. However, a society-wide unwillingness to talk about it badly hampers patient-doctor conversations. In the UK, patients take an average of seven years to seek medical help for post-birth incontinence.[9] A long time to suffer the effects in silence. If patients don’t feel able to seek help, their continence issues could potentially worsen or they could develop related conditions and comorbidities. We know that comorbidity is associated with worse health outcomes, more complex clinical management and increased health care costs. When incontinence is a side effect of something more ‘serious’ – part of a neurological disorder, a cancer treatment, the reason for a fall or infection – it never seems to be at the ‘top of the list’ of things to talk about, despite the huge impact it has on a person’s daily life.[10] We have to ensure that incontinence is spoken about in settings beyond those dedicated to maternity, postnatal and pelvic healthcare. If patients with conditions linked to a higher prevalence of incontinence (e.g. COPD in women) are not asked about it, the silence and stigma will continue.[11] I’m a writer, a patient and a lay contributor to healthcare initiatives. I’m not a researcher or a clinician. But I do have insight into incontinence after writing and speaking widely about it. This year I launched my book, an intimate memoir and wider take on being an incontinent woman, PMSL: Or How I Literally Pissed Myself Laughing & Survived The Last Taboo to Tell The Tale. Anecdata from this work has revealed that many women who experienced urine leaking post-birth were brushed off by practitioners or labelled as ‘normal’. Some were told that they were making a fuss or complaining. Sadly, these experiences are not uncommon. The recent Cumberlege Review highlighted similar attitudes towards women who underwent surgical mesh implants. Adopting a safer approach We really have to change the way we approach incontinence. We have to avoid dismissing, ignoring or trivialising it. If incontinent men and women are told their leaking is ‘just’ anything, ‘just’ an oops moment, ‘just’ a brief side effect, ‘just’ an inevitability after a vaginal delivery, ‘just’ a problem for their male partner in sex, ‘just’ a part of aging, then they are less likely to speak up or feel able to get help. They are already conditioned to put up and shut up. And that can make them more susceptible to further harm, both physically and mentally. By speaking about incontinence widely, clinicians will help it to become recognised as a legitimate and non-taboo healthcare conversation. This will mean more patients will be referred for help if incontinence is part of the full burden of their other conditions. It will also set a tone for stepping away from the harmful silence of the past. Good practitioners are also mindful of the safety issue posed by not ensuring that the incontinent patient’s mental health is taken care of. They are prepared to create space for some of the most embarrassing or uncomfortable issues incontinent patient might face – such as sexual dysfunction or leaking during sex. Ignoring incontinence may be less awkward or allow people to avoid difficult conversations. However, like all taboos in medicine, this comes at a cost to patients – leaving them prone to worse health outcomes. We can all do better than that. Get 20% off Luce Brett's book Members of the hub can receive a 20% discount on Luce’s best-selling book, PMSL Or How I Literally Pissed Myself Laughing & Survived The Last Taboo to Tell The Tale. To access the discount, please sign up to the hub and request the code by emailing us at [email protected]. References 1. European Guidelines on Urinary Incontinence. World Federation of Incontinence and Pelvic Problems. 2. Excellence in Continence Care. NHS England. 2018. 3. “My bladder and bowel own my life.” A collaborative workshop addressing the need for continence research. 2018. 4. Steers WD, Lee K-S. Depression and incontinence. World J Urol 2001; 9: 351–357. 5. Incontinence, anxiety and depression. Beyond Blue and the Continence Foundation of Australia. 6. Meyer I, Richter HE. Impact of Fecal Incontinence and Its Treatment on Quality of Life in Women. Womens Health (Lond) 2005; 11(2): 225–238 7. Meyer I, Richter HE. Impact of Fecal Incontinence and Its Treatment on Quality of Life in Women. Womens Health (Lond) 2005; 11(2): 225–238 8. Brown JS, Vittinghoff E, Wyman JF. Urge urinary incontinence was associated with increased risk of falls and non-spinal, non-traumatic fractures in older women. Evidence-Based Nursing 2001; 4 (1): 26. 9. Breaking the taboo of incontinence after childbirth. National Childcare Trust. 2016. 10. “My bladder and bowel own my life.” A collaborative workshop addressing the need for continence research. 2018. 11. Button BM, Holland AE, Sherburn MS et al. Prevalence, impact and specialised treatment of urinary incontinence in women with chronic lung disease. Physiotherapy J 2019 105 (1): 114-119. -
Content Article
Urology Services Inquiry
Patient Safety Learning posted an article in Other reports and inquiries
A decision was taken by the Minister for Health, Robin Swann MLA, to establish a statutory public inquiry following the lookback review of urology patients (January 2019 until May 2020) initiated by the Southern Health and Social Care Trust. These concerns were related to Mr Aidan O’Brien, Consultant Urologist employed within the Southern Trust. Terms of Reference Key documents, the hearings and latest news on the Inquiry can be found on the Urology Services Inquiry website.- Posted
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- Surgery - Urology
- Investigation
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Content Article
Mesh slings made of the same polypropylene plastic as the suspended women’s slings have been implanted into nearly 200 men across the UK suffering incontinence after prostate cancer. The operations were part of a trial in 28 hospitals where half the slings failed to fix men’s urinary leakage. Worse, just like the majority of women’s mesh implant trials, the full range of mesh-related pain was not logged in any paperwork. The trial, called the MASTER study, shows up to half the men given mesh surgery experienced: Burning or stinging when passing urine Discomfort and bruising in the perineum, scrotum and groins. Other complications of men’s mesh slings include: Mesh slicing into their urethra Overactive bladder Groin pain Chest infection, pulmonary embolism, stroke, deep vein thrombosis Heart attack Death. The MASTER study wanted to see if men’s mesh slings were more effective than the traditional non-mesh surgery; an operation using an artificial urinary sphincter that requires more time and surgeon skill. The trial set out to see if mesh slings were quicker, easier and more cost effective. Sound familiar? Now, trial authors admit they need to log and compare pain levels between mesh and non-mesh surgeries for their five year follow up – but why was this not included from the outset?- Posted
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- Medical device
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Content Article
Urinary tract infections (UTIs) exert a significant health and economic cost globally. Approximately one in four people with a previous history of UTI continue to develop recurrent or chronic infections. This review aims to present a novel perspective on chronic UTI by linking microbiology with immunology, which are commonly divergent in this field of research. It also describes the challenges in understanding chronic UTI pathogenesis and the human bladder immune response, largely conjectured from murine studies. Lastly, it outlines the shortcomings of current diagnostic methods in identifying individuals with chronic UTI and consequently treating them, potentially aggravating their disease due to mismanagement of prior episodes. This discourse highlights the need to consider these knowledge gaps and encourages more relevant studies of UTI in humans.- Posted
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- Urinary tract infections
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Content Article
The European Network for Safer Healthcare (ENSH) joined forces with the European Association of Urology Nurses (EAUN) to work on a policy campaign to prevent catheter-associated urinary tract infections (CAUTI) in Europe as a path to improving patient safety and preventing anti-microbial resistance (AMR) through: Improvement of adherence to existing European guidelines to prevent CAUTI. Development of European indicators to support the European Centre for Disease Prevention and Control (ECDC) and/or national surveillance systems. Key recommendations This list summarises key recommendations for healthcare professionals. Adherence to these recommendations would improve patient outcomes, reduce the spread of AMR and save public healthcare budgets millions of euros per year. Proper use of the urinary catheter: Urethral catheters should be used only when indicated, with a closed-circuit system and a port for taking samples. Catheters should be removed when they are unnecessary and their indication should be assessed daily. Proper insertion of the urinary catheter: Hand hygiene should be performed immediately before and after catheter insertion or any manipulation of the urethral catheter. A sterile/aseptic insertion technique should be used. Proper maintenance of the urinary catheter: Always keep the collecting system closed (urethral catheter, drainage tube and collecting bag). Keep the urine flow free, without obstacles in the circuit, and the collection bag below the level of the bladder. Maintain good catheter hygiene and use a catheter securement device. Use checklists/ care bundle to aid in urinary catheter maintenance. Guarantee the quality of the care: Health professionals must receive specific training on the insertion and maintenance of the urethral catheter. The urethral catheter insertion and maintenance protocols must be reviewed and updated periodically (every 3 years and/or when new evidence is published) Healthcare professionals need to receive regular feedback. Unit coordinators will periodically inform staff about urinary infections rates. Do not: Do not use antiseptics and antibiotics in daily hygiene. Do not use prophylactic antimicrobials in the insertion, maintenance or withdrawal of the urethral catheter. Do not change the urethral catheter routinely and periodically. Do not carry out bladder washes. Do not take cultures if infection is not suspected, except for colonisation studies. Do not routinely use antimicrobial-impregnated probes. Do not use antimicrobial treatment in asymptomatic bacteriuria.- Posted
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Content Article
In this insightful and informative review by Dr Shaffi from Cleveland Clinic learn how you can target Zero catheter-associated urinary tract infections (CAUTI) through close attention to practice - from patient selection through management of the catheter lifecycle and delivery of data driven practice learn the changes that matter.- Posted
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- Medicine - Genitourinary
- Urinary tract infections
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News Article
Women suffering from chronic urinary tract infections (UTIs) are facing mental health crises after being “dismissed and gaslighted” by health professionals for years, according to a leading specialist. Daily debilitating pain has left patients feeling suicidal, with those in recovery describing lingering mental health problems “akin to post-traumatic stress disorder (PTSD)”, said Dr Rajvinder Khasriya, an NHS consultant urogynaecologist at the Whittington Hospital in London. Patients have said they feel crippling anxiety over planning ahead to ensure there is always a toilet around, even after their condition has been controlled with treatment. Vicky Matthews, who searched for a diagnosis for three years after a recurrent UTI became chronic, said the condition caused a “gradual decline” in her mental health as medical professionals were unable to pinpoint what was causing her pain. "I questioned my pain. I questioned what was going on. I questioned whether it was actually real and that was a pretty awful thing to be dealing with on top of having physical pain,” the 43-year-old said, describing what she felt was “mental torture”. Read full story Source: I News, 12 February Further reading on the hub The clinical implications of bacterial pathogenesis and mucosal immunity in chronic urinary track infection- Posted
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- Womens health
- Urinary tract infections
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Content Article
Slides on preventing catheter-associated urinary tract infection (CAUTI) presented at a Safer Healthcare and Biosafety Network meeting. The session aimed to: Provide a brief overview of CAUTI as a clinical problem. Summarise evidence for key infection prevention practices to reduce CAUTI. Consider how to implement improvements to support best practice and promote safer care. -
Content Article
Complications of surgical mesh procedures have led to legal cases against manufacturers worldwide and to national inquiries about their safety. The aim of this study from Keltie K et al. was to investigate the rate of adverse events of these procedures for stress urinary incontinence in England over 8 years.- Posted
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- Womens health
- Patient harmed
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News Article
Trust focused on ‘reputation’ failed to address patient harms
Patient Safety Learning posted a news article in News
A focus on “reputation management” was a factor in how an acute trust failed to properly investigate serious safety concerns in a dysfunctional department where consultants were “divided along ethnic lines”. An external review into the urology services at University Hospitals of Morecambe Bay Foundation Trust has identified 520 cases where patients suffered “actual or potential harm”, including several cases where patients died. The review, commissioned by NHS England, has found there were “multiple individual, team, organisational, and regulatory shortfalls which have resulted in a systemic failure to deliver good urological care at all times”. Much of the report focuses on the trust’s failure to properly investigate concerns being raised, and to sort out poor relationships within the department which dated back 20 years. Read full story (paywalled) Source: HSJ, 24 November 2021- Posted
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News Article
NHS England: Pelvic floor physiotherapy will see improved services by March 2024
Patient Safety Learning posted a news article in News
Far too many women were rushed into mesh sling surgery for stress incontinence after birth when pelvic floor physiotherapy could have fixed or eased the problem. In France, women are offered pelvic floor physiotherapy after childbirth as standard. A recent question to the Secretary of State for Health and Social Care asked what assessment the Department has made of the potential benefits of offering new mothers pelvic floor physiotherapy. This question was answered on 15 November 2022: "The National Institute for Health and Care Excellence’s guidance recognises that physiotherapy is important for the prevention and treatment of pelvic floor problems relating to pregnancy and birth. The NHS Long Term Plan committed to ensure that women have access to multidisciplinary pelvic health clinics and pathways in England. NHS England is deploying perinatal pelvic health services to improve the prevention, identification and access to physiotherapy for pelvic health issues antenatally and postnatally. Two-thirds of local maternity and neonatal systems are expected to establish these services by the end of March 2023, with full deployment in England expected by March 2024." Source: Parallel Parliament, 15 November 2022- Posted
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Content Article
Providing high-quality care means putting patient safety at the forefront of every action and decision made in the provision of healthcare services. To achieve this requires the conditions of close cooperation, good communication and the application of effective systems, processes and controls - through good governance. This investigation carried out by Niche Health and & Social Care Consulting describes a complex and evolving set of circumstances where these conditions were not met at Morecambe Bay and which played-out negatively over many years, resulting in uncontrolled legacy. A primary objective of this investigation has been to seek a full and validated understanding of any patient harms or clinically untoward outcomes in Urology. Particularly, but not exclusively, to validate concerns raised publicly in the ‘whistleblowing’ publication Whistle in the Wind. The investigation found a multi-faceted set of contributory issues which cannot, in many cases, be singularly applied to individual Consultant failings.- Posted
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News Article
At 34 years old, Dawn Jaxson had two young daughters. Since going through childbirth she had been experiencing a prolapsed bladder and urinary incontinence. Her doctors recommended she have a vaginal mesh fitted to treat the problem, and she didn’t question their advice. But more than 15 years later, she wishes she had. “As soon as I’d actually had it fitted, I felt discomfort,” says Jaxson, now 50. “Then the pain just didn’t go.” After years of almost constant pelvic pain and “countless” medical appointments, Jaxson says: “This little tiny piece of tape is still ruining my life.” “I can literally be sat down and then out of nowhere, it will be like somebody is shoving a red-hot poker through my bladder,” she tells iNews. “Being intimate with somebody is just impossible. Sex is no joy. Imagine your worst period pain you could possibly have, and that’s what it’s like on a daily basis.” NHS Digital records show that between April 2008 and March 2017, 100,516 patients had a tape insertion procedure for stress urinary incontinence. A further 27,016 patients had a mesh procedure for pelvic organ prolapse. But the surgery was suspended in Scotland in 2014 and across the rest of the UK by 2018 following complaints about complications – and a review ordered. The review panel, overseen by Baroness Julia Cumberlege, spoke to more than 700 affected individuals and concluded that pelvic mesh procedures had caused “anguish, suffering, and many ruined lives”. In 2020, the panel set out nine recommendations to help the thousands of women affected, including the creation of specialist centres, so patients could have their mesh removed or receive further treatment. But two years on from that landmark report, women say they are still suffering debilitating symptoms and struggling to access the help they so desperately need. Kath Sansom, the founder of the campaigning group Sling the Mesh, has heard many similar stories from among the group’s 9,700 members. “The lack of action on financial redress is the biggest disappointment for women,” she says. “Pelvic mesh caused lifelong damage, and worse, the majority of us were not given any information on the risks. It’s not our fault this happened to us." “Some women have been left disabled in wheelchairs or walking with sticks. Others have had organs removed where mesh has turned brittle and sliced into them. Seven in 10 have lost their sex life. Everyone suffers chronic pain in varying degrees. Women have lost jobs, marriages, homes, and their quality of life.” Read full story Source: iNews, 18 August 2022- Posted
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News Article
A pilot scheme to reduce infections following catheter insertions has shown a 100% fall within a hospital trust. NHS Supply Chain is now encouraging acute trusts in England to take advantage of the scheme which has shown to not only reduce infection rates but shorten patient length of stay and save clinicians’ time. Catheter associated urinary tract infections (CAUTIs) are not uncommon and can cause patients significant pain, discomfort, confusion and anxiety for family and friends. They further impact healthcare with increased antibiotic use, prolonged hospital stays, increased clinical activity and risk of complaints and litigation. University Hospitals of North Midlands NHS Trust had audited its urethral catheterisation practice, and the way catheterised patients w19 July ere cared for in clinical areas. The audit highlighted a wide variation in care delivery leading to inconsistent outcomes for patients and staff. After reviewing the available options, the University Hospitals of North Midlands NHS Trust decided to pilot the BARD® Tray which contains all the essential items to catheterise or re-catheterise a patient in one pack and includes the catheter with a pre-connected urine drainage bag. This unique ‘closed system’ prevents ingress of bacteria and helps avoid catheter related infection. NHS Supply Chain: Rehabilitation, Disabled Services, Women’s Health and Associated Consumables worked alongside supplier Beckton Dickinson to provide the tray products required by the trust. During the three-month pilot, catheter related infection rates fell by 100% at the trust which coincided with a reduction in complaints and a reduced length of hospital stay for patients. Clinicians reported that the pack was intuitive and saved around five minutes per catheterisation, which during the pilot process meant saving 83 hours from 1,000 catheterisation procedures. While the BARD® Tray was more expensive than the individual components that were currently purchased, the pilot study demonstrated the clinical and financial value that was delivered by the tray being implemented across an organisation. The overall cost of components is slightly cheaper, but due to reduced catheterisations, consumables spend fell by 24%. Read full story Source: NHS Supply Chain, 19 July 2022- Posted
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Content Article
Urinary tract infections are painful - but usually short lived. For thousands of women and children though, the problem can last years. Is relief in sight? -
News Article
Women asked if bladder drug should be available to buy
Patient Safety Learning posted a news article in News
A pill to help treat an overactive bladder - which affects millions of women - could soon be available to buy in the UK without prescription. The Medicines and Healthcare products Regulatory Agency (MHRA) wants women and doctors to submit their views. Aquiette tablets treat the "urge to pee" condition which can cause frequent toilet trips and distressing accidents. Symptoms include having to urinate at least eight times a day and more than once during the night. It would be the first time a medicine for the treatment of overactive bladder would be available without prescription. Dr Laura Squire, from the MHRA, said: "For many women, an overactive bladder can make day-to-day living extremely challenging. "It can impact on relationships, on work, on social life, and it can lead to anxiety and depression. "Fortunately there are treatments around, and from today you will have a chance to have your say on whether one of those treatments, Aquiette, can be available for the first time without a prescription." Minister for Women's Health Maria Caulfield said: "When it comes to sensitive issues such as bladder control, speaking to a GP may act as a barrier for some women to seek help. "Reclassification of Aquiette would enable women to access vital medication without needing a prescription." The Commission on Human Medicines has been consulted and has advised that it is safe for Aquiette to be made available over-the-counter at UK pharmacies. The consultation will run for three weeks, closing on 6 May, 2022. Read full story Source: BBC News, 23 April 2022- Posted
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