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Found 20 results
  1. 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
  2. Content Article
    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.
  3. Content Article
    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 content@pslhub.org. 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.
  4. News Article
    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
  5. News Article
    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
  6. News Article
    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
  7. 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
  8. 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
  9. Content Article
    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.
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