From my experience as a doctor, there is an undeniable stigma surrounding certain health issues when it comes to the male population. Even the mere mention of a prostate examination sends most men into a silent panic, and for many, it is that fear that prevents them coming to see us doctors in the first place.

I have had conversations with countless men who have admitted they would rather risk having an undiagnosed serious illness than go to see the doctor, a thought I find quite terrifying. This stigma becomes amplified when it comes to prostate concerns. 

Let’s be frank; men are embarrassed when it comes to anything to do with the private parts, but to us doctors, this is baffling. A prostate examination is quick and painless and for medical professionals this is a procedure we will do day in day out. I hate to trivialise the issue, but a prostate exam really isn’t a big deal.

Embarrassment is stopping men seeking help

So why the stigma? Personally, I believe that television, films and social media have all contributed to this fear, as well as myths passed down from the generations. In other countries, such as France, for example, there is no such stigma. Much of the medications we take orally, they will use in rectal form. They are very relaxed about the issue, and so they should be. 

I have seen men in the A&E department who have presented with urinary retention, i.e. being unable to pass urine – sometimes for many hours, or even a day or so in some instances. Often, it turns out they have had symptoms for several months and only sought medical attention when it got to an extreme point.

Time and time again I hear the phrase, “I didn’t want to trouble the doctor,” but often, on further questioning, it comes out that they were embarrassed to talk about sensitive subjects for fear of judgement.

Not only is this really sad but also potentially very dangerous.

Earlier diagnosis means more effective treatment

I have personally seen the consequences of patients leaving it late to visit the doctor, and that delay has caused damage to the kidneys as a result of urinary retention. This is even more frustrating when it turns out that the underlying diagnosis – such as a benign prostate enlargement – is the cause, which is very much a treatable condition.

As a general rule, if we are able to pick up problems early, often, we are able to diagnose and provide treatment much more effectively than if we find problems later down the line.

It is so important that we tackle these stigmas head on, so that men feel more open and able to come forward and ask for help, rather than suffer in silence. 

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Tips from the Mitrofanoff Support charity for keeping your bladder healthy after having the Mitrofanoff bladder diversion surgery.

What is a Mitrofanoff?

In 1976 Professor Paul Mitrofanoff created a procedure, now known as the Mitrofanoff, for people who were unable to empty their bladder in the usual way.

• The procedure creates a channel between the bladder and the skin of the abdominal wall either on the side of the stomach or in the tummy button.
• A small tube (catheter) is passed through the channel to empty the bladder
• The channel avoids the need for a permanent bag

Who may need a Mitrofanoff?

Surgery may be required due to bladder, bowel or prostate cancer, or congenital birth malformations such as bladder exstrophy, posterior urethral valves and spina bifida. Those with multiple sclerosis or spinal cord injuries may also need the procedure and patients as young as three have been offered this surgical solution.

How Mitrofanoff patients can keep their bladders healthy

After surgery it is important for patients to look after their bladder to reduce the risk of urine infections, kidney and bladder stones.

Bladder washouts: Patients who have a neobladder or who have had their bladder enlarged using part of the bowel will need to perform weekly washouts to remove debris such as mucus, which is naturally produced by the intestine.

Management of mucus: Certain foods and drinks including dairy products, caffeine drinks, ale etc. can increase the production of mucus. Similarly, ailments such as colds, hay fever or gastrointestinal upset can also have an impact on mucus levels.

Drinking plenty of fluids: It is important patients drink enough to flush out the chemicals and debris that build up in the blood, kidneys and bladder and to help prevent urine infections. Two to three litres a day is ideal to keep urine a healthy light colour.

Regular toilet breaks: Mitrofanoff patients are sometimes unable to feel when they need to empty their bladder and so it is important that emptying takes place every three to four hours to reduce the risk of infection.

Healthy eating: This type of surgery can have an impact on the bowel function, either short or long term. If patients find there is a change in their bowel movement once they have fully recovered from surgery, they should discuss this change with a healthcare professional. Eating a varied and balanced diet will help the immune system to fight off any bugs and enhance recovery. Junk food should be avoided as it is high in fat, sugar, salt and calories.

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Urinary tract infection (UTI) is very common, especially among females, and around half of all women will experience a UTI in their lifetime. Typical symptoms would include pain on passing urine, frequent urination and dark, cloudy or strong-smelling urine.

Traditionally, UTI has almost always been treated with a course of antibiotics, but recent publicity surrounding the potential disadvantages of antibiotics has encouraged UTI sufferers to look for alternative treatment strategies.

The major concern surrounding the overuse of antibiotics is the emergence of bacteria which are resistant to antibiotics. The UK antimicrobial resistance strategy and action plan states that resistant bacteria are becoming more common and causing international concern. This plan suggests that the emergence of resistance is an inevitable result of the use of antibiotics and stresses the urgent need for prudent prescribing by clinicians as part of the strategy to control resistant bacteria.

There have already been a number of cases of bacterial infections that are resistant to all known antibiotics and the publicity surrounding these has rapidly increased awareness of this global threat.

Alternatives to antibiotics

For urinary tract infections there are several strategies that patients can use before recourse to antibiotics. Most patients will increase their fluid intake at the time of UTI in an attempt to ‘flush out’ the infection and indeed this is one of the body’s natural in-built defences against UTI.

Bacteria that have attached to the lining of the bladder can be expelled in the urine via increased urination. Furthermore, making the urine less acidic with a urinary alkalinising agent, such as sodium bicarbonate, may also help alleviate symptoms, specifically pain.

Simple pain killers, such as paracetamol or anti-inflammatory drugs such as ibuprofen, can also be effective for symptom relief.

Painkillers may be adequate for acute, one-off episodes

There is a growing body of evidence to suggest antibiotics may not be necessary for mild infections such as acute cystitis in patients without pre-existing urinary tract abnormalities. A 2015 study published in the British Medical Journal looked at over 200 women with mild UTI treated with ibuprofen and found that two in three made a full recovery from their UTI episode without the need for antibiotics.

Studies such as this have led to clinicians and patients alike questioning the need for antibiotics for all cases of UTI. Mild symptoms may respond to these strategies but patients with severe symptoms or systemic effects, such as high fever or feeling very unwell, should not rely on these options as they are likely to require antibiotic treatment to prevent a significant infection developing.

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There is a range of patients affected by issues relating to their bladders early in life. Some may be born with conditions – such as bladder exstrophy or posterior urethral valves – others may have neurological problems, such as spina bifida, which can affect the function of the bladder and bowel.

Some may develop changes in the way their bladders work as a result of conditions that arise in childhood – e.g. infections, some forms of tumour or injury as a result of trauma.

Most of these conditions are rare, but for those affected there are some important messages.

There is increasing expertise in the medical and surgical management of these (sometimes) complex conditions. While doctors are always looking to develop ideas to further improve care, the treatments that exist today have made a huge difference to the quality of life that many patients can expect to enjoy.

Healthcare professionals support patient self-care

It is important to know that, while there may still be some challenges to manage, many people go on to live very happy, healthy lives. As healthcare professionals, we try to support individuals to become experts in their own condition and what has happened to them. This allows them to describe their condition, the surgery or other treatment they have had and what has gone wrong. With appropriate back-up and education some may be able to describe or even undertake the first steps of self-management when things go wrong.

It is important that everyone knows when to seek expert help and how to get hold of those who can help them if needed. This comes as part of the long-term care and regular follow-up that is vital for everyone to get the best from their body and to avoid as many problems as possible.

Don’t let bladder and bowel issues take away your independence

This gives anyone affected by these conditions a huge amount of independence, allowing them to socialise with friends, fulfill their full educational potential, engage in relationships and (for many) have children. A child who has been affected by any of these conditions, will grow up with questions – and at times fears – about what life will hold for them. These are questions that we all ask ourselves, but the added worries about their condition or its treatment may amplify some concerns.

Christopher Woodhouse and I carried out an audit to look at what our patients were doing in 2010 (see Table 1) ¹. They are adult patients, many of whom have been affected but conditions they were born with and, as a result, have needed complex surgery. We found that only 8% were unemployed and around two-thirds were working in professional or skilled jobs. They are an extraordinary group of patients to work with – courageous, persistent, determined, knowledgeable and often achieving great things.

Table 1: Occupation audit results by diagnosis

[1] Woodhouse, C. R. J., Neild, G. H., Yu, R. N. & Bauer, S. Adult care of children from pediatric urology. J. Urol. 187, 1164–71 (2012).

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Whether it’s celebrities talking or something you see on the TV, urinary incontinence is becoming more well-known. But that doesn’t mean we’re doing anything about it.

For one in three women, urinary incontinence is something they will have to endure throughout their lives. Whether it was the outcome of pregnancy or the onset of menopause, there is certainly more acceptance these days that it can happen. However, little is mentioned about the psychological effects suffering can have.

Incontinence can cause anxiety and embarrassment

The anxiety that women can feel while suffering from urinary incontinence is a personal interest for Urology and Continence Nurse Specialist, Jane Brocksom, President of The British Association of Urological Nurses. “Mental health and incontinence go hand-in-hand,” she says.

“I have ladies who can only plan a trip into town if they know where all the toilets will be. It is even stopping previously outgoing ladies from leaving the house because they are scared they might leak and embarrass themselves. It really is debilitating.”

And with scandals in the media such as the Mesh campaign, there often seems like little choice for women but to suffer in silence. However, that’s not the case says Brocksom.

“Often, I find that the act of speaking up and talking to your GP or a specialist nurse is half the battle. I find that, for a lot of ladies, being able to have a good chat and examine why you might be suffering often goes a long way to resolving some of the problems.”

If I can help a woman to feel able to leave the house or pick the grandkids up, that’s a huge step forward.

Feel yourself again with lifestyle re-training

With women often juggling young families and older parents, there can be little opportunity to think of their own health. But often a frank and honest chat with a professional can help women to re-evaluate their drinking and toilet habits.

“I can’t remember learning to drink or go to the toilet” says Brocksom. “Sometimes we just need a bit of re-education. We might drink five cups of tea a day and think we’re hydrated, but we’re not getting the good stuff that we need. Equally, our lives are more sedentary, so if we’re sat on an office chair for most of the day, our pelvic floor muscles just aren’t getting any training. And it’s this lifestyle evaluation that a health professional can offer.”

A work out for your pelvic floor

Today’s women have little training on the pelvic floor, or the need to rest after childbirth, so with the onset of the menopause causing the pelvic floor to weaken, it can often come as a shock that the body is not as robust as it once was.

“It’s being able to evaluate and say I can’t do at 60 what I could do at 18, but how can I improve and continue to live my life?” adds Brocksom. “If I can help a woman to feel able to leave the house or pick the grandkids up, that’s a huge step forward.”

Certainly for Brocksom, making sure that women have access to specialist continence nurses is a big concern of hers. She says: “Women just need to know that there is someone there who cares about them. Mentally, that can make all the difference.”

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Minimally-invasive procedures could end the sub-optimal treatment being endured by men with benign prostatic hyperplasia (BPH).

Benign prostatic hyperplasia (BPH) has been described as ‘practically inevitable’ in older men. According to the NHS, 40% of men over 50, and 75% of men in their 70s have urinary symptoms caused by an enlarged prostate, which forces the urine tube to narrow.

There was a time when many men just accepted BPH and its associated symptoms as being part of older age – but not anymore. “In the past, there was a perception that this was an old man’s lot, but people are much more proactive about seeing their doctor,” says Dr Jonathan Rees, a GP with a special interest in urology.

By and large, the first course of treatment for most men is still medication. Alpha blockers, which relax the muscles and make it easier to pass urine, they are effective but are also a lifetime commitment. Surgery is another a proven option for those with more severe symptoms, but with that comes the risk of sexual dysfunction and incontinence.

Minimally-invasive procedures

Minimally-invasive procedures could offer more viable solutions to more men, whereby tiny implants are inserted into the urethra to hold open the obstructed pathway.

“We’re seeing new, minimally-invasive treatments, like this, that are simpler, quicker, cheaper and more tolerable for patients and have a better side-effect profile,” continues Dr Rees. “These could be a consideration for people who might have less severe symptoms, but don’t want to take medication for the next 25 years.”

Better access and results

Alternative treatments could also encourage the estimated 69% of men with BPH who choose not to take medication or undergo traditional surgery, to get the support they need. Dr Rees also believes that the procedures (many of which can be conducted in outpatient, or day case units, under local anaesthetic), could help to improve the quality of life of many patients.

“We realise many men are being sub-optimally controlled on medication but, subjectively, we know they would have better outcomes with minimally-invasive therapy,” he says.

Availability is not consistent

While the new treatments have been approved for use within the NHS, the threshold criteria for referrals differs across the country. This is something that Dr Rees would like to see change.

“What we’re after is a fair and level playing field, so all men get equal access to the therapies,” says Dr Rees. “There is cost, the impact on patients, and there are the side-effects of medication and surgery… We need to look at all these things together.”

With an ageing population, the number of men with BPH is only going to increase and alternative therapies, if universally available, could help ensure these men get the treatment they need.

The UroLift^® System treatment is a revolutionary, minimally-invasive approach to treating an enlarged prostate, or BPH, that lifts or holds the enlarged prostate tissue out of the way so it no longer blocks the urethra. There is no cutting, heating or removal of prostate tissue. Clinical data has shown that the UroLift System treatment is safe and effective in relieving lower urinary tract symptoms due to BPH without compromising sexual function^1,2,3. The goal of the UroLift System treatment is to relieve symptoms so you can get back to your life and resume your daily activities.

1. Roehrborn, Can J Urol 2015, 3-Year L.I.F.T. Study
2. Roehrborn, Urology Practice 2015, 2-Year L.I.F.T. Study
3. Roehrborn, J Urol 2013, L.I.F.T. Study

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Overactive bladder can completely ruin a life and it is more common than both diabetes and asthma, yet it’s almost never spoken about. It’s time we brought a stop to that. Here’s our guide.

For the roughly eight million people in the UK who struggle with overactive bladder (OAB), it means that they find it very difficult to hold their bladders. If you are suffering from OAB you may find yourself suddenly desperate for the loo and you will have to find a toilet in time or risk wetting yourself.

This can have an enormous impact on a life. You find yourself going to bed at night knowing that you’ll have to get up multiple times to rush to the loo. If you have an important meeting at work, you’ll find it difficult to be there for long without having to rush out. Going out anywhere is risky because you always need to know you can access a toilet.

Anything from going to the cinema or theatre, to a sports match or country walk, can become fraught. For some people with OAB, the fear of not being able to find a toilet can leave them housebound.

Overactive bladder (OAB) can ruin a life, but help is at hand

We don’t talk about OAB enough. In fact, we more or less don’t talk about it at all. There is a shame aspect associated with toilet troubles and it’s time we tackled it. No one should be too ashamed to come forward for help because treatments for OAB are readily available.

For World Continence Week this year, The Urology Foundation (TUF) celebrated 15 years of the use of Botox as a treatment for OAB.

This is, in part, thanks to research that Mr Arun Sahai conducted with a grant from The Urology Foundation. With TUF’s funding, Mr Sahai was able to run the world’s first, level one, double blind placebo controlled trial of Botox as a treatment for idiopathic OAB.

Botox, as well as drug treatments, is easy to access and so no one should be worried about seeing their GP if they have an issue with holding their bladder.

Get your Need To Pee card

If you struggle with holding your bladder and finding yourself needing the toilet often, then you might benefit from having one of TUF’s Need to Pee cards.

These cards are designed to get you access to a toilet in a local business with a minimum amount of fuss and time.

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Pelvic health refers to the function and wellbeing of the muscles, organs, nerves and connective tissues in the pelvic region. Many men and women are affected by pelvic health conditions. The majority of these conditions have a significant impact on quality of life due to pain and/or embarrassment.

Why is pelvic health so important?

Many of these conditions affect lifestyles, causing a decline in activity and social interaction and have a huge role to play in the decline of mental health. The figures speak for themselves. Between 15-30% of first-time mums will experience urinary incontinence, and a startling one in five first-time mums complain of faecal incontinence at one year postnatally. One in nine men leak urine and one in ten have faecal incontinence.

Urinary incontinence is cited as the second most common reason for elderly women being taken into care. Pelvic health conditions are, however, often preventable and treatable. 84% of women who suffer urinary incontinence stress that the condition improves with pelvic health physiotherapy. So, the outlook is by no means bleak – we just need to make pelvic health physiotherapy more accessible and improve education around this subject.

What sort of conditions do pelvic health physios treat?

Pelvic health (PH) physiotherapists treat women and men of all ages. Women will benefit from seeing a PH physio at every stage of their life cycle, including pregnancy, post baby and menopause.

PH physiotherapists treat women who leak urine, have bowel issues such as constipation and faecal urgency, pelvic organ prolapse, pelvic pain, dyspareunia (painful sex), diastasis recti (tummy separation) and pelvic girdle pain of pregnancy.

Men also have PH issues and many PH physios treat them too. Male conditions include leaking urine, faecal incontinence, pelvic pain, sexual dysfunction and pelvic dysfunction.

What impact can the strength of pelvic muscles have and how are we able to train/strengthen them?

The pelvic floor’s function is to stop us leaking wee and poo, support our pelvic organs (in women that includes the uterus, bladder and bowels), and improve our sexual function. It contributes to low back and pelvic stability and serves as a lymphatic ‘pump’. It’s a very important muscle.

Like any other muscle it needs to be exercised otherwise it stops working as well and its functionality is reduced. To ensure that you are doing your pelvic floor exercises correctly we advocate seeing a PH physiotherapist who will assess and teach you how to strengthen your pelvic floor. If you are unable to see a physio – download the ‘Squeezy app’, which is designed to help you exercise your pelvic floor correctly. Follow the simple instructions below to get started!

How to squeeze your pelvic floor muscles:

1. First, tighten (squeeze) the muscles around the back passage, as if you are trying to stop yourself passing wind.
2. While you hold this squeeze tighten around your vagina and urethra as if you are trying to stop yourself for passing urine.
3. It should feel like a squeeze and lift inside.
4. After each squeeze and lift make sure you fully relax your muscles by letting them rest back to the starting level.

Try not to hold your breath when you carry this out. You need to carry out both strong long holds, and short squeezes. The idea is that you carry out 10 second holds x10 reps and 10 quick flicks, three times a day.

There seems to be a taboo associated with conditions affecting the bladder and bowel: how do you think we can break this?

We need to talk about these conditions, raise awareness in the media and highlight that they are, unfortunately, common, but also very treatable and not just something you have to live with. It is not acceptable to suffer with these conditions and, by raising awareness, we can break the taboos, desensitise people’s embarrassment and give them ‘permission’ to talk about them.

What advice do you have for anyone who is suffering from a pelvic health condition?

Seek help. Visit your GP and request a referral to a PH physiotherapist. Alternatively, seek help privately if you are able to. You can find out where your local physiotherapist is by visiting the Squeezy directory too (www.squeezyapp.com/directory).Start your pelvic floor exercises today, using the squeezy app as a guide and reminder.

There is a heap of useful information on the internet about a variety of PH conditions, but it can be bewildering to know where to look!

There are excellent patient resources at pelvicroar.org and pogp.csp.org.uk

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Almost 42,000 people are diagnosed with bowel cancer annually.. Sadly, around 16,000 people die from the disease each year, making it the second biggest cancer killer. But this shouldn’t be the case. Bowel cancer is treatable and curable, especially if diagnosed early.

Early diagnosis is crucial to survival rates as nearly everyone will survive if diagnosed at the earliest stage. Screening is the best way to diagnose bowel cancer early when treatment has the best chance of working. It can also prevent bowel cancer through the removal of polyps (non-cancerous growths) that may develop into cancer.

The Bowel Cancer Screening Programme in England, Wales and Northern Ireland currently sends all men and women aged 60 to 74 (50 – 74 in Scotland) a home test kit every two years. However, both Welsh and English governments have since committed to lower the age at which people become eligible for bowel cancer screening to 50, in line with Scotland and international best practice.

With around 4,500 people aged 50-59 in the UK diagnosed with bowel cancer each year and a further 1,200 dying from it, this commitment will save many lives.

A new, simple and potentially more accurate test, known as the faecal immunochemical test (FIT), has recently been introduced into the Bowel Cancer Screening Programme in England. This test detects hidden traces of blood in poo that could indicate bowel cancer or polyps. It has the potential to detect twice as many cancers than the previous test and has been proven to increase participation in screening. If blood is detected, people will be referred for a colonoscopy to either confirm a diagnosis of bowel cancer or receive the all clear.

End the workforce capacity crisis

Improvements to the screening programme, an ageing population and changes to GP referral guidelines have meant more people are being referred for a colonoscopy – a key diagnostic test for bowel cancer – and this is putting NHS hospitals under unprecedented pressure.

At the very least, nearly a million more tests are needed, year-on-year in England, with demand for colonoscopies doubling in the last decade. But this has not been matched with additional trained workforce by the Government, and is having a significant impact on both colonoscopy and pathology services.

In fact, staff shortages in bowel cancer diagnostic services are the single biggest barrier to meeting commitments to improve survival rates for the disease. Already, thousands of patients are waiting longer for life-saving tests that diagnose bowel cancer.

Catherine’s story

Catherine, who was diagnosed with stage 3 bowel cancer, shares her experience of waiting longer than she should for life-saving tests. She explains: “In 2014, I spotted bleeding and visited my GP. They dismissed it as nothing serious. In late 2016, the bleeding became more frequent so I returned to the doctor. I was finally referred for a non-urgent appointment and asked to wait three months.”

Bowel Cancer UK’s Capacity Crisis campaign is urgently calling for these workforce capacity issues to be addressed in the NHS Improvement’s upcoming People Plan. It’s vital that clear commitments are made to increase capacity in bowel cancer diagnostic services so that more lives can be saved from the UK’s second biggest cancer killer. This is particularly important as the NHS Interim People Plan, published in June, failed to outline measures to address these capacity issues.

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