OneStat

Question:
I suffered a T12 burst fracture in my back and damaged my spinal cord. I am on the road to recovery quite well as I suffered paralysis but now, 6 months later, most of it is gone. I am now doing intermittent catheterisation as I cannot completely void my bladder. I can feel the urge to go, I wake up in the morning with the urge to go but when I urinate I can only go a little (50 - 100cc) so I end up having to catheterise. Is there anything I can do to help maintain the flow so I can get away from catheters?
25th Mar 2008

Answer:
You have been through a lot and after such a serious injury you are doing really well. The bladder is also going through the healing process and depending on the amount of nerve damage you experienced this may take some time. The fact that you are starting to urinate independently is a good sign but you will need to continue to empty your bladder with clean intermittent catheterisation as long as your bladder doesn't drain completely. Apart from performing the regular drainage you must allow time for complete healing to take place.

Lee O'Hara
Clinical Nurse Specialist

Question:
My husband had radical colostomy surgery after a bad accident 5 years ago. He went to his surgeon to ask about having it reversed and was told no. We live in the UK and the NHS is less than helpful with any of his ongoing problems. I am from the US and am convinced there must be some second opinions out there. He has a prolapsed hernia now that stands out alot and is in constant pain which has only been dealt with at a pain clinic. Can you offer any hope or suggestions?
25th Mar 2008

Answer:
I am sorry to hear you are dissatisfied with the NHS. If your husband has radical surgery that resulted in him having a colostomy then I think the surgeon who did the surgery is in the best position to know whether it is reversible or not. But you can ask for a second opinion and your GP should be able to arrange this. If your husband has a swelling under or around his stoma he may have a hernia and you could consult his stoma nurse for help with this. I hope you can find some resolution to his problems.

Lyn Kirkwood
Nurse Consultant
Urology, Stoma & Continence Care

Question:
I have just had an operation to have my stoma refashioned as i had a prolapse as i had mine done over 40years ago. Now my stoma is very small and my usual bags are'nt fitting very well.Any suggestions?

28th Feb 2008

Answer:
I would refer you to your local stoma therapist. Products are constantly being improved and it is quite usual for a change in product to be required when a refashioning has taken place. Most stoma supply companies also have help lines which are manned by specialist staff and they may be able to advise you. If you cannot find the contact details of your local stoma therapist, your GP surgery or local hospital will be able to help you.

Lee O'Hara
Clinical Nurse Specialist

Question:
Two weeks ago I had a TOT Tape fitted in the hope of easing my problem with Stress Incontinence. Should I still be having a blood-stained discharge or should I consult my doctor about this?

28th Feb 2008

Answer:
Normally after this type of surgery a little discharge may occur. You do not say how much there is and there is a risk an infection may have developed. I would suggest that if you haven't got an appointment with the specialist very soon you make an appointment with your GP.

Lee O'Hara
Clinical Nurse Specialist

Question:
After having had a number of strokes I find to my utter dismay and embarrassment that I am doubly incontinent, which I am told is that the cause is my sphincter muscles. I have tried pelvic floor muscles to no avail. Someimes I find I have messed myself without even knowing, so it comes as a real shock. Urine leaks out in the same way. I get out 2 or 3 times in the night and urine trickles out as I walk. What can be done about it?

28th Feb 2008

Answer:
I am very sorry to hear of your problems. Strokes are well known for causing bladder and bowel difficulties. I wonder of you have had a specialist assessment. It may not always be possible to cure the problem but there are ways in which to make your problems more manageable. Why don't you approach your GP or even your Stroke Care Specialist, I am sure they will refer you for assessment.

Lee O'Hara
Clinical Nurse Specialist

Question:
This week the doctor told me that I have diverticular disease. I have severe pains on my right side, my stomach swells. I have fever and chills often and at times I loose feeling in my legs. I have diarrhoea alot and I have no energy. My doctor told me to just take more fibre and that it was not serious because the pain is on my right side. I have had pain for 12 years. Is my condition worse than my doctor says and what can I do besides changing my diet?
26th Feb 2008

Answer:
Pains in the right lower abdomen often occur when gas stretches the walls of the caecum. This can occur even if the diverticular disease is on the left side of the colon since the caecum can balloon out with gas if the transit times are slow. Try your GP's advice to see what happens.
If more fibre does not improve the symptoms then try less in the diet as an experiment. Changing the diet is often the first type of advice given but taking more exercise and drinking more water may help as well. It is always useful when readers of the Incontact magazine who email their questions give some background information such as age, gender, occupation, whether they work shifts, eat regular meals etc. This way the quality of the general advice may improve. As always we encourage you you to seek advice from you GP or practice nurse.

Geoffrey Hutchinson
Consultant Surgeon, Gastroenterologist

Question:
I am a paraplegic and suffer from constant flatulence and some bloating which is very uncomfortable. What are the worst things to eat? I try not too eat too much roughage but eat healthily. I think I could have diverticulitis.
26th Feb 2008

Answer:
You have already identified the fact that too much residue or roughage in the diet may cause bloatedness because of bacterial activity and fermentation processes producing copious gas. You may also have additional problems as a paraplegic since physical exercise can stimulate peristaltic activity and affect transit times for residue. You could try massaging your abdomen which stimulate peristalsis, the sausaging motion of the bowel. Please visit your GP who could arrange tests to confirm or rule out any colonic diverticular disease.

Geoffrey Hutchinson
Consultant Surgeon, Gastroenterologist

Question:
I am a 32 year old male and I have an enlarged prostate that is causing me much discomfort, I am constantly having to go to the toilet even though I sometimes do not need to. The flow of urine is very slow and painful, and sometimes smelly. I sometimes go to the loo up tp 3 or 4 times in the space of 3 hours at nighttime and through the day. I also get alot of pain in my penis when passing urine, it feels as though the urine is getting trapped halfway up my penis and it can be very painful. I have had this problem for around 2 years now and have had tests, scans etc but so far no medication. I am concerned as around 18 months ago we decided to try for another baby, yet nothing has developed so far. Could this problem and the lack of treatment make me unable to have any more kids?
Is there any treatment you can recommend, herbally, if possible as I have read alot of bad reports about medications prescribed through GP's. There was a small article recently that says cocoa extract is a very good source to take for this problem, do you know if this is true? I will try anything even if I only get a little bit of relief.
8th Feb 2008

Answer:
I am not sure if you have been told you have an enlarged prostate and by who, but a man of your age would not normally have an enlarged prostate. Prostates don't tend to start enlarging until about the age of 40 onwards. You mention you have had tests but don't say what tests and who carried them out. From the symptoms you are describing I would expect you to have a flow test and complete a frequency volume chart. You may have some scarring in the penis and that may account for some of your symptoms. I would advise you to see your GP again and ask for a referral to a Urologist, if you have already seen a urologist you could be ask to be seen again.
There are no herbal remedies for this problem because we don't know what the problem is and until it is diagnosed you should not try taking anything especially when you read about them in newspapers. Medications that are prescribed by your GP would be safe but again, we need to know what the cause of your problem is and if medication would help.
If you are failing to get your wife pregnant, it may be related to your problem but it may not. Seeking professional help to get your problem sorted is the best way forward for you.
Good luck.
Lyn Kirkwood
Nurse Consultant
Urology, Stoma & Continence Care

Question:
I have recently had a Hartmanns reversal operation and experiencing some problems- excessive wind which is painful when passed and very noisy internally, back passage bleeding and diarrhoea although this is sometimes better than others. I find the bleeding distressing although it is not too excessive. Is this normal after this type of operation? When can I expect to make a full recovery?
8th Feb 2008

Answer:
I am sorry you are having problems since your Hartmanns reversal but your symptoms are not uncommon and you were probably warned about these by the surgeon before your op. Diet may have an effect on the amount of wind you are passing, you should try and avoid wind producing food such as beans, onions, cabbage etc. As your bowel has been disturbed and there is scar tissue there, the passage of stool can cause some bleeding and the wind going past may also account for the noise.
You should have a follow up appointment with your consultant and if you still have concerns you should raise them with him. But this usually does settle but I cannot say how long it will take as everyone is different. I hope you feel better soon.

Lyn Kirkwood
Nurse Consultant
Urology, Stoma & Continence Care

Question:
If you have any information on how to cope with IBS, I would be most grateful, i.e. foods - I have cut out green vegetables and lettuce and tomatoes, cucumber. I also suffer with acid reflux.
7th Feb 2008

Answer:
GORD (gastro-oesophageal reflux) and IBS often go hand in hand. It would be useful to know if you had Helicobacter Pylori (HP+ve) in the mucus of the outlet port of the stomach (antrum) since a course of so called 'triple' therapy would elimnate this acid-associated infection. Your GP could help with tests for Hp. H2 blockers or proton pump inhibitors (ppi) help to reduce acid levels. You have already started to experiment with diet and this may be crucial. Keep a record of the changes so that you can note any symptom improvements (you could score the symptoms on a 0-10 scale and watch for better scores). Often omitting or reducing dairy products and/or wheat content is worthwhile. Stress reduction in life style and weight loss and exercise may help you generally.

Geoffrey Hutchinson
Consultant Surgeon, Gastroenterologist

Question:
Hello Please help! I don't know what my problem is but it is ruining my life, sometimes I feel like I have to pee every ten minutes during night time and every hour during the day, but when I go to see the dr they don't find any infection. please what do you think I should do or what kind of problem do I have?. thank so much for your future answer.

22nd Nov 2007

Answer:
I am sorry to hear you are having such a miserable time with your bladder. There are quite a few causes for your symptoms besides infection.

You may have a small bladder capacity, you may not be drinking enough to dilute the urine therefore causing bladder irritation or you may have a condition called Overactive Bladder. All these things can be helped, but you need to have an assessment of your symptoms by your local Continence Adviser. You can be referred by your GP or you can self refer. I hope this helps.

Lyn Kirkwood
Nurse Consultant
Urology, Stoma & Continence Care

Question:
I WOULD LIKE SOME INFORMATION ON SURGERY I HAD DONE. WAS CALLED A DETRUSOR MYOMECTOMY. I HAD THIS DONE IN 2001 AND AM EXPERIENCING NO END OF PROBLEMS BECAUSE OF IT. I HAVE HAD TO HAVE SURGERY ON MY BOWEL BECAUSE OF IT WHICH WAS CALLED A DELORMES PROCEEDURE.

I AM LEFT TO DATE WITH DIFFICULTY DAY TO DAY LIVING, MY BOWEL IS EXTREMELY PAINFUL EVERY DAY, I HAVE BOWEL INCONTINENCE I CANT WEE PROPERLY.

22nd Nov 2007

Answer:
A Detrusor Myectomy is an operation done to help with a condition called Overactive Bladder, you may have tried lots of medication that didn’t help with your original symptoms. The operation cuts the muscle in the bladder to stop it from contracting. Most patients who have this surgery have to intermittently catheterise to empty their bladder, if you are not doing this, this may be the reason why you are having problems in passing urine.Your muscle will probably not be able to squeeze enough to empty your bladder. You need to contact the Doctor who did your operation or your local Continence Adviser who will be able to help you.

I am not sure that your bowel problem was caused by your Myectomy Operation as this operation does not have anything to do with your bowel. A Delormes Procedure is done to repair a rectal prolapse, at the time of the operation the angle of the bowel may be altered and this can lead to pain and incontinence. Again you should consult your Continence Adviser who will be able to advise about medication to help with your problem.

I hope things get better soon.

Lyn Kirkwood
Nurse Consultant
Urology, Stoma & Continence Care

Question:
What can I do to stop diarrhoea? I go about six times even though I take 6 to 8 lopermide a day. I have no life as I cannot leave the house as it is getting worse. I have been told I have IBS.

20th Nov 2007

Answer:
If proper colitis has been excluded by your doctors then a diarrhoea-predominant irritable bowel (IBS-D) is probable and the long duration of symptoms (>20 years) gives testimony to the benign nature of IBS. Sometimes bile from the small bowel reached the colon to cause a 'chemical' type of colitis and medication to bind bile salts and bile acids within the small bowel before bile reaches the colon may help. Certainly there would be no harm in discussing with your GP a trial of something like Questranlight, one sachet taken with water at about noon each day, to bind the bile, perhaps in combination with 1 sachet of Normacol taken at bed time (with water). The Normacol granules will soak up excess water in the bowel lumen to produce a more solid stool. The bonus of Questranlight is that it may also help to lower the circulating cholesterol levels. I am sure your GP would be keen to discuss all your on-going worries.

Geoffrey Hutchinson
Consultant Surgeon, Gastroenterologist

Question:
I had an L5/S1 prolapse nearly ten years ago now and have been left withCauda Equina Syndrome. I have tried all the usual continence medication, vesicare, ditropan etc. I was then given a TVT to cure part of my incontinence, this however made my stress incontinence a lot worse, which I was warned about before the op. I have now had BOTOX injections into my bladder and for the first 4 weeks I was in heaven, no leakage or anything, however, I have since had 4 infections, usually a couple of weeks apart. I ISC every 4 hours on the advice of my urologist, who I don't see for another 6 weeks. What can I do to reduce these infections. I clean myself regularly, shower twice a day, and am very careful whilst using my catheters. I'm at my wits end with all of this, and its starting to affect my working life as well.

15th Nov 2007

Answer:
I am sorry to hear you are having problems with infections following your Botox treatment, have your infections been proven by your GP sending samples away. If not, it is important not just to treat on symptoms alone, it is important to get the right antibiotics. Drinking cranberry juice may also help. Otherwise you seem to be doing all the right things.

Lyn Kirkwood
Nurse Consultant
Urology, Stoma & Continence Care

Question:
I am a 47 year old male and I have been using intermittentent indwelling catheterisation for a number of years to resolve short term urine retention problems associated with an over extended bladder and stress. Generally urine retention only lasts 12-24 hours but I have found a single catheterisation procedure is easier than repeated procedures using a non indwelling catheter. Over time, I have found catheterisation with a larger diameter (22-24 FG) easier to insert, is less likely to result in any trauma and reduces leakage. Additionally, as I remain fully mobile during this period I find it less prone to 'pistoning' and is generally more comfortable than a smaller 12 FG cathether that I used initially. Following withdrawal of the catheter I remain incontinent for a day or so but this is manageable.

My questions: Are there any long term complications associated with occasional but regular (once a month or so) use of indwelling catheters such as I describe?
Currently I have been advised that, within reason, an indwelling catheter should not restrict mobility but I would welcome a second opinion.

15th Nov 2007

Answer:
We would normally recommend that you do intermittent catheterisation when you have episodes of retention rather than put an indwelling catheter in. We normally don’t use anything bigger than a size 16fg catheter. And I am surprised that your GP is prescribing a bigger catheter. You can do damage to the urethra if you continue using such a big catheter and that is why you may be incontinent after removing the catheter. An indwelling catheter does not restrict movement. You should discuss this with the Doctor or Urology nurse at the hospital where you were treated in the first place.

Lyn Kirkwood
Nurse Consultant
Urology, Stoma & Continence Care

Question:
A close relative has recently had an operation through the abdomen to repair a prolapsed rectum. Since the operation her health has deteriated although supposedly the operation has worked. She has no feeling in her bowel and is unable to push. She has been put on the laxative movicol which she has to take everyday. She has been taking it now for over four months. She is in constant discomfort. She feels sick, doesn't feel like eating anything, her stomach feels bloated and full and swishes about, she has wind and cramps, and she can't sit down for long because it is so uncomfortable. She has lost several stones in weight and is very weak. She cannot do anything she could do before this happened (eg sport, go out with friends) and she is very depressed that this will not get better. Should she keep taking the movicol or what would happen if she doesn't take it? No one seems to be able to give her any help and we don't know who to speak to. The doctor just said she may need to take movicol for ever. Could there be something wrong the doctor is missing? Any advice would be very greatly appreciated. Thank you.

15th Nov 2007

Answer:
I am sorry to hear your friend isn’t doing so well after her surgery .If you repair a rectal prolapse you can alter the angle of the rectum and therefore it makes it more difficult to pass stool, so the movicol is necessary to help with this. I am not sure why she is getting the other symptoms, if she hasn’t had a follow up appointment with the consultant who did the operation she should ask for one, she can do this by contacting the consultant's secretary. If she has seen them, she needs to go back to her GP to see if he can refer her back or ask for a second opinion by referring her to another consultant. If you live in an area where there is a bladder and bowel continence service, you can refer yourself to that service.


Lyn Kirkwood
Nurse Consultant
Urology, Stoma & Continence Care

Question:
My 83 year old mother has severe diverticular disease. She is anaemic and has constant, severe diarroea. Her bowel is leaking into her bladder therefore she has been peeing faeces for the last three months. She has been told she will have to wait until January before they will operate. Is this safe and /or acceptable?
22nd Oct 2007

Answer:
Vesico-colic fistula, where an abnormal connection between bladder and colon develops, is a well-recognised complication of DD. The inflamed colonic out-pouching can penetrate the adjacent bladder and the normally sterile urine becomes infected with the faces from the colon. On some occasions, if a patient is frail or medically unfit, the surgeon may decide that it is safer just to keep the patient on antibiotics to try to sterilise the urine. Sometimes, nature will close the fistula if it is very tiny. Again, in the frail or elderly, a simple colostomy upstream from the fistula will allow the connection to close. The resection of the fistula itself is often a very major undertaking especially in the elderly and as an alternative a prolonged course of antibiotics is often given to provide an opportunity to heal and seal the fistula.

Geoffrey Hutchinson
Consultant Surgeon, Gastroenterologist

Question:
I was recently told I have diverticulitis after been scoped by my gastro doctor. During my follow up meeting i was told the diseased part needs to be cut out - resection. I have never had a traditional diver attack - no pain, fever, blood in stool ect however a few bouts of what was thought to be IBS. How do i go from an annoying IBS type symptoms to having my bowel operated on? Do i need a second opinion?

22nd Oct 2007

Answer:
Surgical resection for DD is usually offered when complications have arisen, such as narrowing of the bowel (or stenosis), recurrent abscess formation, fistula into the bladder or very severe bleeding. Uncomplicated DD can normally be treated conservatively with dietary measures or antibiotics. Your GP should have received a letter from the consultant with the reasons for the planned surgery and it would be sensible to go along and discuss the treatment options at the practice. They could also advise on the need for a second opinion before any major surgery is planned.

Geoffrey Hutchinson
Consultant Surgeon, Gastroenterologist

Question:
Hi there, I am looking after a lady who has a supra-pubic catheter. At night she has been getting very upset as she is waking up finding that the catheter is by-passing. The catheter has been changed and she has had a bladder washout and the catheter is patent. Today she was also passing urine per urethra. Why is this happening please?
8th Oct 2007

Answer:
Suprapubic catheters (SPC) are inserted into the bladder through an incision in the abdomen. Usually they are used as a last resort in bladder care once all other options have been explored.
Often patients have had a urethral catheter in place for a time before SPC is considered. Unfortunately this can lead to damage of the urethral sphincter (Tap mechanism) caused by the weight of the balloon ( the method by which the catheter is held in place ). This can lead to urine leaking urethrally despite having the SPC in place.
It is useful to ensure the night drainage bags are fitted correctly and are not being kinked by being inadvertently laid on.
Sometimes people can experience bladder spasm as the catheter irritates the sensitive lining of the bladder. This can cause the leaking of urine around the site of entry and/or urethrally. It may be worth exploring the use of anticholinergic (antispasmodic) medication with her GP.
If all else fails and she has not been catheterised for urine retention, it may be worth managing her incontinence with pads.

Lee O'Hara
Clinical Nurse Specialist

Question:
I had a prolapsed bowel operation last year. I also feel my bladder is full even when I have been to the toilet. My bowel was pushing through to the front before the operation and about six months later the same thing is happening again. The operation was supposed to prevent this.
It was a terrible operation, it went wrong as my bowel twisted four days after and I had to go back in and have it done again.
I do not know what to do now as I cannot go through that operation again. I have to get up two or three times during the night as I always feel I need to go the toilet. It is disrupting my sleep and I feel like a zombie. I am worried that I can get an infection with my bowel pushing through ( I have never had one). My Mother recently died with bowel trouble. I have tried the exercises but they do not work as I feel my bowel is crushing my bladder.
Can you please advise?
8th Oct 2007

Answer:
I feel you would benefit from an assessment from a Continence Specialist.
There are several areas here that need looking at.
Firstly, your bowel pattern – are you constipated or do you have loose motions?
Secondly, diet – how much and what type of fibre are you eating? Are you drinking sufficiently?
Thirdly, your pelvic floor muscles need assessment. You say you have been doing them but your technique needs assessing to ensure you are doing them correctly. It is very common for ladies to not fully understand which muscle to exercise.
I would visit your GP and ask what services are available locally. Good luck.

Lee O'Hara
Clinical Nurse Specialist

Question:
I am a healthy 69 year old male who has just undergone a TURP procedure for BPH. At day + 5, I have excellent flow rate (up 300%+) and no more urine discolouration or clots or debris. Just one problem, when part way through voiding, and still feeling urge, flow stops abruptly. This is followed by acutely uncomfortable pressure build-up sensation, which fortunatley subsides. Urge tends to remain, increasing with time until next voiding. (Similar phenomenon in months before procedure, but allowed more complete voiding and without discomfort). GP advice is 'drink plently of water, urinate when you want to and wait till it gets better'. (No comment as to how long this may take). I gather this may be a form of 'dyssnergy', where the bladder muscle is contracting but the sphincter is deciding to close prematurely. I can live with this, but would like to think that there is some combination of bladder rettraining exercises, medication, drinking regime or diet which might make the return to normal faster and/or more effective. Is there anything you can suggest?

8th Oct 2007

Answer:
Your research is quite correct and there is a condition known as Sphincter Dyssinergia which as you say causes the sphincter mechanism to close when it should relax.
It may have been caused by some interference to the nerve supply at the time of your surgery.
It would be advisable to see your Urologist again as you do not say how long it has been since your TURP.You may need further tests to assess the extent of the condition.

Lee O'Hara
Clinical Nurse Specialist

Question:
My father is due to have his indwelling catheter changed to a suprapubic catheter. Can you explain what are the potential problems with this new catheter? The original indwelling catheter worked very well but he experienced occasional very heavy bleeding which was apparently due to the urethra being traumatised by the catheter.

5th Oct 2007

Answer:
If your father is experiencing bleeding at each catheter change this is usually as it goes through the prostate. The prostate is quite a vascular organ and can bleed easily, this can lead to the catheter blocking. A suprapubic catheter goes into the bladder through the abdominal wall, therefore it is well away from the prostate.

Most patients find the suprapubic catheters more comfortable and less traumatic to change.

The problems that patients get with a urethral catheter are the same as with a suprapubic as the catheters are exactly the same, it is only the entry site that is different.

Some patients get a slight discharge around the suprapubic site, this can be helped by alternating the leg that it sits on daily.

There really are no other problems with a suprapubic catheter.

Lyn Kirkwood
Nurse Consultant
Urology, Stoma and Continence Care

Question:
My surgeon has suggested collagen placed at the bladder neck will help the urinary leakage problems that I have when playing sports. However, I have had a radical prostatectomy followed by radiotherapy and have read on the internet that this collagen treatment is not possible or suitable where there has been a radical prostatectomy followed by radiotherapy. Should I have this treatment or not?
5th Oct 2007

Answer:
I cannot advise you which treatment you should have but in the Trust where I work, collagen treatment is not used to treat this type of incontinence post prostatectomy and radiotherapy. If the symptoms are severe enough then an artificial sphincter is used. It may be worth discussing your concerns with your consultant and also ask him about artificial sphincters before deciding what to do.

Lyn Kirkwood
Nurse Consultant
Urology, Stoma and Continence Care

Question:
When I catheterise I sometimes have a small trace of blood in the tip. Why?
5th Oct 2007

Answer:
It is not uncommon to get a small trace of blood when you catheterise. Depending on which type of catheter you use, some have polished eyes and some don't, so may be slightly rougher and can cause slight trauma to the water passage as they go through.

The other causes of bleeding may be a urinary infection. If you feel unwell or have offensive urine it is best to send a urine sample to your GP to get it tested.

Lyn Kirkwood
Nurse Consultant
Urology, Stoma and Continence Care

Question:
I am 39 years old and have been suffering from stress incontinence since giving birth to twins in 2001. I was orginally referred for physiotherapy, but leaking urine was still troublesome. I have just had urodynamics investigations and was told the best form of treatment for me would be the injectables (bulking agents). I am a little aprehensive as the success rate is about 70% and the treatment is less or not affective after about two years. If I opt for this treatment and it doesnt work could I then consider other treatments such as the tvt afterwards?


14th Sep 2007

Answer:
There are many treatments for your problem including surgery. Injectables in our Trust are usually our last resort for patients who have failed surgery or are too old or frail for surgery. You should ask you Doctor about alternative treatments ie TVT or TOT that may be suitable for you.

Lyn Kirkwood
Nurse Consultant
Urology, Stoma and Continence Care

Question:
My mother is 84. She has had concerns about incontinence for some time. She has needed to find a toilet very quickly. At the beginning of July 2007 she had an operation on her spine (balloon Kyphoplasty. In early August she began waking 3 or 4 times a night to go to the toilet. She consulted her doctor who prescribed anti biotics but the condition did not improve. She has consulted her doctor again and he has informed her that as she is not incontinent he does not propose to do anything. She received this message from the receptionist. Can we seek a referral to the continence adviser? If they do not have one at her practice, how would we find one?


14th Sep 2007

Answer:
I am sorry to hear about you mums problems, there is help available out there and you can refer directly to your local continence advisor, or you can ask another GP to refer your mum to the service.
Incontact can assist you in locating a local continence advisor.

Lyn Kirkwood
Nurse Consultant
Urology, Stoma and Continence Care

Question:
Hi there. Thank you in advance for taking the time to read my letter. I am 35 years old, and have Pelvic Prolapse - uterin, cystocele (bladder), and rectocele (bowel). I first noticed a heaviness in my vagina 8 years ago when my daughter was born, but the pressure seemed to lessen within a year of her birth. After my son was born 3 years ago, my condition worsend significantly. My uterus has actually fallen into my vagina, and sits at the vaginal opening probably 80-90 percent of the time (when standing). Both of my children's delieveries were vaginal, however, I do not doubt that this was an issue I had long before my children were born. I have had a lifelong struggle with constipation, I have NEVER been able to wear a tampon, and I have suffered from back pain for about 10 years. I do not have a problem with continence, athough my bladder doesn't always completely empty. At this point, I am scheduled for a hysterectomy in January. The surgery will also consist of rectocele and cystocele repair as needed - as well as any vaginal repair my surgeon deems necessary. He feels that a hysterectomy, rather than a repair, would provide the most successful outcome for me. Although the plan is to only remove the uterus (keeping the ovaries), my fear is early onset menopause, and sexual issues after surgery. As a very sexual person, and an active 35 year old, my question is this: Is a repair job something I should push my surgeon to consider? And, am I right to fear early onset menopause? I have read that the ovaries stop producing hormones within 2-3 years after hysterectomy due to lack of blood circulation. I am terrified that this surgery will result in side effects that may outweigh the obvious benefits; and I would appreciate any advice or insight you may be able to provide.


14th Sep 2007

Answer:
From your history I think your Doctor is giving you the best operations to sort out your problems. In my experience if you don’t have a hysterectomy then despite a repair your uterus may prolapse again at a later date.
I am not aware that having a hysterectomy will lead to early onset menopause especially as your ovaries are being left.
If you have concerns about these issues you could ask for another appointment with your consultant so that you can clarify the issues, and therefore you will feel better informed about your operation, and at the end of the day you need to way up the pro’s and con’s before making your final decision.

Lyn Kirkwood
Nurse Consultant
Urology, Stoma and Continence Care

Question:
I have suffered with double incontince now for the past 2 years. I have been buying my pads through differant firms. Is there anywhere I can get them on the nhs????

10th Sep 2007

Answer:
Incontinence pad supply from the NHS can be varied depending on your needs and where you live. May i suggest that you contact your GP surgery and ask what continence advisory services are available in your area.It may be possible to have some treatment for your condition as well as products to help you manage it.

Lee O'Hara
Clinical Nurse Specialist

Question:
I am a male in my 20s and have a problem... After urinating, and leaving the toilet, I find that a small quantity of urine comes (1 or 2 drops). This may be in the first few minutes of leaving, or within the first half hour. Sometimes no urine comes out (for example after a motion). This problem has been present for many years, during which time I have tried many methods to expel the remaining urine. I always ensure that I allow all the urine to pass fully before I leave the toilet. (ie, i don't stop early/rush). I have tried coughing a couple of times to expel the urine, squeezing the penis gently, and even pelvic floor exercises, but none of these work fully or all the time. I recently talked to my doctor about the problem, and he said that there is some residual urine left in the urther and this can be expelled by gently pressing on the under side of the penis. I have examined my penis and there is a vessel on the top right side of the base of the penis which goes to w!
ards the tip. It bends left and then rght towards the front of the penis, and then disappears from view. I can't work out if this is the urether or the corpus cavernosum. I would appreciate if you could answer the following questions:
What type of incontinence do I have?
Is the vessel that I can see the urether or something else?
How do I expel all the urine, including residual urine?

10th Sep 2007

Answer:
This type of leakage is called post void (emptying) dribbling.This occurs when a small amount of urine is trapped in the 's-bend' of the male urethra. After you have emptied your bladder try tightening your pelvic floor muscles strongly while still standing over the toilet. You can also lift up your scrotum which help eliminate that collection of urine within the urethra. As for the vessel you can see on your penis, it is likely to be a blood vessel close to the surface of the skin but I would recommend you visit your GP for an examination to relieve your anxieties.

Lee O'Hara
Clinical Nurse Specialist

Question:
In 2001 I had hysteretomy. I felt fine for a few years, the last 2 years I now have bowel problems, being constipated alot and over active bladder where to I am always wanting to urinate.Why am I like this years later and what can be done?


10th Sep 2007

Answer:
It is very difficult to be specific with such little information but you could be developing these problems due to quite simple changes in your diet or fluid intake.Stress can also play a part as can other physical changes within your body, which can be quite complex. I think it would be a good idea to have a chat with your GP in the first instance.He/she may suggest you see a specialist.

Lee O'Hara
Clinical Nurse Specialist

Question:
Can diverticulitis affect body odour and hair growth?
10th Sep 2007

Answer:
I have never seen this type of relationship but these symptoms are certainly interesting and may point towards other systems eg endocrine problems etc. Please discuss them with your GP whom, I feel certain, would love to get to grips with these intersting symptoms.

Geoffrey Hutchinson
Consultant Surgeon, Gastroenterologist

Question:
Is there a link between body ache and diverticular attack i.e legs, thighs etc?
10th Sep 2007

Answer:
Symptoms in the legs and thighs from DD are not usual but IBS can often have symptoms of back ache, leg pains etc. Fibromyalgia can sometimes be associated with IBS symptoms. Your GP may be able to link your abdominal and locomotor symptoms.

Geoffrey Hutchinson
Consultant Surgeon, Gastroenterologist

Question:
I am suffering from constipation over the last 7 years. Is it possible to get back to normal? Is there any effective medication for this? Can you help me? Thank you.
10th Sep 2007

Answer:
Please go along to your GP to discuss your worries about constipation. There are many helpful preparations to take but a detailed history and dietary diary may point towards specific changes. Sometimes simply increasing the volume of water in your daily intake may help together with an improved exercise programme.

Geoffrey Hutchinson
Consultant Surgeon, Gastroenterologist

Question:
I have IBS (diarrhoea) and would like to know what I can take to bulk the waste, I have tried all sorts of things like gluten free, dairy free, wheat free, nothing is working. I am living on immodium every day, sometimes 8 a day. I have even tried only having 1 meal a day, but drinking plenty of fluids, can you help? It is getting me down and I am due to go away on holiday and am dreading it. Everywhere I go I have to make sure there is a toilet, otherwise I will not go, that is making my life worthless and unhappy, I hope you can help. I just want to be normal.
10th Sep 2007

Answer:
Sometimes bile reaches the colon and causes a chemical type of colitis. If this is the case then a bile acid binding agent such as Colestid or Questran Light might help. In addition, Normacol, one sachet per day, may help to mop up excess water in the lumen of the colon and produce more solid stools. It would be well worthwhile discussing the details of your symptoms with your GP because simple solutions are often available.

Geoffrey Hutchinson
Consultant Surgeon, Gastroenterologist

Question:
My Father is suffering from prostate cancer and is now incontinent. About a month ago he started using Conveen. However, the sheath sometimes comes off because of retraction. Can you suggest any alternative type of sheath that would be more reliable? Is there any answer to the problem of retraction? Any advice you could give would be much appreciated.
Thank you for your help

9th Aug 2007

Answer:
There are many types of conveens on the market. Some are shorter than others and are suitable for retraction. There are other devices that are also available to help with retraction. Your local District Nurse or continence advisor should be able to help.

Lyn Kirkwood
Nurse Consultant
Urology, Stoma and Continence Care

Question:
I am a 33 year old mother of 3 (11,10,7) I have suffered from stress incontinence for 3 years now but have in the past 2 years had problems with urge incontinence. For some reason this only seems to happen in the week and first 2 days of my period. I have to use pull ups during this period as pads wont hold enough but even then, sometimes a I leak. I also, randomly, suffer from bed wetting and can't have sex anytime without leaking. During these times I rarely go out as I don't want to risk any problems ( I recently had a major leak in the supermarket). I have used Kegel exercises and cones to help with the stress with a small improvement. My GP doesn't seem interested. I am a severe asthmatic so do cough alot. Please can you offer some suggestions.
9th Aug 2007

Answer:
There is help available for you. You sound as if you could have stress incontinence and a condition called 'bladder overactivity'. Pelvic floor exercises will help with the stress incontinence; bladder training, fluid adjustment and medication will help with the urgency. Some women get worse symptoms just before their periods.

You can refer yourself to a local continence advisor or ask your GP to refer you to a Urogynaecologist. The continence advisor will help you with the conservative treatments I have mentioned.

Lyn Kirkwood
Nurse Consultant
Urology, Stoma and Continence Care

Question:
Hi I am a 42 year old man who's been self catheterising since I was 18. Emotionally it's crippled me and destroyed every relationship I have ever had. The main problem is that most nights I still wake up soaking. It normally happens just before I wake up. When I drink a large amount of alcohol I usually wake up dry, or when I am staying at someone's house. I really can't understand this and believe its all in my mind. Also in 2003, I was in hospital with a serious bladder infection and I was fitted with a balloon catheter which collapsed the muscle round the neck of my bladder, resulting in my ejeculation going back into my bladder. Please can you help as I feel I've been left to just deal with it without any help.
9th Aug 2007

Answer:
I'm sorry to hear about the problems that you are having. You don't say why you need to self catheterise or how many times a day you catheterise. If you don't catheterise before going to bed at present, you could try this to see if it might relieve your problem.

There are people out there to help you, so don't despair. There should be a continence advisor in your area who will be able to offer help and support, so please do make contact. I'm not sure if you are under the care of a Urologist, but if you haven't seen one for a long time you can ask your GP to refer you.

Lyn Kirkwood
Nurse Consultant
Urology, Stoma and Continence Care

Question:
My mother has a supra pubic catheter inserted in April. Since then she has had nothing but problems with it. Her catheter will work well for about a week after the tubing has changed, which is done every four weeks, but then it just stops working altogether and she is continuously wet. She has developed pressure sores and being wet with urine all the time will not allow them to heal. We have been back to her urologists several times and he says he doesn't have an answer for us. He says she must be pulling on it but this is not true. We are both frustrated by this. Having this operation was supposed to make her life easier, not more stressful. It makes my life stressful too since I an her care taker. She just had the tube changed about a week ago and once again, nothing is draining into her bag, it is all coming out of her. She will be soaked in the morning once again. I need to know why her urologist refuses to see there is a serious problems and at least try to correct it. What can you tell me?
8th Aug 2007

Answer:
I am sorry to hear that you are having so many problems with your mother's supra-public catheter and that your urologist has been unsympathetic. There are many reasons why catheters give problems. I'm not sure if your mother had a urethral catheter before having the supra-pubic and if she did, was she experiencing the same problems? Supra-pubics will often give the same problems as a urethral catheter.

Catheters can become blocked with sediment or patients can get bladder spasm, either of which will lead to leakage or, it may be positional.

Your local continence advisor or urology nurse specialist may be able to help and advise you, or you could ask your GP if he could refer your mother to another urologist for a second opinion.

Lyn Kirkwood
Nurse Consultant
Urology, Stoma and Continence Care

Question:
Just wanted to ask a question about intermittent cathing and a supra pubic catheter. I currently take 15mg of oxybutanin xr and cath about 4 times a day I am able to pee inbetween cathings. My problem is the effect of the oxybutanin is wearing off and I am tired of taking all these different meds, I have in the past used foley catheters when cathing was not available. I would like to ask my urologist about a suprapubic cath, but am not 100% sure. What is the procedure and the recovery time, and what are the good and bad points? Now if I stop taking the meds I wet like crazy this is all due to a wreck I had that damaged some nerves in my neck. Im just tired of all the meds and cathing, the foleys are great but I am sexually active and married. Is this a good alternative?

27th Jul 2007

Answer:
Your bladder sounds as if it is really overactive hence the high dose of oxybutinin you are taking. Any type of indwelling catheter has the possibility of irritating the lining of the bladder leading to an increase of overactive bladder symptoms, e.g: bladder spasm, bypassing of urine around the catheter.
It maybe that you would need to continue taking medication. I think you need to speak to the Urologist, as he knows your particular case in detail and express your concerns.

Lee O'Hara
Clinical Nurse Specialist

Question:
In September 2005 I had a large cyst removed from the sacrum, resulting in neurological damage, making me doubly incontinent. I was told that it would take 18 months - two years to return to normal, yet so far there is no sign that it has. I do attend a continence clinic for help and advice, and I have been prescribed Detrusitol for bladder control. I am concerned that full continence may never return. The cyst affected the right S2 root. The saddle area is still tight and numb. What is the possibility of attaining full bladder and bowel control?

27th Jul 2007

Answer:
The main supply of nerves to the bladder are served through S2 -S4 so the fact that you are experiencing continence problems is not surprising.
You don't mention whether your pelvic floor muscles have been assessed for strength and movement. It would be worth having this done to see whether biofeedback and/or electrical stimulation may be appropriate.
Ask at your next clinic appointment. Unfortunatley I cannot tell what your chances of achieving full continence would be.

Lee O'Hara
Clinical Nurse Specialist

Question:
My 81 year Bulgarian wife has advanced dementia and is doubly incontinent. Once fluent in 6 languages she now only understands Bulgarian. The Care Agency have told me to buy wipes to clean her bottom and vagina and since doing this she has an increasing number of UTI's. My mother taught my sisters to clean with soap and water as I do with my genitals. She wears disposable pants by day and night. Please give me some advice as there are so many different views. My main concern is to stop the infections.

27th Jul 2007

Answer:
I am sorry to hear of the problems your wife is having. Urine infections are common amongst the elderly mainly due to lack of mobility and a poor fluid intake. These infections can increase confusion and it would be worth discussing with your wife's GP the advisability of sending a urine sample to the laboratory to ensure she is being given the necessary and appropriate antibiotics. You should try and encourage her to drink more, especially water.
As far a hygiene is concerned some wipes you can buy have alcohol in them and this can irritate on already fragile skin. Unperfumed soap and water is the best once any excess faeces has been removed with tissue or a disposable cloth.
You should always deal with the vaginal area and bowel separately when cleaning to avoid transfer of bacteria. Wash the vaginal area from front to back and never apply talcum powder or unprescribed creams.
I hope this helps.

Lee O'Hara
Clinical Nurse Specialist

Question:
I have been told that I am to have a tape operation due to stress incontinence in 16 weeks time.I really don't know whether or not to have this done because of the risks.I do not want to be left worse off than I am now.I leak when I run jump or I'm sick and if I sneeze with a full bladder.I control it by wearing pads when I exercise which does hold it.So as I don't wear pads all day every day, do you think I need the operation now or should I wait until it gets worse? Also if I wait would I have to go through the pressure test again because i never want to have that again.

27th Jul 2007

Answer:
You don't mention whether you have tried any conservative methods for improving your stress incontinence; I am thinking of pelvic floor exercises. Many areas now provide physiotherapy sessions called 'biofeedback' which have proved very successful in treating people with your problems.
You don't mention your age but you are obviously very active and I think you have to base your decision on how much the leakage affects you're everyday life.

As you have had Urodynamic tests for your bladder it is unlikely that the specialist would have suggested the operation if there wasn't a good chance of it being successful.

But I would encourage you to find out about other measures and perhaps put your operation 'on hold'.

Lee O'Hara
Clinical Nurse Specialist

Question:
I have been suffering with IBS since the birth of my youngest son in 1980.
I often went to the gp with flare ups and was largely ignored, one gp called it spastic colon, but never told me how to deal with it. I have
since developed fibromyalgia and the IBS symptoms got very bad, I changed gp practice, but was treated in the same way. I changed my diet myself, becoming vegetarian, after suffering with severe diarrhea/constipation pain
and marked bloating. I went to gp then to hospital, diverticular disease
diagnosed with no advice on how to cope with this and no information on
what diverticular disease is. 2 years later I develop diarrhea and now the diagnosis is diverticular disease with abnormal shape in the
sigmoid colon and descending colon. The sigmoidoscopy was very painful, I
couldn’t hold the air in my bowel and I was vomiting. My question is, what
now? This condition does not seem at all important to gp's or dr's at the
hospital. What do I do now? I need to know!
what questions to ask gp or what to tell her I need. Do I need to see a
dietician?

17th Jul 2007

Answer:
It appears that you have an overlap of symptoms from IBS, fibromyalgia and diverticular disease. It would be very useful for your GP or a local dietician to examine a full dietary diary for 3 or 4 weeks and for you to score all your symptoms of bloatedness, pain etc on a 0-10 scale where 0 is zero symptoms and 10 is the worst pain etc that you have experienced. There may be a trigger in the diet. If you could also score your own "stress levels" on the same daily scale then your emotional status could also be factored into the analysis of your gastrointestinal symptoms. In my clinics we often need to spend 2 or 3 half hour sessions with patients with this type of complex problem before we can recommend a management plan, which is tailored to their individual needs. Keeping your own dietary records and scoring the symptoms can sometimes help your GP or gastroenterologist to assess the problem. We are also keen to know about energy/tiredness scores and sleep patterns and disturbances, as well as weight fluctuations. A detailed family history is also helpful.

Geoffrey Hutchinson
Consultant Surgeon, Gastroenterologist

Question:
My son (17 years old) suffers from faecal incontinence. This started as a child but became a big problem at secondary school. He would soil himself almost everyday. He saw the Continence nurse off and on but the message was this was a behavioural problem and he had to learn to train his bowel and learn to manage his problem. The last time I took him back to the GP I was at my wit's end. Again I was told there is nothing that could be done. The last time he was seen in hospital was when he was 15-16 and he also saw a psycologist. But the sessions were so far apart and I don't beleive that they felt they were helping him. He is still soiling himself. This is having a huge imapct on him emotionally, it hinders him forming relationships now he is at college. He is reluctant to do go anywhere unfamiliar. Both my husband and I are at our wits end. We have probably handled this all worong, we have tried rewarding him, reasoning with him, trying to get him to take responsibility for himself. He does have a minor learning disability, he tells me that he does not have warning signals and that when he has to go, he has to go.
Can he be seen privately, I don't think the NHS knows waht to do, nor does it have the resources. Even the clinic he used to go to was called the 'Continence' Clinic. Can you imagine a young person's shame at having to attend this clinic so publicly?

11th Jul 2007

Answer:
Have you been in contact with ERIC (Education and Resources for Improving Childhood Continence) they have a help line that you could call 0845 370 8008. They are a really useful source of information for your sons age group with continence problems.
I feel you need to go back to your GP. There is a specialist centre for people with bowel problems in London and you may be able to have your son referred for indepth assessment and possibly treatment. Good luck.

Lee O'Hara
Clinical Nurse Specialist

Question:
Hi, last year I started having a few wetting accidents in bed, I went to my Dr who made all the right noises (this shouldn't be happening we can investigate etc) and asked for a sample of my first wee of the day. I supplied this then waited the week she said the results would take to come back but heard nothing. I waited another week then called only to be told "nothing we can do, it's your age (I'm a 40 yr old male) it'll probably go away". It HASN'T, if anything it's getting worse, I'm always rushing to the loo in the mornings at work, sometimes not making it in time!(afternoons I'm not SO bad but it's getting there)
I asked about NHS pads/nappies but was told they can't help with that either.
My question(s) is / are: Where do I stand with getting NHS pads/nappies as buying them is costing me a fortune I cannot afford.
Should I give my Dr a miss and go straight to the local GUM(Genito-Urinary Medicine)clinic, can they help?
I've just about given up on my own Doctor but should I give them another go before resigning myself to nappies?


11th Jul 2007

Answer:
I feel you need an indepth assessment of your bladder problems. This should include a bladder diary ( recording drinks and visits to the toilet ). It is not uncommon for young men to experience symptoms of overactive bladder ( the feeling of the need to pass urine frequently ) but you also need to have a check up on your prostate too.
I would make another appointment to see your GP and try to be referred to a continence specialist locally ( most areas have one ). Don't give up. Help is available.

Lee O'Hara
Clinical Nurse Specialist

Question:
Can you help?
I have an aunt whose completely incontinent, this problem has been going on for years.
The first lot of treatment she had was botox, i suppose to paralyse that area. Unfortunately it didn't work.
Next lot of treatment was to have a catheter fitted, not to sure what happened there but that didn't work I think it made her too sore.
Her latest treatment was a catheter done under a general inserted through her stomach. This worked for a while, until 6 weeks afterwards when she had her catheter change. She now wets everywhere and unfornately now is back on incontinence pads. Her urine is not going down the tube, even if a bag has been fitted, the catheter has been flused out several times and there doesn't seem to be any blockage in the tube. It's when the tube has been connected to the bag she seems to be having problems. Her urine is bypassing the catheter so she's weeing everywhere.
Has the wrong size cath been fitted? Or could it be the bag itself or the connecting tap? Or is something not right in her stomach were she has had the surgery?
If this catheter method is failing, can you tell me what other alternative there is?
We are desperate hear, if you can help?

11th Jul 2007

Answer:
Any type of indwelling catheter can cause irritation to the inside of the bladder, which can cause leakage of urine around the catheter.
As your Aunt had a tube via the bladder outlet(urethra)this may have caused problems with the closure mechanism of the bladder.This can lead to constant leakage,despite having the tube through her tummy(suprapubic).
Indwelling catheters also cause infections of the urine which can cause irritation and leakage.
My advice would be that the catheter be removed and her incontinence managed with pads at least for a while.This would enable her bladder to settle down then she could be reassessed by an appropriate specialist.She also needs her urine tested for infection.

Lee O'Hara
Clinical Nurse Specialist

Question:
I have noticed that each time I drink red wine I have very bad pain in the bladder. I suffer with OAB and 7 wks ago had botox injections which I feel really well on, but just this problem which I get with wine,is it a coincidence?
29th Jun 2007

Answer:
There is some thought that alcohol can irritate an already overactive bladder as can caffeinated drinks such as tea and coffee. It is unlikely to be the cause of intense pain on its own unless your bladder is very oversensitive. You don't describe any other symptoms.It is relatively recently that you had your treatment so it is early days. I suggest you avoid the main irritants of your bladder ie alcohol/tea/coffee ubtil you have your check up with the specialist.If this continues then make an appointment to see your GP.

Lee O’Hara
Clinical Nurse Specialist

Question:
I have been trying to use coveen Anal Plugs for the last 18 monthes but find them difficult to insert and rather uncomfortable. Are there any other alternatives to these, my Community Nurse has suggested using a normal applicator tampon which may not be as effective but would at least reduce my problem to a controlable level and make use and insertion easier. Any thoughts?
29th Jun 2007

Answer:
Anal plugs can be very useful if used on the right person and with the right expertise. An applicator tampon is NOT a suitable alternative as they are not designed for this purpose and may cause internal damage.
I would suggest you get intouch with your local continence nurse specialist as you need to reassessed as it is possible that your needs have changed in the 18months since you've been using the plugs.Ideaaly you should have a physical examination to identify any problems rectally.
Please do not use the vaginal tampon though.

Lee O’Hara
Clinical Nurse Specialist

Question:
On May 21 2007 I had a TVT put in because I suffered severly from stress incontinence. I am 44 years old. I had some bladder injury during the surgery and was told that I would have to use a catheter for 10 days to allow my bladder to heal. Its now June 9 and I am still wearing it. Everytime the doctor takes it out I pee but after that I am unable to pee. I have tried three times and my bladder keeps retaining the urine. What could be wrong and how can I treat the problem. I do not want to wear a catheter for the rest of my life. Help

13th Jun 2007

Answer:
How sorry I am to hear of your problems. I think this does highlight that surgery isn't without problems and I would hope that any risks would have been discussed with you before you agreed to the operation. I also hope that before you underwent the procedure you were given tests called Urodynamics which would have assessed your bladders suitability for surgery as it certainly isn't for everyone.
It is common place to teach ladies prior to surgery how to empty their bladders with a small catheter intermittently as one of the side effects of surgery is the bladders inability to empty effectively. This lessens the need for an indwelling catheter.
You don't say how your bladder was injured during surgery. In the case of bladder injury a catheter is often used to help the bladder heal but it may have been that your bladder would still have retained urine anyway.Without the urodynamic tests it would be difficult to assess.
My gut feeling is that you should be given the opportunity to learn intermittent self catheterisation so that you could be more in control. Specialist Nurses are well practiced in this procedure and sometime it is only necessary for a short time as the bladder can in a lot of cases improve considerably.
Speak to your specialist in charge of your care or your GP as soon as possible as indwelling catheters are prone to developing infections and causing discomfort. I wish you luck.

Lee O’Hara
Clinical Nurse Specialist

Question:
I am currently 76 years old. I am frequently overtaken by the need to urinate, especially when bending over to pick something up such as a basket of shopping. Similarly if I am driving for more than an hour I have an urgent need "to go". I am currently visiting a NHS urologist and he prescribed yesterday FLOMAXTRA XL 400 micrograms and Detrusitol XL 4MG to be taken one tablet each day.

Can you reccommend any physical exercises which may help me?

13th Jun 2007

Answer:
I'm glad to hear you are under the care of a Urologist.So many men do not seek help for these embarrassing problems. From the information you have given us it seems the Urologist is treating you with medication for your particular symptoms. You have been given two different types working in a slightly different manner and both do take a little time to act. It seems that you have problems with a bladder that is overactive and in my experience the medication for these can work more effectively with lifestyle changes. These include avoiding caffeinated and carbonated drinks and avoiding constipation. Actively retraining your bladder is a good method of increasing your bladders ability to 'hold' on for longer. Pelvic floor exercises are also a positive way in which you can help yourself. There are some very good leaflets available to help you with these but I always feel having some advice from a specialist nurse is invaluable to tailor a programme especially for you.You can ask your Urologist or your GP to refer to your local service. I hope this is helpful.

Lee O’Hara
Clinical Nurse Specialist

Question:

I am currently experiencing colon spasms and developing pouches, especially in the ascending colon. My GI specialist has prescribed several anti-spasm medicines, but to no avail. Herebal fiber and oatmeal are a part of my diet. I've been fighting this battle for over 7 years. I stay away from nuts and other foods that are harmful. I've noticed that shortly after eating a meal the pain begins in the ascending colon(right side) and sometimes in the descending colon (left side).

12th Jun 2007

Answer:
It is difficult to blame DD for the symptom pattern which you are describing, but it would fit nicely for irritable bowel syndrome (IBS). Normally the transit time for food from mouth to colon is several hours and then symptoms arise after bacterial fermentation and gas production which can take even longer. When patients keep a log of food intake in dietary diaries and then score their symptoms, sometimes the pain score relates to food eaten a day or two earlier. You mention fibre and oatmeal as part of your diet - this high fibre component does not suit every individual and it would be sensible to experiment with fibre content. Why not omit it for a few days and score your symptoms on a 0-10 scale (zero = no pain, 10 = worse day you have suffered, with a range between) and gradually increase the fibre intake to find your own individual optimum. And remember that antispasmodics may reduce normal peristalsis required to move residue and waste through the colon - then bacteria produce extra fermentation, and more gas and bloatedness results. It may take several weeks or months to achieve your ideal balanced intake to suit your own GI system.

Geoffrey Hutchinson
Consultant Surgeon, Gastroenterologist

Question:
I suffer from Diverticulosis and often from Diverticulitus. I avoid all seeds and nuts and have a high fiber diet, including Metamucil. I have a very specific question. Do I need to continue avoiding tomatoes, strawberries and figs; cornnuts, soynuts, and dried peas; and soft nuts like macademia and cooked pecans?
12th Jun 2007

Answer:
Most patients with DD experiment with the diet to see which food stuff triggers an attack (and which helps, of course). Some DD sufferers seem to thrive on tomatoes, strawberries etc and in others they seem to cause bloatedness, pain and spasm symptoms. I urge you to experiment with small quantities of these items to see what happens, so that you can enjoy as varied a diet as possible, long term.

Geoffrey Hutchinson
Consultant Surgeon, Gastroenterologist

Question:
I have bladder incontinence following a Lupus stroke in 2000. I've been offered Botox bladder treatment, which I've declined, and currently take Desmospressin tabs which seem to be losing effectiveness. Can you suggest any other treatment, preferably non-invasive? I'd be most grateful. Thank you
12th Jun 2007

Answer:
You don’t mention what problems you are getting with your bladder, I presume because you are taking desmopressin you must get out of bed a lot at night and have urgency, as Botox is often given to treat urgency and urge incontinence. If you have not already tried drugs that are called anticholinergics these may be your next step, but if you have tried them and they didn’t work then Botox may be the last resort. I can understand your apprehension but a lot of patients have found Botox very helpful,

You should dicuss this with your Consultant or your local continence advisor.

Lyn Kirkwood
Nurse Consultant
Urology, Stoma & Continence Care

Question:
My partner is stuck in hospital because they say that all the ISC kits contain latex which she is violently allergic to. Could you tell me if a non latex ISC product is available so I can get her out of that place?

12th Jun 2007

Answer:
I’m not sure when you say ISC kits you mean the catheters or the equipment you need to do ISC. If you do mean the catheters then all ISC are usually made of plastic and are either left plain or given a hydrophilic coating. Therefore they should be suitable for patients with a latex allergy. Plain soap and water is fine to clean before catheterising. The names of commonly used ISC catheters are Coloplast-Speedicath or Astra-tech Lo-fric. But your local continence advisor or urology nurse should be able to help you.

Lyn Kirkwood
Nurse Consultant
Urology, Stoma & Continence Care

Question:
My husband, very occasionally wets the bed, he says it's because he’s always had a weak bladder, if he needs the loo he can't wait at all. I found this hard enough to get my head around, however the other day he needed the loo urgently but didn't make it in time and wet himself. I'm at a loss as to know what to do as he obviously just wants to ignore the problem and pass it over as 'just having a weak bladder' I'm sure this isn't normal but don't know what to say to him, it's not something I can talk about with anyone either so would really value some advice on how to handle this. I find myself worrying when it'll next happen, and dread it if we have to say out at someone’s house for the night. It's happened twice overnight in the last year and this once during the day. Please can you give me any advice?


5th Jun 2007

Answer:
It is very common for men’s' partners to be concerned about their bladder problems than it is for the man to be bothered themselves. Partly this is due to embarrassment and also the fear of the unknown. Research shows that men are far less likely to consult a GP with any health problems than women.
Your husband certainly does need to have these symptoms looked at. You do not say how old your husband is and the first thing that springs to mind with men is a possible problem with the prostate gland, but it does depend on his age. Also you do not mention whether he has any other medical problems.
It is really hard to help people with any problem if they cannot admit to it as there will often be embarrassment and a feeling of interference. May I suggest getting hold of some leaflets from Incontact and perhaps leaving them in your house in the hope that your husband will read them and consider asking for help. There are so many things that can be done and it would be a shame if your husband didn't get help but he does need to want to. He is very lucky to have such a caring wife.
Good luck.

Lee O’Hara
Clinical Nurse Specialist

Question:
I am currently 23 and I have found for I think it's around the past 5 years that I have been having trouble with my bladder. When I was at school I used to always have to go to the toilet before I left the house because I was always worried I would wet myself when I was out. For the past few years I have found that I have been leaking droplets into my pants. At first I thought it was maybe a discharge and went to the doctors about it, after doing tests they couldn't find anything, and after going back 3 or 4 times with no joy, I gave up and thought maybe it was just me and never went back. However the past couple of years I’ve noticed that it is definitely not a discharge and that it is urine I am leaking, and have started wearing panty liners daily. when I go to bed at night I always have to go to the toilet before I go to bed as I’m so worried I might wet the bed, though I never have, and I find that a couple of minutes after I go to the toilet I have to go again, even
if it’s just a couple of drops I do. I can’t settle unless I go to the toilet. I find the same thing before I’m due to go out anywhere, and I’ve tried telling myself I don't need to worry about it, because when I get to work for example that they have a toilet and if I need to go I can go again when I get to work. I also find that when I’m on the toilet that I feel like sometimes that there's drop of urine there but unless I sort of jingle onto one hip that they will then come out. I’ve tried doing pelvic floor exercises but find that they make me need to urine is this normal? I also find I need the toilet when I’m having sex or doing exercising and don't feel like I can join any kind of exercise class incase I have an accident. I'm due to start college in sept to train to be a nurse and I really don't want to be worrying about this, I just don't know what to do.


5th Jun 2007

Answer:
You seem to be in a bit of a vicious circle with your bladder and your anxieties are understandable but will certainly make the problem worse. You didn't say exactly which tests you have had on your bladder as there are various ones available to us. The symptoms you describe seem me to be of an over active bladder, one which is easily irritated. It would be interesting to find out more of your symptoms and a detailed bladder diary would be a valuable tool in working out your particular problem.
I feel this needs to be explored further as there are some lifestyle changes which may be appropriate and which you could easily do yourself. I would suggest that you go back to your GP and asked to be referred to your local Continence Specialist. Initially this will mean an in-depth interview with the Specialist and then possibly some simple physical tests to give a diagnosis. For example, you say pelvic floor exercises make your bladder worse but it is common for many women NOT to do these properly, it may be as simple as that.
Please have the courage to ask for help as there is a lot that can be done. I wish you well.

Lee O’Hara
Clinical Nurse Specialist

Question:
I had a sphincterotomy Dec 2005 for an anal papilla (sp). I am now pregnant with our first and due Feb 14th. My latest US shows the baby to be about 8lbs. I am not sure if I should proceed with a vaginal delivery or should I choose a c-section. I am afraid about being incontinent if the vaginal delivery tears me. My colorectal MD says do what is safe for me and the baby. I just do not want anal problems after this delivery. I am an average built women, I was in shape before pregnancy, and probably have gained 40lbs when all said and done. Please help me make a decision.
30th Jan 2007

Answer:
Congratulations on the forthcoming birth of your first baby!

I understand what a dilemma this must be for you. Unfortunately you do not
mention how your bowels are working at the moment and pregnancy can affect
bowel function in its own right.

There are no straight forward answers here. To have a caesarean section delivery involves a major although common operation and recovery after the surgery can take some time. This may well have an impact on your bowels possibly causing constipation which could be uncomfortable for a time and straining can cause bowel symptoms.

Vaginal births do cause stretching of the pelvic floor muscles which occasionally can lead to bladder and bowel problems and if the baby is
assisted out with instruments this can be worsened.

Some ladies commence labour vaginally and if the specialist feels the labour is overly long, or there are other difficulties, may then continue to a caesarean section.

Modern methods of delivering babies and the aftercare that Mums receive has improved so much. In your particular case it is likely that you will need some guidance in pelvic floor muscle exercise so matter which type of
delivery you opt for. Do speak to your midwife about your concerns and they can put you in touch with a professional locally that deals with pelvic floor rehabilitation.

I wish you luck.

Lee O'Hara
Clinical Nurse Specialist
North Herts & Stevenage PCT

Question:
My daughter at the age of 31 has two children aged 6 and 4 that in November 2005 was given diazipan for pain relief as her right knee kept locking after an accident. She was knocked out for 48 hours and in that time was catheterized and has never been right since. She is not incontinent but gone the reverse were she can't go at all. We have seen urology consultants who have done the euro dynamics test (3 times), had supra-pubic catheters, done intermittent cathetering, 10, 20 30ml balloon catheters inserted that end up expelling themselves so she is taking oxybutynin for bladder spasms and each time ends up with infections, given antibiotics that she has come immune to and a year later no further forward. Tried second opinions where her file has been transferred to other hospitals but they come back with discharged as there is nothing they can do. Her doctors say there is nothing they can do for her and at the moment she is in bed with no catheters, pain round her side and back with infection and the doctors won't prescribe any more antibiotics. We are all very distressed and don't know where to turn that we just want to know who do we go to for answers as we still don't know what the problem is and is anyone in the same position. I would most grateful for any help or advice you can give me as soon as possible.

23rd Nov 2006

Answer:
Your daughter’s case seems very complicated and she has been through quite a lot.

Without knowing the full details regarding your daughter it is very difficult to be specific.

You don’t mention how she is managing to go to the toilet now. She has had a variety of catheters to empty her bladder but now she has none.

Is she drinking plenty? About 1 ½ litres per day is a good average and there is some thinking that cranberry juice is effective against urine infections.

Are her bowels open regularly as this can have a major impact on the bladders ability to empty.

Are there any Specialist nurses involved in her care? It may be worth asking your daughters GP if there is a continence specialist locally who may be able to offer practical help and support.

Above all don’t give up in your search for help. Speak to the GP and tell him/her exactly how your daughter feels.

I wish you luck.

Lee O'Hara
Clinical Nurse Specialist
North Herts & Stevenage PCT

Question:
I have a very serious problem in that I pass urine far more than is normal. At worst it was 20-30 times a day, until I cut out all diuretics. This life-destroying issue only began March 2005 and I've had a variety of tests done to try and get to the root cause: blood/urine tests, ultrasound, uro-dynamics etc as far as the health professionals are concerned I'm completely healthy and have been told to bladder train which is very difficult for me. I've been told that I may never know what caused my over-active bladder and am concerned that something may have caused permanent damage. I'm a frustrated 20-something year old male and am becoming severely depressed as a result of this urge frequency which is holding back my future plans!
3rd Aug 2006

Answer:
I can understand your frustration about your problem. The average person needs to pass urine 5-6 times a day because you are going so many times a day you must feel you are always in the toilet. It is true to say that there is still a lot we do not know about the way the bladder functions which makes it even more frustrating for someone in your position. You haven’t mentioned whether you have had any treatment at all for your problem. Cutting out drinks with caffeine in them has long been thought to help reduce bladder irritability. Having said that, it is important that you maintain a good fluid intake as reducing fluids too much can lead to very concentrated urine which in turn can irritate the lining of the bladder. Also this can lead to infections and general dehydration.
Several medications are available for the treatment of an overactive bladder and when used in combination with bladder retraining can be really successful. It can take a while to find a drug that suits you as an individual as there are a few different types. It is also important to have support whilst you are trying to retrain your bladder and Specialist nurses often run clinics where you can be seen and individually assessed so that an individual pattern of treatment can be designed for you.

Go back to your GP and ask if you can be referred either back to the Specialist you saw last year or to a local continence clinic. Help is available. Good luck!

Lee O'Hara
Clinical Nurse Specialist
North Herts & Stevenage PCT

Question:
Since having my first child six years ago I have suffered with stress incontinence. I had a Urodynamics test done and I have no pelvic tone. I have tries physio and pelvic cones but they have not worked. It is really getting me down as I am only 32 years old and it is affecting my life. What do you think is the best way for me to cure the problem?
3rd Aug 2006

Answer:
I’m sorry that you are experiencing this problem, you must find it devastating. You haven’t said when you had the Urodynamic tests and obviously without knowing the finer details of your condition I cannot be terribly specific. This problem is still getting you down. You mentioned that you have no pelvic tone and so it doesn’t surprise me when you say that physio and cones haven’t been successful. Sometimes electrical stimulation therapy can be used to re establish some muscle movement, and then physiotherapy is used to build on this to improve muscle strength. To see if you would be suitable for this treatment you would need to be assessed individually as there are some general health conditions where electrical stimulation cannot be used.

I do suggest that you see your GP again, who may feel that you need to be seen again by the Specialist who carried out the Urodynamic tests. There are other avenues open to you for assessment and treatment and I feel you would benefit from some further advice. It is not always possible to cure the problem but I am certain that something can be down to make life easier for you.

Lee O'Hara
Clinical Nurse Specialist
North Herts & Stevenage PCT

Question:
Eighteen months ago I had a severe attack of stomach pain which my GP felt was Diverticulitis. I was put on antispasmodics and antibiotics. It cleared up but I was referred for a sigmoidoscopy which confirmed I have diverticular disease. Over the years I have been told I had IBS and have coped with this. Ten days ago I knew I was unwell again but was unable to distinguish whether it was just IBS so I waited. Suddenly the pains and fever arrived and I was totally debilitated. I really dont want to take antibiotics too often but how do you distinguish between one and the other? Any ideas?
7th Jul 2006

Answer:
Whenever you have a high temperature (pyrexia) in combination with the abdominal pains, then it is safe to assume that the symptoms are
not simply IBS related and it is likely there is an element of diverticulitis. Usually the pains localise to the left lower quadrant of the abdomen. In these circumstances an antibiotic from your GP is often the wise option, to accelerate the healing process, in combination with a fluids only diet for a day or so and the reduction in roughage intake until the acute episode has resolved.

Geoffrey Hutchinson
Consultant Surgeon, Gastroenterologist
BUPA North Cheshire, Stretton

Question:
Following voiding difficulties after TVT implant, I had the tape dissected suburethrally but still saw no improvement. My consultant has now prescribed Flomaxtra XL. I have noticed an improvement but am not happy about taking drugs to help me empty my bladder. Apart from SUI I had no problems whatsoever emptying my bladder before the tape was put in. Will I have to take the tablets permanently to continue the improvement? The thought of taking this drug every day for ever makes me feel low. The tablets make me feel dizzy, heavy headed and lethargic. I work full time as a teacher and it's not exactly helping me do my job feeling like this. I am glad that they help my bladder- I'm just not happy about having to put them into my body every day for ever. I know this drug is usually given to men with prostrate problems. I am a 41 year old woman who had SUI and prolapse of the bladder and bowel both of which have been repaired.



6th Jul 2006

Answer:
Not an uncommon story, sadly! You will need to see a Urogynae or Urology specialist for urodynamic studies and to consider self-catheterisation but this will involve a lot of counselling. You could then stop the drugs.
The other option is a urethral dilatation if there is proven obstruction.

Hope this helps.

Robert Freeman
Consultant Obstetrician and Gynaecologist
Derriford Hospital
Plymouth

Question:
Since April last year I have had 2 lots of Botox Injections. The first lot coped very well with, had some retention, and kept the Spc in place for about 6 weeks. In October I had the next lot which has not worked the same. I am now having very big retention problems, and unable to pass urine without the use of a catheter unless there is about 500mls in bladder. I do have a urethral one in place with a valve and not on free drainage, suffering very badly with spasms on Vesicare. I did try to learn to do ISC but couldnt manage, my urogyn consultant didn't want to do an spc without speaking to the urologis, he saidno wait till the botox has worn off. I want to know how do I know it has worn off, and will things improve. This was my last resort without having major surgery of a diversion. I have tried every other treatment I know over the years, can anyone suggest anything else?
15th Jun 2006

Answer:
I'd need more information about the symptoms, history etc but my immediate thought would be sacral nerve root stimulation which can be used initially as a trial to see what effect it has. If sucessful a permanent stimulator can be inserted.

Clare Fowler at the Middlesex might be able to advise. In the meantime I'd agree with the Urologist; wait till the Botox has worn off. You could have a suprapubic or urethral catheter till then.

Robert Freeman
Consultant Obstetrician and Gynaecologist
Derriford Hospital
Plymouth

Question:
I was diagnosed (via CT scan and colonoscopy) with diverticular disease two years ago and at variable intervals suffer symptoms of colicky pain, usually beginning after I get up to pass water during the night and sometimes continuing until morning, and often followed by bowel frequency for several hours afterwards. At such times I usually feel bloated, uncomfortable and sometimes my abdomen is tender. I think it is likely that these symptoms are triggered by particular foods or drinks (in particular certain vegetables and pulses, spicy foods, rice, red wine, yogurt) but every time I think I have identified something I then begin to doubt it because I am not always adversely affected by the same food. The problem is that I have no idea when the food that has affected me was eaten, because I am uncertain of bowel transit times. For instance, did the vegetable chilli I ate on Thursday evening give me pain, bloating and diarrhea on Saturday morning, or was it the red wine I drank on Friday night, or even something I ate earlier in the week?

2nd Jun 2006

Answer:
This is another question where an analysis of a comprehensive dietary diary, which has been scored in relation to symptom pattern, would be extremely useful. I describe this type of dietary and scoring system in my next article for InContact, and it is certainly a very valuable tool to employ. Your symptoms are subjective (experienced by yourself) and we often need an objective measure of what is happening so we can see how much you are suffering and how effectively any medication works. Read the article, keep the diary and scores and let us know if you can pinpoint any trigger factors or pattern. Obviously your feedback to your GP should be as comprehensive as possible (and any feedback on our website would also be welcome!).

Geoffrey Hutchinson
Consultant Surgeon, Gastroenterologist
BUPA North Cheshire, Stretton

Question:
Beginning when I was only 11, I have had "digestive" issues for many years. I am now 27 years old and continue to deal with the same issues.

I am not a doctor. Therefore, I can only explain my symptoms (and their diagnosis) using the terms they provided me.

When it first began, I suffered from constant stomach sensitivity and incredibly painful (this is not an exaggeration) stomach/intestinal spasms. Literally, they would have me doubled over in pain (which is a big deal considering that I do have a tolerance for pain).

When I was a sophomore in High School, I had "pre-ulcers" lining my esophagus and stomach and my stomach was constantly sensitive (I could hardly stand to lean over the sink to wash my face).

My doctors coudn't identify what the cause was, so they attributed my symptoms to "hyper-acidity in the stomach". Already on a very strict diet for athletic training purposes, I was given a series of medicines for maintenance. Prilosec for two weeks to "neutralize the stomach acid and heal the sores" and then 3+ years on Zantac (this was before the OTCs). In addition to many bottles of Tums and Pepto Bismol (which only helped by taking off the edge).

The medicine helped. But, I was far from cured. The sensitivity and spasms persisted, but occurred less frequently.

For whatever reason I can't remember, we stopped the Zantac. Continued with the Tums and Pepto Bismol, though. Again, the spasams persisted and gradually (almost without notice) became more frequent.

No pattern. No recognizable triggers. No rhyme or reason.

Then more doctors, more tests. I have been cleared of "nearly everything that would make sense". Again, no obvious patterns, triggers, no food sensitivities, no allergies...

In the last few years, it seems that they may be a very loose connection (definitely inconclusive evidence) with levels of stress and anxiety. I have always suffered from (though mild) issues with anxiety and depression. Untreated for a long time, I currently take 150 mg Wellbutrin XL, daily, and have been taking the medicine for approximately 3 years.

Once again, the stomach sensitivity and stomach/intestinal spasms persist, but the sensitivity is less and more sporadic and the spasms are far less frequent. (I do not know if this is attributed to the Wellbutrin - there isn't any observable connection to anything).

But over the last two years, additional symptoms have started to occur. These include: terribly odorous gas, excess gas, explosive diarrhea(usually immediately following a meal; within 30 minutes), loose stool more frequently than in the past, halitosis, bloated abdomen, and a wierd substance which seems to coat/cover my stool (which is difficult to describe -but in my best attempt, appears transparent to opaque, runs the length of the stool, completely surrounding it, and has wrinkles which extend from end to end; seems to be a dense substance).

I am hoping you can shed some light on these new symptoms (especially the issues with my stool). The most recent GI doctor again attibuted it all to stress and anxiety. Which I can't dismiss, my life is usually fairly stressful. But, since these symptoms are new and nothing else about my habitual behavior or health has changed, I thought you might be able to help me.


2nd Jun 2006

Answer:
The names of the medications in your letter tell me that you spent your early years in the USA! Your symptoms really fall into 2 categories; upper GI with likely reflux and hyperacidity; and lower GI, with a colonic problem. Obviously there is an overlap in the pattern but the symptoms are obviously distressing.


Interestingly, my next article for InContact stresses the importance of keeping a dietary diary and scoring your symptoms to see if we can identify any trigger factors.


The differential diagnosis, or list of likely problems to investigate, would include irritable bowel syndrome, non-ulcer dyspepsia, gall stones, mucous colitis etc etc and it looks as if your GP and gastroenterologist have done comprehensive tests. We often try to exclude Helicobacter pylori, a bacteria in the antrum of the stomach, which predisposes to acid-related conditions. Stool cultures and IgE allergy testing are also sometimes helpful and an ultrasound would quickly exclude gall stones.


I am sure your GP would be interested to see you again, especially if you come armed with a dietary diary to analyse.

Geoffrey Hutchinson
Consultant Surgeon, Gastroenterologist
BUPA North Cheshire, Stretton

Question:
I was diagnosed with diverticular disease 2 years ago. In September 2005, I had a really bad attack and have been off work, hospitalised 4 times and have had 7 lots of antibiotics, with one month on antidepressants. I have attended a Chinese medical centre and they have given me lots of tablets to take plus a detox and I am also having acupuncture....will this cause me harm? I am 53 and have had a full hysterectomy and there is also some fusion with my scarring and colon.
2nd Jun 2006

Answer:
I am sorry to hear you have had so many flare ups of diverticulitis since last autumn. A bad run of attacks can certainly occur without ant obvious trigger factor and very often it is the same diverticulum which becomes inflamed each time (like a "grumbling appendix").


You ask about various complimentary herbal remedies and acupuncture and as you know there has been a lot in the newspapers recently about their true value ... perhaps just placebo benefits. Our heir to the throne, Prince Charles, is convinced that we should keep an open mind about other means of treatment, but the medical establishment prefer hard evidence from controlled trials. However, acupuncture has one advantage - it can do no harm. All medications come with a list of possible side effects but acupuncture is safe and usually not too expensive. Apart from minor discomfort it really does not have any physical side effects so it may be worth a trial, especially if the attacks have caused some depression of mood. Some Chinese herbal remedies do have side effects and I would always check out the ingredients with your GP or nurse.

Geoffrey Hutchinson
Consultant Surgeon, Gastroenterologist
BUPA North Cheshire, Stretton

Question:
Hi, I have been diagnosed with IBS, when I get anxious I lose control of my bowels which as you can understand is very embarrasing, I think to try and overcome the problem I need to stop worrying about having an accident and the only way I can see is to wear some type of incontineience protection and hopefully with that as a saftey net it might help me to venture out. Can you recommend anything?


11th May 2006

Answer:
Thanks for the question. Sometimes we employ low dose beta blockers, such as propanolol 10mg once or twice a day, when anxiety makes IBS symptoms worse. Occasionally the snooker players and some professional musicians use this medication to overcome a troublesome tremor. Why not discuss this problem with your GP?

Geoffrey Hutchinson
Consultant Surgeon, Gastroenterologist
BUPA North Cheshire, Stretton

Question:
I have had my gallbladder removed for some 19 years and over the years the diarrhea has gradually got worse. I have had numerous tests but nothing has been found, what is causing it? I have pains often in my stomach, with a burning acidy feeling. If I eat something and it doesn't agree I will have pains for a while and then have to rush to the toilet. Often I only just make it, and have had several accidents before, which is most distressing. This is ruining my life, as I am only 46.

11th May 2006

Answer:
Sometimes so called "intestinal hurry" can be caused by bile reaching the colon and causing a chemical type of colitis. Bile is normally
absorbed back into the system in the distal small bowel and should not reach the colon. We sometimes use questran to bind bile acids.
Your GP will know that it is normally used to lower cholesterol in the diet but it can be employed to bind bile acids, and if this is
the problem then one or two sachets a day may help, especially if all necessary tests have proved negative.

Geoffrey Hutchinson
Consultant Surgeon, Gastroenterologist
BUPA North Cheshire, Stretton

Question:
What can I do to improve my continence, I suffer from reflux disease, chronic pancreatits and IBS,which causes severe abdominal pain,cramps,diareoha,nausea,heartburn etc. I avoid eating like the plague as anything in my digestion causes agony and upset(I also cannot drink alcohol as it makes me very ill). I have been to the GP and a gastroenterologist and a continence advisor, and I am STILL waitng for test, I take about 5 different medications which have helped but I still get weeks or days of extreme suffering. As for continece issues I leak and suffer extreme urgency and now I have a perineal sinus to boot. What can I do to sort this problem for good? It has been over a year since I saw the gastro and as I say I am still waitng for endoscopies to be done and a small bowel meal.

11th May 2006

Answer:
Thanks for the comprehensive question. Pancreatitis can cause malabsorption problems associated with pancreatic digestive enzyme
deficiency. These enzymes can be replaced in tablet form eg creon, from your GP but the other medication that you take for the IBS and reflux symptoms (you mentioned 5 different sorts) may need monitoring. Sometimes there are adverse drug interactions which can be tricky to spot and your GP or gastroenterologist should be able to help. When you see your doctor always take with you a list of your tablets, including all those you buy over the counter from the chemist, so any interactions can be determined.

With the new "choose and book" system which has been recently introduced by the government your GP should be able to accelerate any necessary tests with a choice of 3 or 4 different local hospital providers. Many will even have the option of a private hospital which has agreed a contract with the local GPs to provide consultations or tests, to speed up your investigative pathway.

Geoffrey Hutchinson
Consultant Surgeon, Gastroenterologist
BUPA North Cheshire, Stretton

Question:
I have been told that I need to have a cystoscopy to find out why my bladder is not emptying. I was told that I will be given a general anaesthetic, but I am worried about this as I was abused when I was younger, and would prefer to know what has happened during the procedure. Would this be possible? The urogynaecologist has been extremely helpful but the people at the pre-admissions clinic were not interested in my questions, and told me I should hav asked my consultant while I had the chance, and now I am in two minds whether to go back at all.
28th Apr 2006

Answer:
You can have a cystoscopy under local anaesthetic and you could ask your consultant about this. He may have asked for it to be done under general anaesthetic as, in our experience, patients who have been abused do better with a general anaesthetic. If you have had bladder problems, it is worth getting sorted so please don't give up.

Lyn Kirkwood
Nurse Consultant
Urology, Stoma & Continence Care
Weston General Hospital
Weston-super-Mare

Question:
I've had a colposuspension/hysterectomy/large ovarian cyst removed 10 years ago. After 1 month in hospital, it was obvious that my bladder incontinence was worse. I was diagnosed with an irritable bladder which was only able to hold 100ml before voiding. 2 years ago I had a clam ileocystoplasty carried out by Lawrence Stewart at Western General. After 1 more month in hospital, a suprapubic and urethral catheter which were both voiding constantly, it is obvious this op has symptomatically been a failure (Mr Stewart's own words) Not only have I been incontinent urethrally, but for the last 2 years I've been incontinent feacally, both without let up and several times daily. I've no control over my bladder and bowel and also have the distressing urge to constantly push when in toilet. This urge has worsened my rectocele and cystocele but until I can stop pushing, there's no point repairing the prolapses. I've had enough now but no-one knows what steps to take. I want my bladder removed but wonder if it is possible to have a new bladder made out of stomach, not bowel. I do not want to go straight for a bladder removal and bag. If it ends up requiring this, at least I will have tried something before this final step. Can I demand this treatment? Am I able to take this risk as my own choice? If my surgeon refuses and decides to leave me like this, do I have no say in my own treatment? I have consulted urologists, gastrointentinal experts, bowel specialists etc and am now awaiting another cystoscopy next week. My last urodynamics test showed minor spasms, however, my belief is that because a large volume of water was inserted artificially into my bladder, both the rectocele and cystocele blocked the flow of urine and gave a false impression that, my now too large bladder, could hold more than it in reality does. When my prolapses are really bad, I cannot void my bladder or bowel without pushing them manually through my vagina. When they are not too bad, I cannot hold more than 100 mls.
28th Apr 2006

Answer:
I am sorry that you have had problems for so long. You are usually given choices of treatment by your Consultant to choose from. Your case is quite complicated and difficult to answer in this form. I have not heard of anyone
having a new bladder made out of stomach, it is usually made up from bowel. You are entitled to ask for a second opinion but you may be reaching the end of treatment options. As you have been with this Consultant for a long time, it is worth discussing with him your obvious frustrations. If you are involved with a urology nurse or continence advisor, it may be worth contacting them to discuss the situation.

Lyn Kirkwood
Nurse Consultant
Urology, Stoma & Continence Care
Weston General Hospital
Weston-super-Mare