In a recent study, 55% of people considered having bladder and bowel incontinence to be 'worse than death'. Being incontinent was rated higher than 'relying on a breathing machine to live' (50%), 'being bed-bound' (45%), and 'being confused all the time' (40%). This result is staggering, and highlights the stigmatisation of incontinence. Professor Adrian Wagg, Canadian Geriatrician, shared this study in his recent keynote address at the 26th National Conference on Incontinence held in Sydney in November 2017.

Urinary tract infections (UTIs) are incredibly common, affecting 1 in 2 women and 1 in 20 men in their lifetime. Twenty to thirty percent of women who contract a UTI will experience recurrence. A common treatment for recurrent UTIs is low dose antibiotic prophylaxis, however such treatment programs can lead to antibiotic resistance. The increase in antibiotic resistance has re-ignited interest in non-antibiotic methods such as cranberry to prevent UTIs.

A Post Prostatectomy Incontinence Masterclass at the Asia-Pacific Prostate Cancer Conference 2017 was convened by Shan Morrison and Rachel Heerey. The masterclass brought together experts in urology, pelvic floor physiotherapy, nursing, and psychology. We were very lucky to have such an expert faculty presenting on the day, including surgeons Mr Daniel Moon, Mr Peter Sutherland and Mr Homi Zargar, pelvic floor researcher Dr Ryan Stafford, specialist physiotherapist Dr Trish Neumann, and psychologist Dr Chris Nelson from Memorial Sloan Kettering in USA. Here are 10 highlights from the day.

Sonya was referred to WMHP for obstructed defecation and pain with bowel emptying. However, following a thorough biopsychosocial assessment, it emerged that Sonya’s main concern was dyspareunia. This case study explores the complex inter-relationships of bladder, bowel, and sexual function, and highlights the sequela of increased tension in the pelvic floor muscles (previously termed an “overactive pelvic floor”).

Chronic Pelvic Pain Syndrome (CPPS) is only recently being recognised as the “black hole” of men’s health. It’s not well understood by health professionals and has a huge impact on men’s physical, emotional and social health and wellbeing. A holistic management approach is needed to address the complex influences of psycho-social factors as well as the biological ones.

Provoked vulvodynia is one of the many chronic pelvic pain syndromes we see presenting in women. This complex and multifactorial condition has a significant impact on every aspect of the lives of these women who are often young. There is increasing evidence supporting a multi-disciplinary, biopsychosocial approach. This case study illustrates Physiotherapy best practice.

The recently published and highly anticipated 6th edition of the ‘International Consultation on Incontinence’ book highlights the very strong evidence base supporting pelvic floor muscle training as an effective treatment for many bladder and bowel disorders. Pelvic floor muscle training is Grade A recommended treatment for female urinary incontinence and pelvic organ prolapse.

Interstitial cystitis / painful bladder syndrome (IC/PBS) is a complex condition, and often difficult to treat. Professor Curtis Nickel, urologist and pelvic pain guru from Canada, was a key note speaker at the recent USANZ conference, and shared ‘10 Tips For Managing IC/PBS’. His overwhelming message, loud and clear, was that IC/PBS is a multi-factorial condition, and a multidisciplinary treatment approach is essential.

Chronic pain is a huge health problem, and is expected to cost the western world as much as diabetes and cancer combined.  Dr David Butler and Professor Lorimer Moseley have pioneered the understanding and treatment of chronic pain internationally and, luckily for us, they live right here in Australia and work at the University of South Australia.  Their latest research tells us that educating patients in the science of chronic pain is the single most important thing we can do to help their recovery^.

I recently received an email from a referring GP asking for a copy of our bladder diary. This request made me think about the importance of bladder diaries because patients are typically very poor historians regarding their bladder function. Often their subjective history will be quite different from what is actually happening!  Bladder diaries are an extremely useful diagnostic tool and their utilisation has evolved with research advances in lower urinary tract dysfunctions.