SEPTEMBER 2016

AN INDEPENDENT SUPPLEMENT DISTRIBUTED IN THE GUARDIAN ON BEHALF OF MEDIAPLANET WHO TAKE SOLE RESPONSIBILITY FOR ITS CONTENTS

Bladder and Bowel HEALTHAWARENESS.CO.UK

Ben Richards The actor on bowel cancer and why you should listen to your body

PROFESSOR CHRIS CHAPPLE

Patient awareness can improve urological care P2 PROFESSOR MANDY FADER

We need to talk about incontinence P4

2 HEALTHAWARENESS.CO.UK

AN INDEPENDENT SUPPLEMENT BY MEDIAPLANET

IN THIS ISSUE

MEDIAPLANET

READ MORE ON HEALTHAWARENESS.CO.UK

No time for British reserve Why it’s time to shed the fear and report bowel cancer symptoms early P4

What’s new in IBS treatment? Dr Anton Emmanual outlines recent developments P6

Global Congress on Bladder Cancer 27 - 28 October, Brussels. Discussions on the dilemmas of clinical decision making - read more on bladdr.org

Good patient awareness improves urological care Urology is a very varied branch of medicine covering urinary and male reproductive disorders from overactive bladder to cancer. We can help ourselves by getting informed

U

rology Week runs from September 26th to the 30th, with events across Europe to raise awareness. “We share experiences, look at new developments and help people understand there is help for their symptoms,” says says consultant urological surgeon Professor Chris Chapple. “We want the best quality care for patients, and people can help by being well informed,” he says, adding that you must do online research at validated NHS or hospital sites. “Beware of internet Follow us

scaremongering and don’t rely on advice over the garden fence. Early diagnosis is very important as it will lead to better treatment and care.” He urges immediate action if you have blood in your urine. “See your GP, even if it goes away after a few days. I see lots of people who think, Professor Christopher Chapple oh it’s gone away, but in six months’ time it’s come back Consultant urological and by then the tumour surgeon at Sheffield Teaching Hospitals NHS causing the problem may have grown.” He stressed Foundation Trust, Secretary General at the European however that most people when investigated do Association of Urology (EAU) not have a tumour but it is essential to exclude one.

facebook.com/MediaplanetUK

@MediaplanetUK

People can help themselves with lifestyle changes like losing weight – being overweight is a cause of urinary incontinence. “There’s physiotherapy for patients with stress incontinence, which women are more vulnerable to because they have a shorter urethral tube than men, and childbirth can weaken that muscle or the pelvic floor. Patients can also see advisors for early stage management while waiting for treatment.” On the medical side, the new beta3 agonist drug therapy for overactive @MediaplanetUK

bladder is NICE approved, and shown to have fewer side effects than traditional anticholinergics. The UK has seen increasing use of robots in surgery over the past 2-3 years, though Chapple stresses that robots are a very useful tool but must be used appropriately by an experienced surgeon. “There’s a lot of work underway in innovative healing methods, and quality of life. Ultimately, we’d all prefer not to have surgery, so the emphasis is on early stage intervention.” Please recycle

Project Manager: Devon Pacey E-mail: [email protected] Content and Production Manager: Henrietta Hunter Business Development Manager: Lucy Arden Digital Content Strategist: Chris Schwartz Managing Director: Carl Soderblom Social Media Coordinator: Jenny Hyndman Designer: Juraj Príkopa Mediaplanet contact information: Phone: +44 (0) 203 642 0737 E-mail: [email protected]

4 HEALTHAWARENESS.CO.UK

AN INDEPENDENT SUPPLEMENT BY MEDIAPLANET

COLUMN

Dr James East Consultant gastroenterologist & endoscopist, British Society of Gastroenterology

Bowel cancer detection: No time for British reserve New and significantly improved techniques mean that we should shed all fear of using the national bowel screening programme or reporting symptoms promptly to our doctors.

We need to talk about incontinence It can be an awkward subject, but a more open conversation around incontinence is exactly what’s needed to drive real innovation, says specialist Professor Mandy Fader By Tree Elven

About 1 in 20 of us will be diagnosed with bowel cancer in our lives. It’s usually detected either when you go to your doctor with symptoms, or via the national bowel screening programme, which consultant gastroenterologist Dr James East terms “a national triumph – it’s the NHS at its very best and the UK is leading the world in this field.” Paradoxically, Britain lags behind other countries in treating bowel cancer partly because “UK patients leave it too late; they don’t want to bother their GP, especially older patients who might think bleeding’s just haemorrhoids – it’s heart-breaking.” Bowel scope screening, now available to over-55s, detects adenomas (pre-cancerous polyps) which can be removed to prevent the development of cancer. “It’s a free test that could save your life,” says East. “If you experience rectal bleeding, unexplained weight loss or any change in bowel behaviour that lasts more than three weeks, don’t be embarrassed or apprehensive – go to your GP”. Tests have improved greatly with innovative products available to help increase early adenoma detection and meaning the cure rate, if bowel cancer is detected early, is 95 per cent.

W

hile it is often treatable, incontinence will affect about 1 in 4 of us at some point as a result of a bladder or bowel problem, an operation, conditions such as multiple sclerosis or sometimes for no very clear reason. If incontinence cannot be cured it needs to be managed with pads and devices to enable people to lead a normal life without fear of leakage. Professor Mandy Fader, Dean of Health Sciences and Professor of Continence Technology at the University of Southampton, says that there is a real need to talk about incontinence and boost creativity among medical manufacturers.

Improving dignity “Men are particularly distressed by incontinence,” she says. “Women have periods, child birth, they’re more used to managing and discussing leakage. Men have no experience; they take a stoical attitude and tend to distance themselves from what they perceive as a great indignity. They’ll tell doctors their condition isn’t too bad, but their wives will immediately say, ‘It’s terrible’. “I’d encourage men to be more forthcoming and to have honest discussions with their doctors and nurses. If men realised it’s quite a common condition, and made more of a fuss, there would be even more improvements made within the industry. For example “pads are now made with a super-absorbent gel which reduces odour and stops leakage – the two main fears of discovery,”

MEDIAPLANET 5

AN INDEPENDENT SUPPLEMENT BY MEDIAPLANET

Change in mentality. We need to make treatment for incontinence much more socially acceptable

PHOTO: THINKSTOCK

explains Fader. “Design has improved too: there are now pads specifically for men which cup the penis and scrotum.” Men have other options too such as a penile sheath attached to a leg-bag which can be better for journeys: “For a man it might be unacceptable to have to open their suitcase full of pads at an airport, and a sheath can be a more manly option that can be easier to change.”

Catheters and coatings There is positive news for both shortand long-term catheter users. Fader explains that there is now a drive in hospitals to use catheters only when most effective. “As a patient, you may be lying there after an operation feeling you don’t want to get up and go to the loo,

Professor Mandy Fader Dean of health and sciences & professor of continence technology, University of Southampton

Read more on health awareness.co.uk

but the longer you have the catheter in, the higher your risk of infection.” There is also lot of research going on into how to avoid bacterial build-up (biofilm) in catheters for long-term users, such as cancer survivors. Biofilm can cause distressing blockages and infections, but “we’re hoping for a breakthrough in the materials used in the coatings,” says Fader.

Choosing a ‘mix’ of pads and devices It’s important to be aware that all products and devices have strengths and weaknesses and may work better for different people and different activities or times of the day, and that there are plenty of designs which aren’t available

NOW AVAILABLE for patients using Ugo 2L Drainage Bags

Great Bear is a UK manufacturer of urology products. The range consists of the Libra Leg Bag, GB Libra Sheath, Mummy and Baby Bear Paediatric Leg Bag, and a comprehensive selection of single use and reusable Night Bags. Accessory items are also available, including Catheter Fixation devices, Catheter Valves and Leg Bag Straps.

Ugo 2L Drainage Bags are available now on prescription! www.ugo2lbags.co.uk Find out more:

0113 263 3849

[email protected]

greatbearhealthcare.co.uk [email protected] 0800 055 6270

www.optimummedical.co.uk

in pharmacies but can be found online. “Incontinence can be severely disruptive to people’s lives, and that’s where products come in,” says Fader, who suggests visiting continenceproductadvisor.org to research options. “We need to see choices, a variety of discreet, effective, reliable options that are comfortable and easy to use, and washable items that avoid waste.” “We need to make sure that incontinence is treated whenever possible, but for people who have permanent incontinence it needs to be much more socially acceptable,” she insists. “Loads of people have long-term conditions – it’d be good if we got to the point where somewhere like IKEA sells these products and it’s an acceptable part of living.”

6 HEALTHAWARENESS.CO.UK

AN INDEPENDENT SUPPLEMENT BY MEDIAPLANET

MEDIAPLANET

INSPIRATION COLUMN

Ben Richards Actor

“Listen to your body, guys”

What’s new in IBS treatment? By Tree Elven

A

ctor Ben Richards was diagnosed with bowel cancer when he was only 40. He encourages younger people in particular not to ignore symptoms. “I was a fit, healthy guy who went to the gym regularly,” says Richards. “I’d noticed some blood, but lots of us – especially men – don’t like going to the doctor, and I just put it down to eating a lot of spicy food while I was filming in India. I was feeling a bit tired, but I was very busy.” After India, he was due to go to the States for work but still didn’t feel right, and took his then-partner’s advice of going for an ‘MOT’. His GP referred him to a specialist and tests revealed that he had bowel cancer that required major surgery. “Had I gone in months earlier, the recovery would have been much quicker and easier,” says the actor, who has now been clear of cancer for four years and is currently appearing in The Bodyguard in the West End. He’s also enjoying family life with partner Kirsten Duffy and their 16-month-old daughter. “I’m feeling great, life is good. But the sooner it’s found and dealt with, the less invasive the treatment.” Support is essential. “Get online and find those communities. Check out the Never Too Young site,” he advises. “I used Twitter to set up #bigcfight, and I get tweets from people of all ages. It helps others to see a younger person has been through it - it used to be mainly an older person’s disease, but that is really changing.” He’s cut various foods out of his diet after a food tolerance test, which he believes is useful for anyone. “The main thing is, listen to your body. If you’re not feeling right for a while, pay attention – you’re not a hypochondriac. Get on top of things.” Read more on healthawareness.co.uk

It’s an elusive, frustrating condition, but fresh approaches to diagnosis and management of Irritable Bowel Syndrome (IBS) spell good news for sufferers.

“IBS symptoms vary enormously,” says consultant neuro-gastroenterologist Dr Anton Emmanuel. “Some people feel suicidal, while others may barely notice the condition unless they have a flare-up. An estimated 12 per cent of healthy Brits have diagnosable symptoms, but thankfully, the percentage of those at the severe end of the spectrum is much lower.” The condition is identified by abdominal pain or discomfort, alteration in bowel habits, and a time relationship between the two – in other words, all three elements need to be present at once. “The key thing is for practitioners to make a positive diagnosis,” explains Emmanuel, who is a consultant neuro-gastroenterologist at University College London Hospitals (UCLH) and the British Society of Gastroenterology. “A big problem until now has been that, after going through tests to show it’s not a disease such as cancer, patients have felt left hanging because there’s no diagnostic test for IBS. They need to be told their symptoms are

Dr Anton Emmanuel Cosultant neurogastroenterologist at UCLH and the British Society of Gastroenterology

not all in their head, it is a real condition.” Identifying IBS has become easier thanks to a new faecal calprotectin test which is less invasive than procedures such as endoscopy; and there are two or three new drugs available. In terms of self-management and avoiding medication, Emmanuel says that some people can find the low FODMAPS dietary approach helps. “It’s a bit boring so it’s tricky to stick to, but it’s useful in the short term. Keeping a diary of what you eat and physical effects is also good.” Probiotics are “undoubtedly helpful”, he says, but you will probably need to try various types over a period of at least one month each to find out what works for you, because our guts are as distinctive as our fingerprints. “Stress is a major factor for most IBS patients; it’s very

important to identify what causes you stress externally, at work or socially, with a view to stopping the symptoms in their tracks,” says Emmanuel. “Relaxation and hypnotherapy techniques are often much more effective than drugs and they’re often available on the NHS, so do make use of those services.”

Chronic constipation As with IBS, women are more likely to suffer from chronic constipation than men. “Infrequency, or difficulty such as straining, over a period of three months are symptomatic – we’re not talking about constipation from eating too much pizza which clears up after a few days on a mild laxative.” Biofeedback has emerged as a useful technique which helps people become aware of their own patterns and mechanisms, and not only has no side effects, but is potentially curative, says Emmanuel. Foodwise, low FODMAPS are not useful for chronic constipation, but eating regular meals is a key habit to get into. “Regularity (two or three main meals a day) is much more important than a high-fibre diet – don’t go stuffing yourself with more fibre if it’s not working for you. Also, don’t overdo liquid intake. The body needs between 1.2 and 1.5 litres a day – it’s not helpful to take a lot more.”