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Work Together, Win Together

So here’s a question for you. At what age would you expect or even demand to be given a pad for your continence problem?

As a new mum experiencing a weak pelvic floor post delivery, as a menopausal woman having more frequent ‘Ooops moments’ or as an man with urgency or leaks due to prostate issues?

Despite the fact that pad companies heavily promote the use of products as an acceptable way of managing continence issues the word is finally getting out that there are better ways to address this problem.

Whatever level you engage with social media, whether you love or hate FaceBook, whether you’re a regular tweeter or find the #World a bit of a mystery, there is no disputing the fact these mediums have been conducive in raising the profile of pelvic health physiotherapy.

That consistent message that #PhysioWorks and active rehabilitation is an effective way to treat and cure rather than just manage continence problems is beginning to be heard.

At what point do our expectations change? When do we move from requesting an assessment and action plan to demanding that we’re left alone and given containment products or ‘pads’ to manage the problem?

I stepped into the world of pelvic health continence physiotherapy about sisteen years ago. Before then I’d been a ‘normal’ physio treating bad backs, aching necks and pulled hamstrings. I was drawn to pelvic health for many reasons the main one being that the evidence showed pelvic floor rehab actually worked!

As a Clinical Lead Physiotherapist based in a Continence Service it stuck me that there were two different services offered to patients.

The first service was the ‘rehab’ world, which is very familiar to physios. A man or woman with pelvic floor, bladder or bowel symptoms present in clinic, they are assessed, diagnosed and a progressive treatment plan is devised.

Over a course of a few months they are supported, reviewed and ‘Bingo’ – symptoms usually improve and they are discharged with a long-term plan of care. I’ve had far more grateful hugs working as a pelvic health physio than I ever had in the musculoskeletal world. Perhaps it’s because continence issues are so incredibly emotive and can have such a devastating effect on a person’s quality of life.

People are often so relieved that they’ve been able to talk to some one about issues they’ve often been struggling with for years and have been supported and guided through the recovery process.

The second service was the ‘pad’ world, which all seemed a bit more difficult to understand. What happened to housebound patients and those who weren’t able to attend an outpatient clinic?

It seemed they weren’t given a continence assessment but received in its place an assessment for containment products. There was sudden change in expectation. Once someone was housebound a shift in attitude often occurred both from the patient and those around them.

Comments rang out such as "I’m incontinent and I need a pad" "I’ve paid taxes all my life and am entitled to products". Yet is seemed to me that without realising people were requesting a second rate service and by reacting to these demands we were complicit in denying patients quality care. Patients, carers and family were giving up on the basic human right to be supported to use a toilet and be continent.

I have been fortunate to share the role of service lead with an inspiring continence nurse advisor with a passion for making things happen. Together and with the support of a newly launched continence team we redesigned the community continence service.

We took the burden of continence issues away from the district nursing teams freeing their time to focus on providing nursing care for patients with often very complex problems.

‘Work Together Win Together’ has been embedded in the DNA of the new Community Continence Team, which comprises of health care assistants, continence nurses with input from a physiotherapist. It has at times been a challenge but we have learnt from each other sharing our skills and have a robust set of competencies in place so everyone feels confident in their skill set.

The Community Team armed with portable bladder scanners, urinalysis sticks and the patients completed bladder and bowel diaries now respond to new referrals and offer a comprehensive assessment. This includes viewing the pelvic floor area and advising about pelvic floor exercises. Health care assistants are key players in getting patients and carers on board and we’re spreading the word that rehab can work whether you’re 18 or 108!

What do patients think?

Well 83.33% reported a noticeable improvement in quality of life after contact with our service and 97.7% scored us as a ‘10’ in the Family and Friends test meaning they would be ‘extremely likely’ to recommend us.

What about pads?

It appears after rehabilitation fewer people require containment products and those that do often needed less. The prescribing cost for products was reduced by 9% in the first year the service was launched.

The end result is that in a multicultural diverse community of around 440 thousand people anyone with continence problems can self refer knowing they will receive the same standard of care whether they can make it to clinic or are assessed at home.

So if I reach a ripe old age and am found pottering around a nursing home with my walking frame I will have a few important requests.

Please make sure I’m offered adequate fluids and switch me to decaffeinated tea and coffee. Most importantly reminded me to activate my core and pelvic floor. I’m hoping not to need a pad!

Written by Jane Appleyard, Pelvic Health Physiotherapist

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