The frail elderly
Urinary incontinence in the frail elderly is a problem all GPs will encounter from time to time. Most of its burden falls on nurses.
This article, featured on Medscape, is taken from a US urology journal and is written with nurses in mind. It deals with strategies, especially pharmacological ones, that may help alleviate the burden for patients and carers. The problems associated with giving powerful drugs to the elderly are recognised, and the issues discussed make this worth reading.
Although this is a US account of the problem, nearly all the drugs mentioned are familiar to us here in the UK.
Why go there: addresses a difficult area.
Downside: general tone is pessimistic.
Information from: Urologic Nursing.
Address: www.medscape.com/viewarticle/488559_13
Exercise advice
Now you know that pelvic floor exercises work, but what do you do if your patient says she doesn’t have time to go or doesn’t want to wait three months for an appointment?
You refer her to this website, or if you’re feeling generous, just print off the two-page PDF.
It is produced by a top physiotherapy team who first discuss the basics, then go on to explain what pelvic floor muscle exercises are, and most importantly, how to do them.
Bookmark this page; I’m sure many of you will find it becomes an essential tool.
Why go there: excellent, clear advice.
Downside: no diagrams.
Information from: Addenbrooke’s NHS Trust
Address: www.addenbrookes.org.uk/resources/pdf/physio/pi049_physio_stressincont.pdf
Pelvic floor exercises
Does conservative treatment work? It will only take a minute to read this abstract, and conclude that the answer is ‘yes’.
I have heard physiotherapists and surgeons who only appear to pay lip service to the use of pelvic floor exercises and decry the use of weighted intravaginal cones.
But this eminent panel suggest that such therapeutic initiatives are well worth while.
Why go there: an authoritative statement.
Downside: you have to pay for the full article.
Information from: International Urogynecology Journal.
Address: www.springerlink.com/content/wul872345n741837/
The herbal option
If you have $300 to spare you could buy a two-month course of the KRN herbal treatment. This is for all types of incontinence, and claims to heal six out of 13 patients in its large-scale clinical trial.
How you ‘heal’ incontinence I don’t know, but one possibility that springs to mind is unpleasant. The ingredients are custom made to your symptoms and here is the really good news — a big selling point is that you don’t have to cook the herbs before use.
If this remedy doesn’t work, I suppose the bottle could be filled with water and used as an intravaginal pelvic floor training weight.
Why go there: good question, no answer.
Downside: could make sufferers laugh and make their symptoms worse.
Information from: HerbChina 2000
Address: www.herbchina2000.com/therapies/KRN.shtml
Dr Barnard is a former GP in Fareham, Hampshire
Website of the week
There are few medical topics that receive more internet mileage than female urinary incontinence (over 1.5 million hits on Google), and almost all of it is aimed at patients rather than medical professionals. Therefore finding information for doctors is not easy, which may explain why I had to make a virtual trip to the Antipodes for this excellent site.
I don’t think I’ve seen a better attempt at explaining the process of dealing with a patient who presents with this distressing symptom. Stress and urge incontinence are discussed separately.
Two items alone make this site worth the visit. One is the table of key questions to ask when evaluating patients, and the other is a downloadable bladder diary.
Why go there: invaluable aid to assessment.
Downside: not much on treatment.
Information from: Royal Women’s Hospital, Melbourne, Australia.
