Women may deny themselves treatment but doctors and a postcode lottery don’t help!Press Release
5 August 2014
Women may deny themselves treatment but doctors and a postcode lottery don’t help!
New research from the US suggests that, in addition to ignorance and fear amongst the female population, it is our doctors that pose a major barrier to the simple, effective treatment of Urinary Stress Incontinence (USI).
Many millions of women suffer the embarrassment of Urinary Stress Incontinence (USI) but seem to put up with the problem and waste money buying a lifetime supply of absorbent pads, when 80% could be cured in a few weeks with a simple exercise programme.
NICE acknowledge the scale of the problem (CG171 Clinical Guidelines for the treatment of incontinence in women) but consider the problem lays with the patient not the physician.
NICE state that incontinence, largely caused by pregnancy and childbirth, affects between a half and two thirds of women and that “there is a general belief amongst women that there is no effective treatment”. NICE acknowledges that the awareness problem is so bad that many women may wait up to ten years before seeking medical help.
Barry Fowler, author of The Kegel Legacy (ebook gbp1.99) notes that NICE makes little mention of the effect of GP attitudes, a poor track record for effective physiotherapy advice and treatment, an obsession with surgical and pharmaceutical treatments and a postcode lottery for treatment.
For over 3 years GPs throughout the UK have been able to prescribe a simple, low cost clinically proven exercise device that has demonstrated 80% cure rates in a matter of weeks. But a postcode lottery exists and local Commissioning Group policy decisions mean that many GPs choose to be unaware of the device or to deny that they can prescribe it.
A campaign to increase awareness (www.elephant-in-the-room.info) has done little to improve awareness amongst GPs or patients.
Now this new US study reinforces the suggestion made by many in the field that the matters will only improve when GPs take a more positive attitude.
The US study acknowledges that lack of knowledge amongst women is part of the problem with key issues reflecting UK studies:
•Normative thinking ie urinary incontinence is a normal part of aging, childbearing
•Fear of treatment, including adverse effects of medication and surgery
•Avoidance/denial ("if I ignore it, it will go away")
•Communication issues, including embarrassment and hesitancy to mention the problem, particularly if the visit is under time constraints
But there is an acknowledgement that doctors put up barriers, including not asking about urinary incontinence, dismissing the patient's concerns, or providing misinformation.
The conclusion of the US study leader Professor Lee applies just as much to the UK: "The message to physicians is to screen patients and ask if they have incontinence. And if they're bothered by it, offer treatment and follow-up."
When will NICE and our primary healthcare experts acknowledge this simple truth?
ENDS
For further information contact Barry Fowler
0117 974 35340117 974 3534
07768 233 67007768 233 670
Reference:
www.thekegellegacy.com
www.pelvictoner.co.uk/elephant
EDITORS NOTES
An estimated 7 million women in the UK suffer the embarrassment of Urinary Stress Incontinence (USI).
5000 new mothers each week will develop serious long term health problems because of the poor post-natal advice and guidance that they receive. Published data shows that there are around 60,000 births per month in the UK, and it is widely acknowledged that a third of these new mothers with develop long term health problems such as stress incontinence and prolapse because they are not encouraged to follow an effective post-natal rehabilitation programme and are not given sound advice or offered effective treatment.
Author Barry Fowler says: “Our research shows that the best that most women presenting with bladder or prolapse problems can expect is a suggestion that they ‘do’ pelvic floor or Kegel exercises. Some may be offered a locally produced leaflet. I have studied the medical literature going back 50 years and I cannot find one clinical trial that demonstrates that giving out leaflets confers any benefits. It is just not a clinically proven treatment.”
He is also dubious of the benefits of the primary treatment recommended by NICE – a three month course of physiotherapist supervised pelvic floor muscle training. “It is widely acknowledged that this approach fails to offer any real improvement in symptoms in any realistic timescale, so it is no surprise that a general perception develops that there is no hope. The fact that the techniques taught lack any rigour, and fail to even acknowledge the principles proven in early clinical trials, must lead to the conclusion that they are not fit for purpose. The fact that there are two year waiting lists for physiotherapy in some parts of the country just compounds the problem.”
Fowler is at a loss to explain the reluctance of the medical profession to face the problem and questions the fact that, despite intense lobbying, the new NICE guidelines ignored developments in lifestyle management and physical therapies and focussed exclusively on much more expensive pharmaceutical and surgical interventions.
He highlights the example of The PelvicToner™ exercise programme which has been available on prescription for over three and a half years.
“The PelvicToner is clinically proven to be as effective as a three month programme of physiotherapy yet it costs one tenth as much and does not take up scarce physiotherapy resources.
But The PelvicToner is another one of those treatments subject to a ‘postcode lottery’ imposed by local commissioning groups or medicines management committees. “In parts of the country physiotherapy departments are so frustrated that their local GPs will not prescribe this device that they are buying and distributing them from their own limited budgets!”
Study Reference:
Physicians Pose Barriers to Urinary Incontinence Treatment
American Urogynecologic Society (AUGS) and International Urogynecological Association (IUGA) 2014 Scientific Meeting: Poster OP116. Presented July 26, 2014
“Even women with health insurance and access to care cite barriers to treatment for urinary incontinence, and on the list is physician attitudes, a qualitative focus-group study has found.
Fear of treatment and lack of knowledge were the top 2 problems named in the group sessions. These were followed by provider barriers and a belief that incontinence is a normal part of aging.
The message to physicians is to screen patients and ask if they have incontinence. And if they're bothered by it, offer treatment and follow-up.
The study was conducted by Jennifer Lee, MD, assistant professor of OB/GYN at the University of California, Irvine, and colleagues.”
Janey Lee Grace, broadcaster and author of many books on natural health, is a great advocate of natural solutions.