On June 17th, the third in our series of three ACCT Let’s talk… webinars took place with the purpose of Advancing Continence Care Together from a holistic perspective. Again, renown lecturers and specialists helped us take a closer look at bladder and bowel management, this time with a focus on the Self with Professor Anton Emmanuel, Dr. Jalesh Panicker and Mrs Collette Haslam. Here we share some of the highlights. If you missed any of the webinars or would like to watch them again, use the link below that will take you to our webinar page.
Professor Anton Emmanuel started with telling us about overlapping areas and differences between neurogenic and functional bowel dysfunction. He pointed out that it’s key to have a practical approach and make a holistic assessment of each patient. Bowel function is complex and the main difference between neurogenic and functional bowel dysfunction is that with the latter there is no actual damage. He insisted on the need to create a unique formula for each patient, neurogenic or functional, and not to use a common diagnosis. Each individual will have a distinct set of symptoms and come from a particular social environment – which will affect his or her quality of life. There are certain common aspects for all patients with bowel dysfunction, such as fear of incontinence and the social taboo surrounding it – but they affect individuals in different ways. This is important to recognize so that therapeutic strategy is tailored accordingly. Patient diaries, questionnaires and attentive record of patient history are preferable to complex physiology testing or radiology studies.
Dr. Jalesh Panicker took us through different aspects of managing intimacy and sexual difficulties following neurological disease. He explained why sexual difficulties occur following conditions like for example MS and stroke, as well as how to assess them and their management options. To better understand the pathophysiology, he started by describing the physiology and pathways for male sexuality and psychogenic erection vs reflexogenic erection. Dr. Panicker furthermore guided the audience into understanding the fundamentals about human sexual response and its four different stages: excitement, plateau, orgasm, resolution. He also explained that many medications may affect sexual performance. For instance, antimuscarinics are commonly used for bladder dysfunction, but a side-effect is vaginal dryness. A better option may be Mirabegron, which has less impact on sexual functions.
Specialist nurse Collette Haslam highlighted the main barriers to help-seeking for sexual dysfunction and pointed to a general perception that people with certain conditions, especially if in a wheelchair, don’t have sex. They do not seek help for several reasons, one of which could be the presence of a family member in the room when talking to the healthcare professional (HCP). Another may be lack of time, or the fact that the HCP doesn’t prioritize this issue. If the HCP doesn’t ask, who should you talk to? Mrs. Haslam provided some hands-on advice for HCPs helping patients in similar situations. Spinal patients with acute injury may have to deal with it for the rest of their lives, hence psychological implications must be considered when talking to them.
Dr. Panicker and Specialist nurse Collette Haslam guided us through the management options that exist for patients like this, from the male and female perspective, respectively. Dr. Panicker explained the drawbacks with medications used for sexual dysfunction, and also about the learning curve necessary for some medications.
Did you miss this webinar or the previous two in the series? All 3 are available on-demand on our webinar page, which you can access here: