The Urogenital Universe - Episode 1: Which vaginal estrogen product isn't as good for lactobacilli We all know how important estrogen is for vaginal and urogenital health. We have seen it help our patients with urge incontinence, stress incontinence due to intrinsic sphincter deficiency, painful intercourse and even prolapse. But what if an estrogen [...]
The Gut Digest - Episode 2: How to reduce constipation in your patients taking iron Do your patients stop taking their iron due to constipation? This can be a real frustration, and can even highjack their clinical outcome due to the importance of iron in physiological function. If they can’t take their iron, your [...]
The Gut Digest - Episode 1: Lactulose and Lactose Intolerance Gut problems…so common in our patients! Constipation, IBS, FODMAPs intolerance, lactose intolerance…and many of our patients have more than one of these problems! Lactose intolerance is relatively common in our patients that we are seeing for bowel problems. There is often concern about the [...]
Three gut-wrenching clinical scenarios: one, the postmenopausal patient with soul-destroying faecal incontinence you just can’t get a handle on. Two, the young woman with IBS, sentenced to a frugal restricted diet and miserably lacking in social life because she reacts to everything she eats. Three, the man not even forty whose colonoscopy just showed 47 polyps, staring down the barrel of twice-yearly colonoscopies for the foreseeable [...]
Your first patient (prolapse) has chronic constipation, with bowels about as lively as an overstuffed armchair. Your second patient (faecal incontinence) has chronic diarrhoea, and every medical investigation under the sun comes up with a shoulder shrug.*Everyone knows you should increase fibre in constipation.* (Except when increasing fibre causes worse problems…) *In chronic diarrhoea, more fibre would logically be the last thing the patient needs.* (Except when fibre is the therapeutic solution…) Holy [...]
Pop quiz for pelvic physios: what is the common denominator in these patient presentations? (These are all real patients, but I bet you feel like you have seen them too!) 30-something woman plagued with recurrent thrush and BV (bacterial vaginosis). 30-something woman who had vaginal Group B strep during pregnancy and persistent bladder irritation after. 60-something [...]
Acidic bowels…you’d be surprised how often patients use this expression with me in clinic. They are usually talking about how some bowel motions feel painful or unpleasant, describing it as a feeling of “acidic bowels”. I learn a lot about how to help people from their symptom descriptions…but when it comes to [...]
You’ve all seen it – the mile-long supplement list your patient brings in. Who knows what all those pills do, or if they need them? If your patient has musculoskeletal pain, curcumin is usually there. Does it work? Do they need it? Do they know something you don’t? You don’t want them being taken [...]
Being a clinician working in persistent pelvic pain (PPP) you’re working with the whole person. Arguably even more than when you specialise in elbows or necks. Persistent pain is complicated, and when it involves the pelvis, it seems to involve even more layers. We can’t understand a woman’s pelvic pain without knowing about her [...]
