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CONGRESS '09 - Pelvic floor exercise ‘should be routine’

Bladder and bowel dysfunctions are major problems for patients with neurological conditions, and can be significantly demoralising and socially disabling.

Dr Doreen McClurg , from the nursing, midwifery and allied health professions research unit at Glasgow Caledonian University, described the causes and types of incontinence and their related neurological conditions, and outlined ways that physios could help.

And it was a considerable problem, she told Congress. Between 40 and 60 per cent of people admitted to hospital after a cerebrovascular accident were affected by urinary incontinence and 15 per cent remained incontinent after a year. Meanwhile, said Dr McClurg, research suggested that recovering from incontinence after CVA could promote morale and self-esteem so much that it could hasten overall recovery.

Her research showed that bowel dysfunction, including constipation and/or faecal incontinence, separately or together, was a psychosocially disabling problem for 45 per cent of patients who had been diagnosed with multiple sclerosis for two to five years, and for 69 per cent of those diagnosed for longer.

Rehab physios should discover if their patient was incontinent, liaise with the multiprofessional team, and if necessary refer appropriately, for example to an MS nurse, continence adviser or specialist continence physio.

But they should also recognise institutional and functional factors that can influence continence, such as nurses’ and carers’ low expectations, using catheters and pads and leaving the call bell unanswered, she said. Her take-home message was to teach pelvic floor muscle exercises to patients with bladder and bowel problems as a matter of routine.

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