Jul 29

‘Continence is everybody’s business’ is one of the main messages to come from Continence Awareness Week (CAW) 2009 (2-8 August).

Incontinence is the term given to the loss of voluntary control over bladder or bowel function, and it’s one of the biggest health issues in the Australian community – affecting nearly four million people. It may not be life threatening, but incontinence can significantly impact on quality of life and is sometimes a sign of more serious health problems.

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The focus of CAW this year is an acknowledgement that continence problems also affect many more millions of Australians – those people who provide care for someone with incontinence. This covers a range of people (both young and aged carers) providing unpaid support and care to family members and friends who have a disability, mental illness, chronic condition, terminal illness or who are frail.

Signs of poor or weak bladder and loss of urine control include frequency – wanting to go to the toilet frequently, nocturia – waking up to go to the toilet more than twice at night, urgency – sudden urges to go to the toilet and the involuntary or unintentional loss of urine from the bladder – that is wetting pants or wetting the bed.

While studies show that women are many times more likely to be affected by incontinence than men, men are far less likely to do anything about it.

Incontinence in men is largely related to prostate problems. Simple age-related prostate gland enlargement is often the cause and a recent study found that 60% of men are affected by incontinence following surgery for prostate cancer. Also, medical conditions such as diabetes, obesity, constipation and chronic cough can cause or aggravate continence problems. Any bladder and bowel symptoms should be treated along with the underlying condition.

As we get older incontinence certainly becomes more prevalent and more severe but incontinence is not just part of the ageing process. Certainly some age-related conditions increase the risk – conditions such as stroke, dementia, Parkinson’s disease or simply impaired mobility. And more than half of all residents in nursing homes – both men and women – have bladder control problems.

Nevertheless, poor bladder and urine control can happen to anyone at any age and other factors which increase risk are menopause, pregnancy, childbirth, having borne children, being overweight and urinary tract infections.

Unfortunately, less than 40% of people with incontinence ever seek professional help. Perhaps because they’re too embarrassed or too busy, or maybe they think nothing can be done, that it’s just a side effect of getting older or having children.

If you, or someone in your family, are affected, firstly get some good advice. Don’t let incontinence disturb your sleep or, worse still, ruin your social life. Talk to your doctor, your physiotherapist, your pharmacist or your nurse continence advisor.

There is excellent advice on the Continence Foundation website at www.continence.org.au or simply call into your local Self Care pharmacy for information on how to prevent and manage continence problems.

Pharmacists throughout Australia who provide the Pharmaceutical Society’s Self Care health information are promoting continence management. There are ‘fact cards’ on Bladder and Urine Control, Pelvic Floor Exercises, Prostate Problems and Urinary Tract Infection; all with self help hints and great advice on how to best manage continence problems, whatever the cause.

Remember, incontinence is a symptom, not a disease. It’s important, therefore, to find out what is causing this symptom. And there are several different forms of incontinence, each responding to a different form of treatment.

Medications are sometimes used to help manage incontinence, but on the other hand certain medications (and the socially acceptable drugs like alcohol and caffeine) can cause incontinence or make it worse.

So if you have bladder problems, don’t keep it a secret. Talk to your doctor or check out the information at one of the 1,650 Self Care Pharmacies around Australia. Call 1300 369 772 for the nearest location.

Meanwhile, reduce your consumption of caffeine containing drinks – coffee, tea and cola; limit your alcohol intake; maintain a healthy weight; unless otherwise advised by your doctor, drink enough water to keep your urine ‘light-coloured’; eat plenty of fruit, vegetables and grains; exercise those muscles on the pelvic floor and don’t smoke.

©2009 Pharmaceutical Society of Australia

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Jul 22

This month we’ve been reflecting on the exploits of three American astronauts 40 years ago; but it’s also interesting to consider what happened much closer to home nearly 240 years ago.

Just like the moon watchers of 1969, Captain James Cook was looking skyward when not quite by accident, but certainly secondary to his main aim, he came across the east coast of Australia.

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In 1769 Captain Cook’s primary role was to observe the transit of Venus. His ‘discovery’ the following year of what he named New South Wales led to the visit and permanent settlement of Arthur Phillip’s First Fleet 18 years later.

Philip sailed into Botany Bay just a few days before French navigator, the Comte de La Perouse. It’s debatable if the French had arrived before the British whether the Tour de France would include Australia; however, different timing of events in 1815 really would have meant our red, white and blue flag may have had a very different design.

Apparently at a critical stage during the Battle of Waterloo, Napoleon returned to his quarters to seek relief from the pain of his haemorrhoids. Whether relief was gained we don’t know, but we do know that for the ‘little general’ the battle was lost.

No time is convenient to suffer with haemorrhoids; and how many emperors today are similarly discomforted is hard to say, but Napoleon had been all day in the saddle, and any horse rider would surely say that having haemorrhoids is not much fun. The reality is, of course, having haemorrhoids is no fun for anyone – it’s a very sensitive issue in more ways than one.

Haemorrhoids are just like varicose (swollen) veins inside or around the anus. They are very common, with 80% of people estimated to have suffered with haemorrhoids at some time in their lives.

Symptoms include pain and irritation – the pain is usually a dull ache, often worse when passing a bowel motion; and the irritation is usually a burning, itching sensation. Fortunately these symptoms can generally be treated effectively with medicines, diet and attention to hygiene.

Rectal and anal discomfort can also be caused by conditions other than haemorrhoids. Therefore, if we are unsure whether haemorrhoids are actually the cause of the discomfort, we should see our doctor in the first instance.

Non-prescription topical preparations containing combinations of local anaesthetics, corticosteroids, astringents and healing agents are soothing and give at least temporary relief of symptoms – they should normally be used twice a day and after each bowel motion. However, long term relief may need some diet and lifestyle modification.

Constipation or straining to pass a bowel motion are common causes of haemorrhoids, so judicious use of laxatives can be useful in addition to an increase in fibre and fluid intake. We should also recognise that medicines (often prescribed medicines) can be a cause of constipation. Your pharmacist can advise you if this is likely to be the case.

With this in mind, paracetamol is the first choice ‘over the counter’ oral analgesic to relieve the pain of haemorrhoids. So-called compound pain relievers containing codeine should be avoided as they can also cause or aggravate constipation.

Keeping the area around the anus clean will help reduce itch and irritation. As soap can itself cause irritation to the already sensitive area, non-soapy cleansers are a better option, as are the use of flushable moist towelettes instead of toilet paper.

If you want to participate in the equestrian events at the next Olympics, perhaps cycle to the local shops, or even sit down for dinner without too much discomfort, check out the Haemorrhoids fact Card. It’s available from pharmacies around Australia providing the Pharmaceutical Society’s Self Care health information – go to www.psa.org.au and click on Self Care Pharmacy Finder. There are other relevant cards: Fibre and Bowel Health, Constipation and Pelvic Floor Exercises.

©2009 Pharmaceutical Society of Australia

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Jul 15

National Diabetes Week has again focused our attention on the fastest growing non-infectious disease in the world. And this year there is special emphasis on the association between diabetes and high blood pressure.

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Uncontrolled diabetes poses a serious risk to our health. Complications can include blindness, kidney failure and increased risk of heart disease and stroke.

Diabetes is the name given to the condition where our body is unable to use glucose properly – and glucose is our major energy source; the fuel which keeps our body functioning effectively.

There are two major forms of diabetes – type 1 and type 2. Type 1 diabetes usually occurs in childhood or young adulthood – possibly because the body’s immune system runs a bit wild and attacks and destroys the insulin-producing cells in the pancreas gland. Because the body stops making insulin, people with this form of diabetes need daily doses of insulin.

However, type 2 diabetes is the form of diabetes likely to affect most Australians (in type 2, insulin is produced, but we just can’t use it effectively). It accounts for 85-90% of the more than a million Australians with the condition – a number that could double over the next 10 years or so, if control strategies are not put in place.

Type 2 diabetes usually occurs in older adults – it used to be called maturity onset diabetes – but increasingly the condition is affecting younger people. Family history is one reason.

Of course our parents are not totally to blame. Family history is just one risk factor. Lifestyle issues are also highly significant. Overweight and obese adults are two to four times more likely to suffer from diabetes.

We now know that high blood pressure is another major risk factor for diabetes; a factor which is apparently not widely understood. According to Dr Neville Howard, President of Diabetes Australia – NSW, “there is a staggering lack of awareness about the link between high blood pressure and developing diabetes and its serious complications.” “While most people are aware that family history and being overweight can put them at risk,” he said, “a Diabetes Australia Study conducted last year has shown that 90% of people surveyed did not know that high blood pressure was a risk factor.”

When blood pressure is measured, two reading are taken; and it is usually expressed as one larger number over another. The top reading (so-called systolic blood pressure) is a measure of the force of the heartbeat. The lower reading (diastolic) is a measure of the blood pressure when the heart is at rest between beats.

There is no “ideal” blood pressure – it will vary from person to person; but as a guide the target blood pressure is less than or equal to 130/80.

Lifestyle changes are the key to reducing the risks of and treating high blood pressure, said Dr Howard. This should involve healthy eating, regular exercise, drinking lots of water, reduced salt intake, alcohol in moderation (no more than two standard drinks per day) and no smoking. Most of us will also need to lose some weight around our waist line. The aim should be a waist circumference of less than 80cm for women and 94cm for men.

And every time we visit the doctor we should get our blood pressure checked. If we seem otherwise healthy, we should make sure we have at least a yearly check up, especially if we’re over 40.

You can get more information about diabetes from the Diabetes Australia website or pick up a Fact Card from one of the 1,650 pharmacies around Australia providing the Pharmaceutical Society’s Self Care health information. Phone 1300 369 772 for the nearest location or go to the Pharmaceutical Society’s website at www.psa.org.au and click on “Self Care Pharmacy Finder”.

©2009 Pharmaceutical Society of Australia

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Jul 09

Urinary tract infections (UTIs) are one of the most common infections requiring medical treatment.

While UTIs can affect any one at any stage in life, they are more common with advancing age and affect more women than men. In fact nearly one in three women will need treatment for a UTI before the age of 24.

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The very descriptively titled Wee Week (19-25 July) aims to promote the benefits of a healthy urinary tract as well as the importance of early recognition and treatment of urinary tract infections.

UTIs can involve just about any part of the urinary tract – the body’s plumbing, filtration and liquid waste disposal system. The kidneys and the bladder can be affected, as can the ureter and the urethra – the “pipes” which carry urine to and from the bladder.

Bacteria which normally live harmlessly in the intestine or the bowel are the usual suspects for causing UTIs. If these bacteria manage to spread from the anus (the back passage) into the urethra and then further into the urinary system, they can cause some rather nasty and discomforting conditions.

Urethritis is the medical term describing the infection when just the urethra is affected. If the infection spreads to the bladder causing the bladder lining to become raw and inflamed the condition is known as cystitis; whereas pyelonephritis is the name for the infection if it spreads to the kidneys.

All these conditions can cause a prickly, scalding or burning sensation when passing urine, and the urge to urinate frequently. If the bladder and kidney are affected, the urine might be cloudy or bloody and you may experience lower abdominal or back pain. Kidney related infections are potentially very serious and need prompt treatment to avoid kidney damage.

Mild cystitis can sometimes be treated effectively by drinking plenty of fluids (preferably water) to flush the bugs out the system, whilst often a urinary alkaliniser – something to make the urine less acid – will also help. Some studies have shown that cranberry juice or cranberry extract tablets may assist in preventing symptoms of cystitis in people who are susceptible to repeat infections. It seems cranberries contain a substance that can help prevent bacteria from sticking to the walls of the bladder. However, results from the studies are not so positive for elderly men and women.

Women, generally, are more likely than men to suffer with UTIs because the urethra is so short. Also, female hormones can affect urine acidity making it more likely the offending organisms can thrive – especially at certain times of the menstrual cycle, during pregnancy and menopause or after a hysterectomy. Sexually active women are more at risk because sex can push the bacteria into the urethra.

Men with prostate problems may have difficulties with urine flow and bladder emptying and so allow the bacteria more time to reproduce. Older people, or people with another chronic medical condition such as diabetes, where the immune system is already under stress, are also more likely to get UTIs.

Recently the Pharmaceutical Society has produced a Urinary Tract Infection Fact Card which has some self help hints on how to reduce the risk of urinary tract infections. It’s all about developing good habits of personal health and hygiene. The best advice is to drink plenty of water – around eight glasses a day. It helps to keep your plumbing system nice and clean. And, if you have an urge to go to the toilet, do so as soon as convenient. Don’t hold on!

Most importantly, if you think you have a UTI and the simple non-prescription products are not successful, see your doctor promptly. An appropriate antibiotic will usually give the desired results quickly and safely. And you’ll avoid any possible serious consequences. Meanwhile, if you would like some more information about UTIs, pick up a Urinary Tract Infection Fact Card from any one of the 1,650 Self Care pharmacies around Australia. Phone the Pharmaceutical Society on 1300 369 722 for the nearest location, or check out the PSA website: www.psa.org.au and click on Self Care Pharmacy Finder.

©2009 Pharmaceutical Society of Australia

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Jul 01

It’s been reported that visitors arriving in Indonesia with flu-like symptoms will be requested, perhaps even required, by the Government there to wear face masks for three days – a measure aimed to reduce the risk of human to human transmission of swine flu.

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Swine flu also remains a problem in Australia, and precautions to help prevent the spread of infection are highly important. Nevertheless, the use of masks is just one aspect or risk reduction. Personal attention to hygiene is vital. Regular handwashing and the use of disposable tissues to capture coughed or sneezed viruses are essential.

However, the flu – whether it’s the swine or seasonal variety – is not the only infectious disease we should be concerned about – nor the only cause of cough.

For instance, already 14,000 cases of whooping cough have been notified in Australia this year. Whooping cough numbers have fluctuated over the last 15 years; but even in the epidemics which have occurred every three or four years, the total number of cases has been around 10,000.

This year NSW has been particularly badly hit, reaching the 8,000 mark by mid-year, compared with a total last year of 7,000.

Whooping cough (which is known medically as pertussis) is a serious, contagious bacterial infection. Early symptoms are similar to those of a cold. Then the typical cough or “whoop” develops which gives the condition its common name. This sound is due to a deep breath at the end of a bout of coughing. Vomiting after coughing is also common.

In young babies symptoms can be severe and even life threatening. According to the Victorian Government’s Better Health website, one in every 200 babies who contract whooping cough will die.

Early diagnosis and access to antibiotics is necessary for effective treatment and to minimise the spread among family and close contacts. Strict adherence to Australia’s immunisation schedule will prevent whooping cough. The vaccine is given, along with vaccination against other common infectious diseases, at two, four and six months of age; and then again at four years of age.

To be fully protected adolescents should receive a booster dose of pertussis vaccine (together with diphtheria and tetanus) between the ages of 15 and 17 years – or about year 10 in high school.

But, vaccination against whooping cough does not confer lifetime immunity, and large numbers of cases continue to occur in older people. Unvaccinated adult carriers of the whooping cough organism can put the lives of children at risk, so a booster dose of pertussis vaccine is recommended for healthcare workers or those caring for young children.

With sometimes sensationalised or misguided stories about immunisation side effects, parents and carers can become understandably concerned and confused. In fact, immunisation strengthens the body’s immune system. It’s a simple, safe and effective way of protecting children (and adults) against disease. Your GP can give you more information.

You can also get more advice and information about whooping cough from pharmacies around Australia, providing the Pharmaceutical Society’s Self Care health information. Phone 1300 369 772 or check out the website at www.psa.org.au to find the nearest location. Ask for the Childhood Immunisation Fact Card. you can also get details about immunisation generally from the Commonwealth Government’s website

©2009 Pharmaceutical Society of Australia

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