Bladder and Bowel - Q4 2022

Bladder and Bowel

Q4 2022 | A promotional supplement distributed on behalf of Mediaplanet, which takes sole responsibility for its content

“Over 21,000 people are diagnosed with invasive and non-invasive bladder cancer annually in the UK.”

Dr Lydia Makaroff, Chief Executive, Fight Bladder Cancer

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www.healthawareness.co.uk

Polly Weston, Chair, Association for Continence Advice (ACA)

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“So many of our lifestyle choices might have an impact on our bladder and bowel function.”

Irritable bowel syndrome can take over a person’s everyday life

Over 1 in 10 people in the UK are thought to have irritable bowel syndrome (IBS) in the UK.

It is not quite known what causes IBS, but there are certain triggers such as emotional stress or sensitivities to certain food. A gut infection such as food poisoning or gastroenteritis and certain medications can trigger IBS as well.

Symptoms and causes of IBS

The most common symptoms of IBS are abdominal pain/ cramping, bloating, nausea, diarrhoea or constipation and sometimes, a mix of both. Symptoms can be worse after eating.

Mhairi Jarvie, 49, from Inverness was first diagnosed with IBS in 2001 after going through a traumatic divorce.

“I was told I had IBS back in 2001 after going through a particularly horrible divorce. I was told it was all stressrelated, and it certainly was the case then. However, I worked out what was ‘normal’ for me when it came to bowel movements and got on with life.”

Issues surrounding IBS

“Fast-forward to March 2001, when I woke up one morning screaming in agony. My bowel had become twisted, and I ended up needing emergency surgery. It was unrelated to IBS at the time,” says Jarvie.

“Since my surgery, my IBS has become drastically worse. I’ve tried removing certain foods for six weeks, which didn’t work, and I panic when I experience stomach cramps. My GP believes my surgery has caused PTSD, and this exacerbates my IBS. The biggest change is that I now experience urgency — I need to go without any warning, and this has impacted my life.”

The biggest change is that I now experience urgency — I need to go without any warning, and this has impacted my life.

Dealing with public situations

Jarvie discloses how she deals with urgency: “I now have a ‘Just Can’t Wait’ card on my phone, which has helped me out in a couple of situations. In one supermarket, all the customer toilets were shut, and I showed my card to one lady, who took me straight to the staff toilets.”

“I’ve got a long way to go until I feel confident again. IBS sadly rules my life; but I have found that by speaking openly about my bowel issues, it’s been a surprise to learn how many others have issues too.”

There is no known cure for IBS; but certain dietary changes, medication and avoiding stress can help to alleviate symptoms. You should check with your GP before making any changes.

WRITTEN

“You don’t have to keep letting your leaky bladder affect your quality of life.”

Janet

“Nearly 43,000 people are diagnosed with bowel cancer each year.”

Genevieve

“7.5 million people in the UK would be too embarrassed to talk to GPs about symptoms of serious bowel disorders.”

Burcu

bladder cancer

Bladder cancer is highly treatable if it is caught early enough. That’s why you shouldn’t delay if you spot symptoms, which can include blood in your urine. See your GP.

Let’s be honest,” says Kathryn Chatterton, Bladder Cancer Clinical Nurse Specialist at Guy’s and St Thomas’ NHS Foundation Trust. If you have the symptoms of bladder cancer, you might be embarrassed about going to the doctor. But her firm message is: Don’t be. Because if this type of cancer is diagnosed early enough, it is highly treatable.

WRITTEN BY Tony Greenway

“The bladder is one of those taboo areas,” admits Chatterton. “People can be embarrassed about it because it’s to do with their private parts, so if they have symptoms — the most common one is blood in the urine — they might be tempted to put off seeing their GP. But they shouldn’t because the earlier this cancer is caught, the better the outcome can be. So don’t ignore it.”

Different types of bladder cancer

We should all talk more about bladder cancer, says Chatterton, because it’s not discussed nearly enough and can be widely misunderstood. For instance, there are (essentially) two types of the disease: non-muscle invasive bladder cancer, which means the cancer is still contained within the lining of the bladder wall and could be more treatable; and invasive bladder cancer, where cancer has spread into the muscle layer of the bladder wall — and possibly to adjacent organs — and could be more difficult to treat.

How common is it, and what are the symptoms?

“Bladder cancer doesn’t get as much coverage as, say, breast, bowel or prostate cancer,” she says. “But it’s not rare. It’s the 11th most common cancer in the UK, and over 21,000 people are diagnosed with it each year.” While historically, it has been thought of as an ‘older person’s disease,’ it can affect adults of all ages. “It’s generally more prevalent in the over 65s — but not exclusively,” notes Chatterton. “We’re seeing increasing numbers of younger people, even those in their thirties and forties, with this type of cancer.”

Make sure you know how to spot the symptoms.

The most common one is blood in the urine, which, when you are passing it, is often painless. Others include urinating more frequently and urgently and/or pain during urination. In most cases, this

will indicate a urinary tract infection, and antibiotics will be prescribed accordingly. But if symptoms persist after treatment, the patient should be referred to a urologist for further investigation.

Treatment options and the best way to lower risk If cancer is diagnosed — depending on its type, risk and seriousness — treatment can include transurethral resection of a bladder tumour (TURBT), where a surgeon will cut tumours away from the lining of the bladder; with a single dose or longer course of chemotherapy into the bladder. In some high-risk or advanced cases, an operation to remove the bladder followed by radiotherapy or a combination of chemotherapy and radiotherapy may be necessary.

Patients will see many healthcare professionals during their treatment, but they will also be supported by a Bladder Clinical Nurse Specialist, such as Chatterton. “We provide a constant, familiar point of contact for specific care needs,” she explains. “That continuity of care is vital for the mental health and wellbeing of patients and their loved ones.”

We can do something to lower our risk of developing the disease. While bladder cancer can be caused by — among other things — exposure to harmful chemicals and untreated, recurring bladder infections, the biggest culprit — by far — is smoking. “Smokers are four times more likely to develop bladder cancer,” says Chatterton. “So, my other big message — apart from seeing your GP immediately if you have concerns — is simple: Don’t smoke.”

It’s the 11th most common cancer in the UK, and over 21,000 people are diagnosed with it each year.

The earlier

is caught, the better the outcome can be “

INTERVIEW WITH

Kathryn Chatterton Bladder Cancer Clinical Nurse Specialist, Guy’s and St Thomas’ NHS Foundation Trust

Five self-help tips for leaky bladders

Urinary incontinence is bladder leakage that you can’t control. It is thought that one in four people will suffer with urinary incontinence at some point in their life, and many people suffer in silence because they feel too embarrassed to seek help.

Whether you can’t get to the loo in time or it’s exercising or sneezing causing leaks, this article may help you.

WRITTEN BY Janet Place Urology Nurse Practitioner, British Association of Urological Nurses (BAUN)

Tip 1.

Drink enough fluids

Many people who experience leaky bladders will drink less water than is recommended. Dehydration will make your urine more concentrated, which in turn can irritate your bladder and make incontinence worse. Not only that, but dehydration can also cause constipation, which can make your bladder leak more. If you want to increase your water intake, try taking small sips of water throughout the day, or aim to tick off eight glasses of water per day.

Tip 2. Cut down on

caffeine and alcohol

Some food and drinks can irritate the lining of your bladder, making you have to rush to the toilet — and sometimes not making it in time. The top two triggers are caffeine and alcohol. You may want to try eliminating these from your diet for just two weeks to see if you notice any improvement in your leakage. If you do, try to eliminate them for good.

cancer:

Over 21,000 people are diagnosed with invasive and non-invasive bladder cancer annually in the UK.

Bladder cancer is the fifth most common cancer in the western world. For men, it is the fourth most common. Despite the high number of people diagnosed, bladder cancer currently receives just 1% of cancer research funding in the UK and is still largely unknown.

The key to survival

There is a huge lack of awareness about bladder cancer, and we are on a mission to change this.

A timely diagnosis offers a significant increase in the chance of long-term survival and quality of life. By ensuring early diagnosis and

Tip 3. Practise pelvic floor exercises

Pelvic floor exercises can help improve urinary incontinence by strengthening the muscles that support your bladder. This is true for both men and women. Simply squeeze your pelvic floor muscles (these are the same muscles you use if you try to stop the flow of your pee) for a count of three, and then slowly release for another count of three. If you can try to do 10 to 15 of these squeezes, three times a day — you will likely notice your bladder control improving within six weeks.

Tip 4. Lose a little weight

Carrying extra weight can put stress and pressure on your pelvic floor muscles, which can then make your urinary incontinence worse. If you think you are overweight, you may be able to lessen your bladder leaks by losing a little of the extra weight.

Tip 5. Seek help

You do not have to suffer in silence — help is available. You don’t have to keep letting your leaky bladder affect your quality of life. Make an appointment with your doctor for a diagnosis and personalised treatment plan.

seeking medical advice and care, the survival rate can be as high as 90%.

Know the symptoms

Bladder cancer is more common than people think, and in many cases, patients hear of bladder cancer for the first time when they receive their diagnosis. People must know the symptoms and get to their GP as soon as they appear.

The most common symptom is blood in the urine, even once. However, one of the main barriers to diagnosis is mistaking symptoms of bladder cancer for non-threatening urinary conditions, especially in women.

Hiding in plain sight

Unfortunately, there is no existing screening test for bladder cancer; and since symptoms are shared with many innocuous medical conditions, they are often overlooked by both patients and GPs in the early stages, resulting in poorer prognoses and outcomes for patients.

This is why we are calling for the NHS to adopt national referral guidelines to help ensure that GPs are equipped to catch bladder cancer symptoms early.

Patient experience:

luck of the draw

There is no consistent patient pathway for bladder cancer, leading to drastically varying experiences for bladder cancer patients across the country. It is unacceptable that survival for patients has not improved over the last three decades. Certain groups affected by bladder cancer, including women and those from lower socioeconomic backgrounds, experience poorer outcomes.1

We want to change the face of bladder cancer care in the UK to guarantee that every patient, no matter their background or where they live, receives the fastest possible diagnosis and the highest quality treatment and care, along with the support and information they need.

References

1. Huddart, R. A., Jones, R., & Choudhury, A. (2015). Clinical Oncology, 27(7), 380–381

Bladder

the fifth most common cancer that you’ve likely never heard of

WRITTEN BY

Dr Lydia Makaroff Chief Executive, Fight Bladder Cancer

You don’t have to keep letting your leaky bladder affect your quality of life.

Successful new drug candidate for patients with bladder cancer - from discovery to the clinic

From scientific discovery to the clinic — a new treatment for bladder cancer has demonstrated efficacy and safety in controlled clinical trials. The active molecule triggers apoptosis in cancer tissue — a beneficial form of cell death. The tumours respond rapidly to treatment, and fragments of the tumour are released, resulting in a reduction in tumour size.

Scientists are developing a revolutionary, new way to tackle bladder cancer using molecules originally found in human milk. As a series of clinical trials progress to test the breakthrough, hopefully, a new drug will be developed to help provide a new treatment.

Serendipity observation

Professor Catharina Svanborg Chairman, Hamlet Pharma

WRITTEN BY Mark Nicholls

Professor Catharina Svanborg explains how the discovery of a tumoricidal protein-lipid complex came from a classic serendipity observation. It emerged as her research group at Lund University in Sweden was studying antibacterial components in human milk and serum to find new antibiotics. During experiments in lung cancer cells and the bacteria that cause pneumonia, they found that the tumour cells died.

They named the active component in milk — a complex between a protein and fatty acid — HAMLET (Human Alpha-Lactalbumin Made Lethal to Tumour). “The molecule kills tumour cells very broadly, and that includes cells from bladder cancer,” explains Svanborg, who is Chairman of the Board at HAMLET Pharma and Professor of Clinical Immunology at Lund University.

Clinical trials

After testing in animal models and patients with bladder cancer, the scientists were surprised with the findings. “If we put HAMLET in the bladder, the tumour responds by shedding pieces and tumour cells out into the urine, and that happens with virtually everyone we have tested it on.”

The pharmaceutical company has performed formalised clinical trials with a synthetic drug candidate called Alpha1H, which attacks tumour tissues with a high degree of selectivity. “After drug development, we are now treating bladder cancer and performed a placebo-controlled trial with excellent results and no toxicity for healthy tissue in patients.” The next step is planning for a phase III trial.

Svanborg says there are clear benefits. “It’s easy to administer. It’s a non-toxic way of telling the bladder cancer to stop growing and start this shedding of tumours.”

The scientists are hopeful the Alpha1H treatment can reach patients more generally soon and is seeking larger partner organisations to advance this. Bladder cancer is the fifth most common cancer in the European Union (EU) and has the highest recurrence rate of all cancer indications. The high mortality of bladder cancer is mainly caused by the lack of effective therapies and the high recurrence rate (~70%). Moreover, bladder cancer places a significant burden on the health care system with high healthcare expenses. In fact, it accounts for the highest treatment cost per patient in the cancer area.

A family of tumour killing molecules with low toxicity and great

promise

The family of active molecules includes HAMLET and the synthetic drug candidate Alpha1H, which is the one used in the bladder cancer studies. They are also working on a bowel cancer treatment which uses a candidate called BAMLET, as it uses a protein in bovine milk. The effects of BAMLET have been extensively studied including animal models with relevance for human bowel cancer. She says trials to date suggest it as “extremely potent and beneficial” against bowel cancer in animal models.

During experiments in

INTERVIEW WITH

WRITTEN BY Polly Weston Chair, Association for Contience Advice (ACA)

Empowering patients to seek help with bladder and bowel concerns

Up to 6 million people, nationally, are affected with bladder problems — many of those with accidental bladder leakage — and 1 in 10 of us will suffer from bowel dysfunction in our lifetimes.

Remaining in optimal bladder and bowel health can be challenging as so many of our lifestyle choices might have an impact on our bladder and bowel function.

Staying hydrated for a healthy bladder

Adequate hydration is key to keeping our body — and in particular, bladder and bowel — healthy. Good hydration is also paramount to the prevention of urinary tract infection and constipation and can help ensure patients avoid subsequent hospital admission.

Limiting fluid intake can exacerbate bladder issues. It is important to remember that the bladder’s main function is to fill and hold onto urine. In order to do this effectively, it needs to remain calm and relaxed. If we limit our fluid intake, the bladder will, in time, learn to empty more frequently as it thinks it is full with a smaller amount of urine. It empties by contracting to void urine. The more frequently it contracts and voids urine, it will forget its ability to relax and hold urine, hence worsening the bladder problem.

Where to get help in the UK

Bothersome bladder and bowel conditions are surprisingly common, so you are not alone. Millions of people in the UK are affected by bladder issues. A high percentage may suffer from bowel dysfunction as well.

Access to NHS bladder and bowel services is often through a GP referral and can incur lengthy waiting times. NHS services are particularly stretched to capacity following Covid-19; and as the NHS referrals have been overwhelming, staffing/recruitment is a concern. While the NHS endeavours to restore its services, it might be useful for patients to be aware of other help available.

Bladder & Bowel UK have a confidential patient advice line, as well as a library of resources to support patients. A new resource is the CONfidence app which promotes self-help and treatment for bladder and bowel conditions. It is a useful resource for patients, carers and healthcare professionals.

A poll has revealed that 7.5 million people in the UK would be too embarrassed to talk to GPs about symptoms of serious bowel disorders.

Generation Z (18 to 24-yearolds) would delay seeing a GP the longest; with one in five (19%) saying they’d take more than a month to see a doctor even when passing blood — more than twice the UK population average (8%).

Bowel health symptom checker

The charity Crohn’s & Colitis UK revealed that they had been contacted by young people who had been living off gummy bears, bran flakes and jelly because their digestive issues had made eating so painful.

In response, the charity is launching a campaign called ‘Cut The

Crap: Get Checked For Crohn’s and Colitis’ to raise awareness that the main symptoms — diarrhoea, blood in the faeces and stomach pain — mean you need to get checked. It signposts people to a new online symptom checker, developed with doctors. It takes 30 seconds to fill out, and then you can find out if you need to see a GP. It produces a list of your symptoms and can send you a letter for your GP to make talking about them easier.

Do not delay seeking help

The charity commissioned a national poll of 10,000 people to find out why one in four people (25%) took

more than a year to be diagnosed, as revealed in earlier research. Delaying treatment can leave people needing stronger medication or even emergency surgery to remove part of their bowel. GP Dr Marion Sloan, Chair of the Primary Care Society of Gastroenterology says: “As doctors, we see and examine patients with bowel symptoms on a regular basis, and we appreciate the symptoms can be difficult to talk about. But the more you tell us, the more accurate our diagnosis can be, and the quicker you can get the treatments you need.”

Delays can be devastating — affecting people’s ability to do their jobs, go to school or college, socialise or have relationships.

Crohn’s & Colitis UK CEO Sarah Sleet says: “Delays can be devastating — affecting people’s ability to do their jobs, go to school or college, socialise or have relationships. It is urgent that we do more to help young people stay in control of their health, and that means providing them with the tools to get the right diagnosis from their GP as early as possible.”

To learn more, visit crohnsand colitis.org.uk

Access to NHS bladder and bowel services is often through a GP referral and can incur lengthy waiting times.

Four million people in the UK would not see a GP even if passing blood

WRITTEN BY Burcu Borysik Head of Policy & Campaigns, Crohn’s & Colitis UK

Helpful solutions for functional regeneration of the pelvic floor

Pelvic floor dysfunction (PFD) symptoms, such as incontinence, pelvic organ prolapse, bowel symptoms (eg. faecal incontinence, rectal prolapse) and sexual problems (eg. erectile dysfunction and dyspareunia), are among the most common problems that are never talked about.

Affecting both men and women, symptoms of PFD are often interconnected and may have different causes, with a major one being weakened pelvic floor support. PFD symptoms generally get worse with age. In women, they are also often connected to injuries during vaginal childbirth. In men, they may arise after prostate removal surgery.

Pelvic floor functions

The pelvic floor is a complex structure consisting of several muscles and connective tissue components with the main task of supporting the pelvic organs and sexual function. Because of these roles, a weakening of the pelvic floor supporting structures can result in more than one symptom of PFD.

As medical technology advances and medicine is moving towards more preventative and regenerative therapies, novel medical device treatments are being introduced in pelvic floor symptom treatment. These include laser technology aimed at the regeneration and strengthening of connective and epithelial tissues, as well as magnetic stimulation technology aimed at strengthening the pelvic floor muscles.

How laser technology helps

Non-ablative SMOOTH Er:YAG laser was introduced in the last decade as an innovative therapy to stimulate functional regeneration and alleviate different symptoms connected with PFD. Its mechanism of action is through so-called dual-tissue remodelling — epithelial tissue regeneration and

strengthening of the connective tissue support, resulting in the improvement of PFD symptoms.

In women, this technology has been used to successfully treat symptoms of incontinence, genitourinary syndrome of menopause, pelvic organ prolapse and vaginal laxity. In men, intraurethral non-ablative Er:YAG laser has also been reported to improve the symptoms of chronic prostatitis/chronic pelvic pain syndrome. The same laser technology may also treat bowel dysfunction symptoms when used trans-rectally.

Magnetic stimulation

While connective support can be strengthened using laser, the pelvic floor muscles — an important building block of pelvic floor support — can be kept in shape by a different type of energy-based medical device technology: magnetic stimulation. High-Intensity Tesla Stimulation (HITS) enables effortless pelvic floor muscle training. Improved tone and strength of the pelvic floor muscles result in the improvement of PFD symptoms, such as stress and urge incontinence, in both men and women.

Treatments that combine both SMOOTH Er:YAG laser and HITS magnetic stimulation technologies will be the next step towards the development of holistic, non-invasive solutions for PFD symptoms.

Nearly 43,000 people are diagnosed with bowel cancer each year. Yet, sadly, more than 16,500 people die from the disease each year, making it the second most fatal cancer. But this shouldn’t be the case. It’s treatable and curable — if diagnosed early.

More open conversations on bowel health

Latest figures show thousands more people are urgently being referred for suspected bowel cancer, which we believe is a good indication that people are speaking to their GP about their bowel health after noticing symptoms or changes. For this, we believe we have our patron — the late Dame Deborah James — to thank.

We’re pleased to see that more people are seeking help for potential bowel cancer symptoms. However, the demand for these tests far outweighs the number of appointments available, meaning that if there are more people on the waiting list, the longer they have to wait.

Is qFIT the key to unlocking improvements in early diagnosis?

To help ensure that people with suspected bowel cancer are prioritised for further tests, NHS England is urging GPs

to ask patients with potential symptoms of bowel cancer to complete a Quantitative Faecal Immunochemical Test (qFIT). The test detects very small, hidden quantities of blood in a stool sample, so it is a very good way of identifying when people urgently need a colonoscopy. It means we can rule out bowel cancer quickly for most people and send the right people on for further tests.

A bold ambition: how to keep up with the numbers

We know early diagnosis saves lives, and this was recognised by the Government which set an ambition to diagnose 75% of cancers at an early stage by 2028. Yet, one of the biggest barriers to this is long-standing workforce shortages in endoscopy and pathology services.

To address this, the Health Secretary must urgently publish the 10-Year Cancer Plan which needs to set out a roadmap for how the NHS will meet this ambition and save more lives from bowel cancer.

WRITTEN BY Dr Irena Hreljac Clinical Affairs Manager, Fotona

WRITTEN BY Genevieve Edwards Chief Executive, Bowel Cancer UK

Lower GI symptoms? Think Crohn’s and Colitis.

Early diagnosis starts with a faecal calprotectin test.

Over 500, 000 people in the UK are living with Crohn’s Disease and Ulcerative Colitis, the two main forms of Inflammatory Bowel Disease. But it is taking too long for them to be diagnosed.

26 % 41%

Waited more than a year for their diagnosis.

Visited A&E at least once before diagnosis.

Our earlier diagnosis campaign, including an online symptom checker, will encourage people to speak to you about their symptoms. Make sure you know how to spot the signs of Crohn’s and Colitis.

Scan the QR code or visit us at www.crohnsandcolitis. org.uk/HCPs for a range of resources, including toolkits, podcasts and CPD modules.