Bladder problems: Can we be less shy about having a pee?

Prof Marcus Drake

Bladder problems affect millions of people around the world, yet they remain shrouded in silence and embarrassment. Professor Marcus Drake, Chair in Neurological Urology, explores why society continues to be shy about this topic, and highlights why more medical research is needed to improve bladder care.

People do not generally spend a lot of time thinking about their bladder. After all, each pee only takes about 20 seconds. Since we might go for a pee just six times a day, that means only a couple of minutes are given over to the bladder daily.

As well as not thinking about it much, we also seem to be reluctant to talk about it. This may be a reflection on society, since peeing is a vital function yet talking about it seems to be discouraged. Perhaps this does not matter so much for most people. But it does matter for anyone with a bladder problem. This reluctance means that people can leave it very late to get help. For many it makes the experience of getting help difficult too.

A common problem

Bladder problems are common. Urinary symptoms, like rushing to the toilet (urgency), going excessively often (increased frequency), and needing to interrupt sleep for a pee (nocturia) affect a third of people over 40 years old. Incontinence affects one in 10 people overall.

If someone does go to the doctor to get help for a waterworks issue, they may see a well-trained and considerate professional. Unfortunately, it’s not certain. Training is inconsistent and given comparatively low priority relative to conditions like cancer or heart disease. Sometimes the professional may react inappropriately, or perhaps even trivialise the symptoms. Interestingly, even the healthcare professionals sometimes experience some embarrassment – we need to deal with that, as the patients rightly expect the professional to consider the subject by enquiring about such problems and leading the discussion.

A new approach

Fortunately, these issues are not common, but nonetheless we need to work to improve things. We are aiming to achieve this through several ambitious projects. One of the biggest is to give GPs the resources they need to treat nocturia. We are doing this by developing a link in the GP health record for the patient which takes the GP to a website with practical information about assessing and treating the problem.

Another big project is the development of a new clinic which sees people with a range of complicated health problems. This includes neurological diseases like spinal cord injury, multiple sclerosis, Parkinson’s disease and dementia. This clinic has a core team of specialists, including urology, colorectal surgery, gynaecology, physiotherapy and neurology. These experts work together in the assessment of each patient. This is a new way of doing things, since generally the patient would see one specialist, then be referred on to the next, and so on in sequence. Our new approach aims to ensure all relevant issues are treated in a coordinated and considerate fashion.

Prof Marcus Drake

We are also reaching out to other areas of medicine where urinary disorders have traditionally received a low priority, but which actually can be very relevant to the patient’s everyday life. This includes the experience of recurrent urinary tract infections (UTIs), which can be miserable to anyone, but medically harmful to certain vulnerable situations, such as people with a kidney transplant, or someone with Multiple Sclerosis.

Normalising the conversation

We are developing new research projects, and currently we are working on an application to treat women with bladder or bowel problems living in underserved communities. Another application will seek funding to run a treatment study preventing UTIs in patients with dementia.

Looking further ahead, if we want to end the taboo around bladder problems, we must start by increasing awareness and understanding. Big change is needed; doctors need to be encouraged not to be shy with their patients, and they need to come together to agree strategies for improving bladder care. Normalising the conversation and making it something that people feel comfortable discussing openly is key.

Professor Marcus Drake is Chair in Neurological Urology in the Department of Surgery and Cancer, and Honorary Consultant Urologist at Charing Cross Hospital. He is also Trustee of the International Continence Society, and a board member of the European Society of Female and Functional Urology.

Watch Professor Drake’s recent inaugural lecture, below.