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get off the hamster wheel
I don't get to watch a lot of T.V. but last night I caught most of a BBC show called "Doctor in the House". The episode was about two ladies who both suffer with fatigue. Fatigue is an issue that health professionals are faced with on a daily basis. Sadly the incidence is increasing and is very common among women. There are many factors, of course, that can contribute, and the show was great at highlighting this. Most of us will feel exhausted at some point in our lives and can easily attribute it to an overly late night, a new baby or similar. However, for some people, extreme fatigue is a daily struggle and they can become so exhausted that just getting through the day seems impossible. Illnesses such as chronic fatigue syndrome, M.E. and fibromyalgia are now commonly diagnosed. Fibromyalgia for example, can also cause widespread pain as well as fatigue. In the past the only treatment that was available was in the form of medication. All too often the possible underlying causes were overlooked. Thankfully health professionals are now more able to help and last night's programme showed the many ways that we can try to help ourselves too.
Some psychologists believe that we were not designed to cope with the constant bombardment of information that is now in our lives. Our nutrition, exercise and family lives have all suffered at the hand of convenience, and the improvement in medicine has meant that all too often we reach for a pill rather than more natural and sustainable remedies.
Nutrition is big business now, with more people realising that how we fuel our bodies and therefore our cells, is vital. Foods that are high in sugar, for example, are known to cause inflammation and can reduce our ability to fight infection. Promoting good gut health is a good starting place for most of us.
Another way to start to improve your energy levels is by getting a good night's sleep. Blue light (from iPhones, iPads and tablets) eating too late (or the wrong foods), stress, and lack of exercise can all reduce your chances of a restful night's sleep.
Another piece of advice from the show was to try yoga or mindfulness classes. Tai-Chi and meditation can also be very helpful.
If you think that you are suffering with excessive fatigue you should visit your G.P. in the first instance.
The link to the show on BBC iPlayer can be found below:
an interview with andy nudds, professional snowboarder
Photo credit - Dan Medhurst
My name is Andy Nudds and I'm 29 years old.
I started Snowboarding when I was 15 at a dry ski slope a few minutes from my house in Halifax, West Yorkshire. I eventually got a membership and ended up snowboarding there pretty much every day for a couple of years. I started entering competitions around the U.K. and after another year I went on to spending the winters in the mountains of Europe and the United States.
Over the years I managed to win a few competitions in the U.K. and Europe, which helped me to pick up sponsorship. I went on to filming video parts for snowboard movies, which is what I'm doing now.
Photo credit - Daniel Tengs
Q - Are there any regular warm-up exercises that you do before you go out snowboarding?
A - I have a little routine of dynamic stretches that I always do before before going snowboarding. These include:
2. Lunges with a torso twist
3. Horizontal arm swings
4. Backwards lunge with arms in a diving position to stretch out the stomach.
Q - What areas of the body do you need to strengthen for snowboarding?
A - Obviously you need to keep your legs strong, but keeping your core strength up is very important too, especially in 'freestyle snowboarding'.
Q - If you haven't been snowboarding before, what can you do to prepare?
A - For a beginner I would say doing a lot of squats will help, as when learning you will spend a lot of time with your knees bent, sitting down and pushing yourself back up again. So try to get your legs as strong as possible.
Q -What other exercise do you do to keep fit?
A - I try to do a lot of skateboarding and wakeboarding when I'm not snowboarding and a little bit of a work-out every day. Short run, push-ups, abdominal crunches and planks.
Q - How do you try to keep yourself injury-free?
A - I think Dynamic stretching before riding and stretching after riding is really important to limit injures. Keep yourself loose.
Q - Do you have any specific exercises that you would recommend to get ready for snowboarding?
A - Specific exercises I would recommend are 'piston squats' and 'box jumps' for the lower body and 'parallettes' exercises for the upper body.
Thank you so much to Andy for this interview. Good luck to all of you preparing for this winter sports season. If you need any help, please ask.
in to africa
A few months ago I was asked to help a guy who was planning the adventure of a life-time. His plan was to ride his motorbike from the U.K. to Tangier, followed by touring the entire coast of Africa. He had already completed other tours in the U.S. and Europe and had been planning the trip in great detail for a year.
Will had been injured a few times in the past and is a keen runner. Knowing that he would spend hours at a time on rough terrain and also expecting to fall off the bike at times, he wanted to do all he could to keep healthy, safe and injury-free.
We spent some time screening his body for any asymmetries in his alignment and bio-mechanics. We then set about putting together a programme of stretches, exercises and postural awareness techniques for on the bike and for sleeping on the floor.
Will has been in touch a couple of times since starting his adventure, and has kindly written a small piece to add to this blog (see below).
I'd like to wish Will a safe and exciting trip and look forward to more updates as his journey continues!
Riding a large, heavily loaded adventure bike across Africa is physically demanding. Jen did a great job to understand the muscles I would be putting under strain, and helped me devise a stretching regime that would help counteract this wear and tear, and keep me fresh. She also helped with stretches in case of accidents - where medical help was scarce, again to enable me to keep moving. This regime has kept me well during a physically (and mentally!) demanding trip, and I can't thank her enough!
Workout @ Work
The 30th of September marks the end of the Chartered Society of Physiotherapy's (CSP) W@W project. They have teamed up with employers to try to improve our wellbeing and health at work. So many working days are lost each year due to musculoskeletal conditions and illness, many of which could be improved or cured by changing some simple work-based habits. Staying active and healthy can also improve your mood, boost performance and reduce stress.
What can you do at work?
Constipation is a major problem towards which poor diet, sedentary lifestyles, dehydration and poor toileting position can all contribute. Millions of people suffer with constipation each year, many of whom visit their G.P. with extreme cases requiring hospital treatment. However, the need for such medical intervention could be prevented with a few key lifestyle changes.
Why is constipation a problem? As well as being uncomfortable, constipation can cause piles (haemarrhoids) which might bleed and contribute to issues such as anaemia. It can contribute to a weakened pelvic floor or even pelvic organ prolapse in extreme cases. Constipation can also irritate the bladder, cause low back pain and abdominal discomfort.
Very often the problem of constipation can be significantly improved with diet and exercise. Some foods might ‘bung you up’ whilst others could help you 'go'! We are all different, so it is important to keep a track of your bowel habits and what you think changes them.
Common foods that can cause constipation are:
Foods that help to aid the gut are:
Drinking enough water or non-irritating fluids is also essential to prevent constipation. If you don’t have any bladder problems, but do suffer with constipation, drinking 2-3 litres of fluid per day will help your bowels to work well. Remember that if the weather is hot or you are exercising you will need to increase your fluid intake accordingly.
Using a small foot-stool or the ‘Squatty Potty’ will change your ano-rectal angle to become more vertical. This can immediately help you to open your bowels without straining. More information (and an amusing advert) can be found on the Squatty Potty website.
Get moving! Is it essential to be upright and active to help your gut to work. You don’t need to join a gym or commit to an exercise class, just 30 minutes of brisk walking per day can work wonders. If you work in an office then opt to take the stairs each time or try to get out at lunch-time for a walk. Small, daily changes can make a big difference over-all.
'Orange this Way' have written this fantastic guest Blog post for us in connection with the Changing Places Campaign, for National Continence Week.
a very public (in)convenience
I don’t know about you, but one of the reasons I’m not at Glastonbury this weekend with all the other mud-coated revellers is because I can’t quite get my head around the festival loo situation. Queuing up in the rain to use a long drop with no toilet paper is enough to put me right off going to Glastonbury, even with the most star-studded of line ups or luxury boutique camping on offer.
But can you imagine if there were no toilets at Glastonbury at all? Or if there were toilets that were only accessible to people over the height of 6ft 5? Or that would collapse if anyone over 10 stone entered the cubicle? There would be uproar among the hundreds of thousands of Glasto fans. Or, quite simply, people wouldn’t go.
We have become used to toilet facilities being available to us pretty much wherever we go in the UK. Public toilets began being introduced in London in 1851 and since then have become a familiar feature of cities, towns, villages, attractions, public buildings and restaurants across the country.
It would be unthinkable to go for a day out in a public place or to a major event and there not be a toilet available, right? Wouldn’t it?
Unfortunately for some of the most vulnerable people in our society this is not the case. Until the advent of the Changing Places Campaign in 2006 there were no toilets available in the whole of the UK for the ¼ million people who cannot use standard or typical accessible/disabled toilets. According to Changing Places, this includes people with profound and multiple learning disabilities, motor neurone disease, multiple sclerosis, cerebral palsy, severe physical disabilities as well as some older people. A quarter of a million people.
This quarter of a million includes my son, Lawrence, who is five years old and wears a pad because his disabilities mean he does not have adequate control over his own toileting, or the ability to transfer to a toilet, even a ‘disabled’ one. He needs to be changed by a carer, regularly, throughout the day.
When he was tiny, we used the baby changing facilities like every other parent. Luckily, these have been installed in most public places and restaurants across the country because managers have recognised that families with young children are an important and valuable part of their customer base who have money to spend.
Unfortunately the same is not yet true for severely disabled people. A quarter of a million people. And their families.
In the vast majority of public places in the UK, the place where severely disabled people get changed by their carer is the toilet floor of the disabled loo. The filthy, often urine-soaked and dirty, toilet floor. A place that most people would only want the soles of their shoes to touch.
This is the now the reality we face with our little boy. The same reality faced by vulnerable, severely disabled people and their carers across the country. It is not safe. It is not dignified. It is not kind. It is often the reason why severely disabled people and their families are limited to local short trips out only, or why they very rarely leave the house at all. For many carers, lifting a disabled teenager or adult from a wheelchair onto the floor of a toilet and back again would quite simply be impossible, never mind the filth.
What people like our little boy need is a toilet that can be used in safety and comfort for both him and for us as his carers, which has more space than a conventional disabled loo and the right equipment – including an adult sized height adjustable changing bench and a hoist.
Changing Places have made great progress on campaigning for suitable toilet facilities for severely disabled people over the last 10 years, but there are still less than 1,000 across the whole of the UK. In Cornwall, where we live, there are only 10 Changing Places toilets in the whole of the county. I am delighted to say that this will soon become 11, as a result of a local parent the new (and fabulous) Cornwall Services on the A30 has understood the need for these facilities and is fitting one as I type. I am, though, sorely disappointed to see that in all the £17.6 million revamp of the Hall for Cornwall, there are currently no plans to install a Changing Places toilet, despite vocal campaigning from parent carer and disability groups.
John Lewis (a favourite retailer of mine until last week) responded to Changing Places a few days ago to say that they ‘didn’t have space’ to fit a Changing Places toilet in one of their flagship stores that has over 70,000 square footage of retail space. Imagine if they said they ‘didn’t have space’ to fit regular toilets, or if they said they didn’t have space for a café, or a shoe department? Unthinkable.
Already, even with Lawrence being quite small, we are finding ourselves planning family days out and long journeys around where there is a Changing Places toilet. We love the Eden Project, because they have a fabulous Changing Places loo, as do the Life Centre and Drakes Circus shopping centre in Plymouth. But beyond that, it’s pretty sparse. What will we do when we can no longer lift him ourselves and when we get sick of carrying around a mat soaked in urine from the toilet floor?
We will be isolated.
You see, it’s not just the person with disabilities who suffers when there is no toilet they can use. The lack of Changing Places facilities isolates entire families too. Families who have money to spend at your restaurant, shop, theme park, hotel or festival, just like everybody else.
So please, if you are a restaurant owner, a hotel, shopping centre or theme park manager, or a local authority public convenience planning officer (do they even exist?) then please, please fit a Changing Places toilet. Not only will you see the investment repay itself with new loyal customers but you will be changing lives.
Oh, and by the way? If you’re heading to Glastonbury this weekend and one of your party is severely disabled, you’ll be thrilled to hear that the festival has a Changing Places toilet in the Spring Ground Accessible Campsite. For everyone else, if you’re not keen on the long drops, you might want to check out the compost loos… Good luck ;)
over-active bladder (oab)
Over-active bladders and or sensitive bladders are very common. If you have been diagnosed with an over-active bladder it means that you have a bladder behavioural problem. The bladder twitches or spasms as it fills with urine. The spasms can cause pain or a sudden urge to void. Commonly a sudden urge to void occurs when the bladder is relatively empty, which in turn is characterised by frequent trips to the toilet (frequency) and having to get up during the night to void (nocturia). You may feel desperate to pee, then get to the toilet and only void a very small amount. Occasionally it may cause you to leak at night (nocturnal enuresis) or leak with movement. Different people will have varying degrees of symptoms and it will depend upon what you chose to drink, and how much.
Because OAB is a bladder behavioural issue, it cannot be cured with surgery. In fact, surgery can often make the symptoms worse. Constipation and or Irritable Bowel Syndrome (IBS) can also affect symptoms, so keeping your bowel movements regular and avoiding food and emotional stress that can affect your bowel will then have a positive effect on your bladder.
So how do you know if you have an over-active or sensitive bladder? If you think that you suffer with frequency, urgency or nocturia it is worth keeping a three-day bladder diary. Record everything that you drink for three days and nights. Also measure each void of urine using a measuring jug and record it. If you regularly void less than 200mls, void very frequently or are waking more than twice at night then it is likely that you have an OAB.
What can be done to help? Most over-active bladders will improve if you reduce or preferably cut out the following:
If you are cutting down on caffeine make sure you reduce it slowly to minimise headaches and feeling unwell (caffeine is pretty addictive).
It is also common for people to fall into the habit of emptying their bladder too often. Voiding before leaving the house, before a car journey or exercising can become a habit. Try to think sensibly about whether you really need to void. If you can wait a bit then do. Try curling your toes firmly or distracting yourself with something to see if you can hold off for a bit longer. You should void when your bladder is full, if possible. It is possible to re-train the bladder, but it can take a little while, so keep trying.
If you have tried all of the above for a few weeks and are still complaining of symptoms then visit your G.P., continence advisor or specialist physiotherapist. Look out for the other blogs this week as they will be full of useful hints, tips, websites and gadgets that can help to improve continence issues.
Useful links, hints and tips for continence.
The Bladder and Bowel Foundation is a charity. Their site is packed with useful information and links. https://www.bladderandbowelfoundation.org
Patient.info is a useful site for checking any concerning symptoms and for common sense advice. http://patient.info
The Squatty Potty is a small foot-stool that fits under your toilet. It raises your knees to enable a more functional “squat” position on the toilet. Great for people who suffer with constipation or struggle to open their bowels. http://www.squattypotty.co.uk
ERIC is a charity that supports children with continence problems and campaigns for better childhood continence care. It has loads of useful information for parents who have concerns regarding their child’s continence. http://www.eric.org.uk
Age Uk is a national charity that supports older people and their carers. Continence advice is just one of their topics. http://www.ageuk.org.uk
Changing Places is a charity. The Changing Places Consortium is a group of organisations working to support the rights of people with profound and multiple learning disabilities and/or other physical disabilities. Established in 2005, the Consortium campaigns for Changing Places to be installed in all big public spaces so people can access their community. http://www.changing-places.org
‘Toilet finder’ apps can be found linked to numerous websites. These can be installed on your mobile device to help you to quickly find the toilet nearest to you.
Toilet Cards: Our ‘Just Can’t Wait’ toilet card uses what is considered to be a universally acknowledged image for a toilet. This generic image should help limit any embarrassment and ensure there is no confusion about the purpose of the card. It may also go some way to helping holders of the card find and access toilets in situations where English may not be the first spoken language. B&BF’s toilet card clearly states that the holder has a medical condition and needs to use a toilet quickly. Although it does not guarantee you access to a toilet, most places you visit will be willing to help you. The card is a small, credit sized card, designed to fit easily into your purse, wallet or pocket. You can show the card when you’re out shopping and socialising and it may help you gain access to a toilet. (B&BF 2016).
Radar Key: The National Key Scheme (NKS) offers disabled people independent access to locked public toilets around the country. Toilets fitted with National Key Scheme (NKS) locks can now be found in shopping centres, pubs, cafés, department stores, bus and train stations and many other locations in most parts of the country. (https://crm.disabilityrightsuk.org/radar-nks-key).
This list is by no means exhaustive, but may help direct you if you are looking for more information on continence matters or additional help with access to toilet facilities.
Some studies suggest that 9 out of 10 women will suffer some form of incontinence in their lifetime. For many it is an embarrassing and life altering daily trauma. Still a taboo subject for most this common and under-treated symptom is a common cause of relationship break-downs, reduction in physical activity and sport and will even limit laughter with friends. One of the biggest and most incorrect assumptions is that it is just a normal part of the ageing process; something that is par for the course. It is not.
The incidence of urinary incontinence in women increases during and after pregnancy, but it is not limited to this demographic. Often we will laugh about it to try to make light of the situation, but I want to promote a shift in society, to increase awareness and ultimately help as many people as possible to throw away the pads!
Whether you just leak a bit with exercise or a sneeze, or if leakage is a part of daily life, the following information has been collated to give you the confidence to start improving your symptoms today.
The female pelvic floor is made up of a group of muscles, the same as any other muscles in your body. They act as a sling and connect from the bone at the front of your pelvis to the coccyx at the back of your pelvis. They work with the muscles that connect to your outer thighs. Together they support your pelvic organs and keep you continent. Unlike the male pelvic floor, females have three openings in their pelvic floor, which makes it inherently weaker and more prone to pelvic organ prolapse. Pregnancies and deliveries, constipation, chronic coughing and heavy lifting, pushing and pulling will all put extra pressure on the muscles.
Pelvic floor exercises are often prescribed for ladies with continence issues. Depending what you read you will see a variety of suggestions and tips for how to perform them. In my opinion, one of the most important things to remember is that you are trying to build muscle. You need to think 'body builder'. Occasionally remembering to do a couple of squeezes, then getting distracted and doing something else, is not going to get you very far. You will need to complete the exercises daily, to muscle exhaustion, to notice any change in symptoms. The good news is that it will not take very long to complete them each day, probably just five minutes.
Lie on your back with your knees slightly bent. Squeeze your pelvic floor by imagining that you are trying to stop yourself from doing a pee or poo. You should not be using your buttocks, sucking in your stomach or holding your breath.
Count how long you can hold the contraction for in seconds and note it down. Wait for a few seconds and then try and hold for the same amount of time again.
Repeat this until you physically can't do any more and note down how many times you managed it.
Now try some quick contractions, pull in quickly then let go straight away. See how many you can do in a row and make a note of it.
You have now completed your pelvic floor 'fitness test'. This will be used as the baseline for your exercises.
Each time you complete your exercises (aim for once per day) try to beat your score by one. For example try to hold for one extra second, one extra contraction and an extra quick one. As soon as you are able to do so then increase it again, and so on. This way you will build muscle quickly.
Another way to make the exercises harder is to change the position that you do them in. From lying on your back, progress to sitting, then standing, then standing with legs apart.
You may have tried pelvic floor exercises and not noticed any improvement. One possible cause of this may be that you have an issue somewhere else in your body that is increasing the pressure on your pelvic floor. A common place for this is in your thorax or chest. This commonly occurs in pregnancy and after childbirth, for a variety of reasons. A good exercise to try is use your breathing to try to stretch out the muscles that surround your chest. A great position for this is something called 'Child's pose'. On a bed or the floor get on to your hands and knees. Keeping your hands in place try to sit your bottom back towards your heels. Keep your head in line and keep your neck relaxed. Go as far as you can comfortably and you should feel a gentle stretch in your back and under your arms. Keep in this position and take a deep breath. Repeat the deep breath six times whilst staying in the position, but take normal breaths in between to stop yourself getting dizzy. Complete this stretch before your pelvic floor exercises, and before and after any exercise classes or physical training.
One last thing to try is to make sure that you don't get constipated.
You can help yourself by:
If you have tried all of the above, have difficulty managing your bowels and or still have symptoms then please book in for an appointment. Urinary incontinence is treatable and doesn't take long to improve. It is never too late!