A friend of mine once admitted that she was uncertain if she attends learning events because she loves giving her patients the best possible treatment or whether she treats her patients to fund her love of learning. I must admit that I have the same problem; I love attending conferences and other learning events just as much as I love helping my patients to get better.

Last month I was lucky enough to be able to travel to Perth for the 22nd National Conference on Incontinence. I got to see an Australian city that I have never visited before, visit a colleague from University days and I got to spend 4 days in the company of learned physiotherapists, gynaecologists, urologists, nurses, gastroentorologists, psychologists and even a sexologist from Singapore.

If you follow me on twitter, @Weefreewomen, you may have noticed the stream of snippets from the conference tagged #CFAConf13. I also got to meet some of the interesting people I follow on Twitter and put a face to the Tweets.

To reinforce the importance of events such as these, more than one speaker mentioned that it takes up to 17 years for research with level/1 grade A evidence (that's the highest level), be adopted by the medical profession as usual practice. One example given is that research evidence and international guidelines recommend that all pregnant and postnatal women should receive pelvic floor muscle training to prevent and treat urinary incontinence, yet this is not yet usual practice. Physiotherapist Helena Frawley presented her research on the uptake of this practice by primary maternity care providers in a public health network and the barriers encountered.

I spent a half day learning about the latest treatments available for over active bladder OAB; from drugs and injections to electrical currents and brain training. This topic needs an entire blog posting of it's own. I must say that the recent ABC program by Todd Sampson on Redesigning your Brain has me doubly excited about this seemingly impossible problem. 

There were several excellent presentations on Pelvic Organ Prolapse or POP which was most simply described as “a hernia”. A debate between the gynaecologists and physiotherapists on whether pelvic floor physiotherapy should be offered as a first line treatment was won hands-down by the pelvic floor physiotherapists according to the audience. It was a difficult debate for the gynaecologists because they all supported the affirmative and found themselves arguing for conservative treatment as a first option with a few rare exceptions.

Dr Ian Tucker presented the current issues around the use of meshes and the hazards associated with mesh surgery, and Dr Chris Maher highlighted the low level of clinical researchinto the use of mesh in vaginal prolapse repair versus the older native tissue repairs. But there is some promising new research being done into the possibility of tissue engineering to enable POP repairs to be done using a woman's own cells.

Another conservative treatment that was discussed was the use of a Pessary to manage the POP either long term, as a temporary measure while pelvic floor muscle training is implemented or to delay the need for surgical repair. Traditionally fitted by gynaecologists there are now some nurse practitioners and physiotherapists trained to assess and fit pessaries.

There were talks on treating constipation, conservative and surgical options to treat urinary incontinence following prostatectomy, a sexologists viewpoint on pelvic floor muscle training, bedwetting, pelvic pain, the psychology of the bathroom, catheter selection and how to communicate so that patients understand and adhere to the treatment prescribed.

For me the most fascinating talk was by a medical scientist, Associate Professior Phil Dinning. Phil has been researching functional gastrointestinal disorders for 20 years. He shared some unexpected findings about the colon which were brought to light by a new Fibre-Optic manometry catheter which he helped develop. The new type of catheter is able to make detailed measurements of gut motility. It seems that there is more activity in a healthy gut than any of us imagined. The old measuring devices could detect large sweeping actions which propel gut contents towards the rectum, what was previously undetectable, and very surprising, is that the gut also has many much smaller waves carrying the contents away from the rectum. It is possible that these smaller waves play a role in faecal continence and may give some explanation as to why Sacral Nerve Stimulation is so successful in reducing faecal incontinence in people who get no relief from other treatments. Of course the research is ongoing, but what we know so far is enough to get us all thinking.

The Continence foundation presented their language specific web pages and the advertisement they created to raise awareness of incontinence, with it's really catchy tune. You can view the ad on youtube http://www.youtube.com/watch?v=hXystI5LQ1Q 

Of course no gathering would be complete without some social activities and the continence foundation did an excellent job with a dinner and dance on the Friday night. The band was so good that I danced until almost midnight and I was told the next day that good music and food is traditionally provided at every CFA conference, so I have my calendar marked next year's conference in Cairns. Perhaps I can drag my husband along next time..