They are the layer of muscles that extend from your pubic bone at the front of your pelvis to your tail bone (coccyx) at the back of your pelvis. They are the the muscular support at base of your pelvis.

• Bladder control. 
• Bowel control.
• Sexual function.  
• Stabilises the pelvis. 
• Supports the pelvic organs.

• Prostate or pelvic surgery (e.g. prostatectomy).
• Radiation to the pelvis.
• Straining to poo due to chronic constipation.
• Certain conditions such as MS, strokes, or uncontrolled diabetes.
• Being overweight.
• Chronic coughs.
• Injury to the perineum. 

Many men experience weakness of the pelvic floor. If this happens you may have a variety of symptoms including:

• Leaking urine during activity, for example when you sneeze, cough or laugh (known as stress urinary incontinence).
• A need to go to the toilet often during the day or night (known as frequency or nocturia, respectively).
• An urgent need to visit the toilet and leaking before you get there (known as urgency incontinence).
• You are unable to control the passing of wind or stool from your back passage.
• Erectile dysfunction (the pelvic floor helps you maintain erections).
• Post micturition dribble (leaking urine immediately after you have finished passing urine).

The pelvic floor muscles can be strengthened to increase the support of the pelvic organs. This can improve bladder and bowel control and can reduce/cure leakage of urine. It may also improve your ability to maintain an erection. 

It’s important to know where the pelvic floor muscles are, so that you’re sure you’re exercising the correct muscles. To identify the pelvic floor muscles, tighten your back passage as if you’re trying to stop yourself passing wind; at the same time, imagine you’re trying to stop yourself passing urine.
You should have a sense of squeezing, pulling the back passage up and in. You may see the base of your penis retract slightly in your body and your testicles rise a little. Do not tighten your thighs or buttocks and do not hold your breath. After contracting it is important to feel the muscles relaxing and softening as you let go.  

You can exercise your pelvic floor anywhere and anytime. They can be performed lying, sitting or standing  but to start with it may be easier to do the exercises sitting down. Make sure you’ve found the correct muscles and know how it should feel when you tighten them before trying these exercises.

There are two types of exercises, slow and fast, it is important you do both:

Exercise 1: slow pull-ups

• Take a breath in. 
• On the breath out, tighten the pelvic floor muscles. 
• Return to normal breathing but continue to tighten for your length of hold, relax, and feel the muscle let go. 
• Rest for 5 seconds. 
• Repeat this 5 times.

As it gets easier, gradually increase length of hold and number of repetitions, aiming for 10 seconds.

Exercise 2: fast pull-ups 

• Tighten the pelvic floor muscles quickly and then let go straight away. 
• Repeat this 10 times – approximately 1 contraction per second.

You may find that the muscles are weak initially and that it takes a lot of concentration to exercise them, but this should improve with time

Do not practice stopping the flow of urine midstream as this may interfere with the normal process of emptying your bladder.

Do exercises 1 and 2 during each session. As soon as you can, increase to 10 slow and 10 fast pull-ups. 

Aim to repeat these 3 times each day, so in total you will be doing 30 slow and 30 fast pull-ups a day. 

It will take up to 3-6 months of regular exercise to increase the strength in your pelvic floor muscles and hopefully reduce your symptoms.

As your muscles get stronger you may progress to doing the exercises standing up.

To help remind you to do your exercises daily try to combine them with an everyday activity, for example, when brushing your teeth, and after breakfast, lunch, and dinner. 

You can also download an app called Squeezy which is recommended by the NHS. It will send you reminders to do the exercises and you can personalise the programme to suit you.

Once your symptoms have improved, continue with these exercises once daily for the rest of your life to keep these muscles fit and healthy (e.g., 10 slow and 10 fast pull-ups daily).

• Being overweight can weaken the pelvic floor muscles so it is important to maintain a healthy BMI. 
• You may want to try sitting in the correct toilet position to help with constipation like in the image below. (This is sat on a toilet with feet on a foot rest, knees higher than your hips, lean forward with your elbows onto your knees. Bulge out your abdomen and straighten your spine). 
• You should try to drink 6-8 cups of fluid a day. 
• Caffeinated drinks, alcohol, acidic drinks (fruit juices) and fizzy drink can irritate your bladder and cause urgency; we suggest avoiding these. 
• Tighten the pelvic floor muscles before lifting anything heavy or if you are going to sneeze or cough. 
• If you have urgency, contract your pelvic floor muscles when you have the desire to empty your bladder and only move when the desire has passed.

Image courtesty of Bladder and Bowel Community:
www.bladderandbowel.org/help-information/resources/toilet-positions/

Overview | Lower urinary tract symptoms in men: management | Guidance | NICE

Alcohol can impair your judgement and alter your behaviour. You can misread situations and react in ways that are out of character. Alcohol can increase your vulnerability to financial and sexual exploitation. Arguments can escalate into assault or fights. 

Delay making important decisions if you have been drinking; consider getting advice/support from trusted friends/family/healthcare professions.

Don’t drink and drive. On average it takes a healthy liver an hour to process one unit of alcohol. An evening drink can mean you still have alcohol in your system the next morning. The safest option is to avoid drinking alcohol altogether when driving.

Alcohol can enhance the effect of some medications, such as painkillers or sleeping tablets, and reduce the effect of others, such as medications to thin the blood (Rivaroxaban) and antidepressants.  

Check with your doctor if it is safe for you to drink with your particular health problems and/or medication. Ask your pharmacist and/or read the leaflet that comes with your prescription, over-the-counter or herbal medicines.

Alcohol can damage nearly every part of the body:

• The stomach lining - ulcers or bleeding.
• The liver - fatty liver, cirrhosis and liver failure.
• Heart muscle - heart failure produces a build-up of fluid in the lungs which results in shortness of breath.
• Cancer - 6% of cancers world wide can be linked to alcohol. Mouth, stomach, liver and breast cancers have strong links with alcohol use.
• Malnutrition - alcohol has lots of calories for energy, but none of the protein, fats, vitamins or minerals you need to keep the body in good repair. People who drink most days are recommended to take Thiamine and Sanatogen.
• Sense of balance - falls and accidents (even when not intoxicated).
• Blackouts, seizures or fits.
• Stroke.
• Poor sleep - broken sleep, early morning waking and daytime tiredness.
• Menopause - increase in symptoms.

Not everyone who drinks too much will develop health problems, but the more you drink, the more likely you are to get such problems.

Anxiety

Alcohol can be a short term fix to relieve anxiety, but the  anxiety will return. It is not a long term solution. So the temptation is to drink again to feel better.

Depression

Alcohol is a depressant. Low mood and depression can lead to a loss of interest in things you used to enjoy. You can feel tired, but have difficulty sleeping. It becomes more difficult to take things in when reading or following a TV programme. Your appetite can be poor, and your body can become depleted of essential nutrition for normal brain function. In extreme cases you may feel life is not worth living.

Hearing voices

This is less common but can happen if you have been drinking heavily for a long time. It starts with vague noises, like leaves rustling, and gradually becomes distinct voices. These can be unpleasant and distracting.

Confusion

Alcohol use plus poor or absent diet can result in low  Thiamine and Magnesium. This can cause confusion and poor memory. If not treated this leads to Alcohol Related Brain Injury, including Korsakoff’s dementia.

Keep a drink diary, this is a good starting point for change. Write down the date, what type of drinks you have, how many units, and add up the total number of units each day. Bottles/cans have information about number of units. 

Have an alcohol reduction plan 

• Think about hobbies, interests, and social opportunities that don’t involve alcohol. This may be a brand new activity or something that you used to enjoy. 
• Alcohol can fill a gap when you are bored so don’t leave space. Occupy yourself and get out of the routine/habits that revolve around alcohol.
• Local Council websites/libraries will have information about volunteering opportunities, wellbeing groups and leisure activities in your local area.
• Friends and family can support you to make changes.
• Home measures are usually large ones. Use a measure or a smaller glass, and make sure you keep track. Don’t top-up your glass before it’s empty. Put the bottle away between drinks.
• Make each drink last longer. Drink a soft drink or water with, or after, each alcoholic drink.
• Eat something before you drink, this will help slow down the absorption of alcohol into your body.
• Plan two or three alcohol-free days a week.
• If you have a lapse or don’t manage to cut down as you had hoped, don’t give up! If it was an easy thing to do you would have done it already.
• Have a plan and acknowledge your successes.
  
   

Age UK
Bristol: 0117 929 7537
South Gloucestershire 0145 441 1707

Alcoholics Anonymous
Bristol helpline: 0117 926 5520
Email: help@aamail.org

SMART Recovery
Self-Help Addiction Recovery | UK Smart Recovery

Bristol ROADS/ Bristol DHI
0117 440 0540

BDP 50+ Crowd
0117 440 0540

South Gloucestershire DHI
0800 073 3011

North Somerset We Are With You
01934 427940

Drinkline
0300 123 1110

• A charitable fund established in 2006.
• Applications are assessed in a two stage process
• Supports research projects from all clinical areas, led by researchers of all levels of experience.
• Supports high quality research projects with the potential for making a real impact within the NHS. 

Benefits for research and healthcare:

• Members of the public should help decide how donated public funds are spent 
• Bring a unique perspective
• Ensures that the process is focused on what is important to patients.
• Ensure research has considered the participants point of view

• Everyone is welcome on the Public Panel, no previous experience needed. 
• All perspectives are equally important 

Two meetings will be held one around the end of July and the second at the end of September.

• There will be a short introduction/training session about taking part- 1hr long
• You will be expected to read and comment on Researchers applications for Funding before attending the meetings
  • The minimum you will need to read is a summary written in plain English of around one page long (500 words) per application
  • We expect there will be around 8-12 applications
  • We ask you to fill in a feedback form (4 questions) to get your comments on the researchers’ applications
  • We give you at least two weeks to read and comment on the applications
• You will be expected to attend two panel meetings
  • The meetings are two hours long (with breaks) and will most likely be held online
  • In the meetings panel is split into smaller groups and discuss their opinions of the applications with one of our Facilitators
• We ask two volunteers from our public panel to attend the awarding meeting to represent the views of the panel

• You will receive payment for two hours of pre reading per meeting at £25 per hour and £5 for home working 
• You will receive payment for attending the meetings at £25 per hour and £5 for home working

• Bleeding: you may get some oozing from the wound after the operation. This is usually not serious but may lead to bruising. If this bleeding continues, it can usually be stopped by holding firm pressure on the wound constantly for 20 minutes. 
• Scarring: every attempt is made to repair the wound in a way that will allow the scars to be hidden as much as possible. We will discuss repair options on the day. 
• Incomplete removal and further treatment: we double check some results afterwards and very rarely find a tumour has been missed on the day. This can mean we recommend further treatment, but not always. 
• Recurrence: the tumour rarely regrows years later.
• Allergic reactions: this is extremely rare but you can get a reaction to rubber gloves, antiseptic solution, local anaesthetics, antibiotics and the dressing. Make sure to tell the doctor if you are allergic to any of these. 
• Delayed repair: rarely if your tumour is complex, you may need to return a few days later for further surgery and repair. Occasionally, the wounds are large or complex and you may need another specialist surgeon, which we will discuss and arrange with you.

Things to be aware of: 

• You will need to arrange time off from work or your usual responsibilities for at least 1 week after the surgery. The amount of time will depend on the complexity of surgery and the type of activities you normally do. You do not want to go on holiday within at least 2 weeks of surgery, which allows sufficient time for the wound to settle down and to have most problems dealt with before you go. Please discuss this with the doctor.
• You may eat and drink normally before and after your operation, unless told otherwise.
• If on Warfarin, please get a blood test (INR) five working days before surgery and find out the result. Please bring this result with you. The INR should be steady and between 2 to 2.5 ideally. If not please contact us straight away and ask your GP to alter your dose. If not we may have to cancel your surgery when you arrive.
• We do not usually ask you to stop aspirin or other ‘blood thinning’ tablets unless you are taking more than one together. This should be discussed with you in clinic. These medicines include aspirin, dipyridamole (Persantin or Asasantin Retard), clopidogrel (Plavix), warfarin, dabigatran (Pradaxa), apixaban (Eliquis), rivaroxaban (Xarelto), edoxaban (Lixiana), and heparin. Usually, the reason for taking the medicine is more important than the minimal risk of a bad experience from some bleeding or bruising after surgery.
• Take all other regular medications as normal.
• Before you attend for surgery, please remove all make-up and jewellery from your face (i.e. earrings), not just from the area being treated.
• If your surgery is in a hair-bearing area, we may clip the hairs nearby to improve access and ease of dressings. If you are shaving, please do so the night before surgery. There is some evidence that shaving just before surgery can increase the chances of wound infection.
• Please tell the doctor well before your operation if you have any implanted devices - for example a pacemaker, defibrillator, deep brain stimulator etc. You may need a device check before the procedure if your usual check is overdue. If so, we will arrange that and let you know.
• Smoking harms the healing process. You can improve your chances of good healing and a better scar by stopping smoking at least a few days before surgery, until at least a few days afterwards. This can be a good opportunity to kick start stopping altogether if you wish, which will help your general health too.
  For Stop Smoking advice phone: 
  0300 123 1044 
  or visit 
  Quit smoking - Better Health - NHS (www.nhs.uk)

Please come to the Brunel building at Southmead Hospital. Report to the waiting area at Gate 24b. You will need to allow enough time to reach Gate 24b before your appointment. When you have arrived, a nurse will escort you to the theatre area, where you will be given a hospital gown to wear.

If you are late your operation may need to be cancelled. At times parking can be difficult so allow plenty of time. You can travel to the hospital by whatever means you wish, but you will not be fit to drive yourself home or use public transport after the operation.

The lesion may be photographed before and during the procedure with your consent. Local anaesthetic is injected to numb the area. You will be fully awake throughout the procedure. You may need repeated injections throughout the day to keep the area numbed. 

Occasionally if your wound is large or complex, another type of specialist surgeon may come to reconstruct your wound or might do this at your local hospital if you live far from Bristol. Sometimes you may need to go to the main operating theatres upstairs in the hospital for part of your operation or reconstruction. This will usually have been arranged in advance, and sometimes might involve a general anaesthetic.

Stitches

If you have stitches in your wound, we often ask you to come back the following week for them to be removed, or you may need to arrange to have them removed at your GP surgery.

If a change of dressing is needed, then either the practice nurse at your local GP surgery or district nurse could 
usually do this for you. We can help you arrange this on the day of surgery.

Will the area be painful afterwards?

• After the local anaesthetic has worn off (approximately 2 hours), the area will often be somewhat painful and we advise you to take regular Paracetamol for the next couple of days (depending on your usual medications).
• You may experience some bruising and swelling; this should settle down within a few days, but may last longer.
• The surgeon may prescribe a course of antibiotics for you to take after the operation.

How will the wound be repaired/reconstructed?

There are several options depending on the size and position of the wound.

Healing naturally (secondary intention healing)

• What does this mean? Healing naturally usually takes longer than if closed together (about one to two weeks per cm of wound diameter). It may be a good choice for a small wound that cannot easily be closed together or if you want a simpler, quicker operation to avoid a skin graft or skin flap, and reduce your visits to hospital.
• How do I care for the wound? The wound will require a change of dressing two or three times per week until healed, but this is usually done by your GP practice or district nurse.
• What will my scar look like? In the right area healing naturally usually ends up looking very good, but this can take many weeks.

Direct closure (sewing the edges together usually in a line)

• When can this be done? Most Mohs surgery wounds are too complex to use this technique. Otherwise this usually gives the quickest healing, easiest aftercare, and best scar.

Skin graft (using a patch of skin from somewhere else)

• Where does the skin graft come from? The “donor” site is usually where the skin is loose and thin and it is easy to stitch the edges together (e.g. above your collar bone, neck, or behind your ear).
• How is the skin graft put on? The graft will usually be stitched in place. Often, a small wad of dressing material is stitched over to hold the graft firmly.
• What will my skin graft look like? Usually some bruising and crusting in the first few weeks. It can take up to 18 months for a scar to ‘mature’, usually becoming pale, soft, flat and supple. Your doctor will do their best to match the skin graft to the skin removed so that it blends in as much as possible. Sometimes it is almost unnoticeable, but other times it is more difficult to hide and the differences to the surrounding skin are more obvious.

Local flap (moving nearby skin or muscle whilst still attached)

• What will my local flap look like? The aim of using nearby skin is to provide a better match to the skin removed. Usually this is successful but the appearance varies similar to skin grafts.

Bleeding

When you go home you will have a bulky dressing covering your wound; this is essential for pressure to stop any bleeding. It is important to leave this on. If you experience bleeding from the wound, apply direct firm pressure to the wound for 20 minutes. This should stop the bleeding. If this does not help contact us on the numbers below, or your GP.

Infection

The usual signs of infection are pain, swelling, redness, increased temperature of the skin near the wound (or a fever), pus from the wound. Pain, swelling and redness are common in the first three days after surgery but should be improving. If not, the wound may be infected, and you may need antibiotics. If you see these signs seek medical advice from us or your GP.

• It is advisable to avoid alcohol for 48 hours after surgery to reduce the risk of bleeding.
• If you are elderly or frail, we recommend having a relative or friend with you overnight after the surgery or at least contactable nearby.
• Avoid bending over, straining, or exerting yourself, and sleep more upright than usual (i.e. with an extra pillow) for a few days to reduce swelling.
• Once healed, care for any skin graft with daily moisturiser, and sunscreen when exposed. Grafts remain more sensitive long term.
• Leave the dressing in place and dry for the first 48 hours, then remove it carefully or soak it off, unless you have been told otherwise (e.g. for skin grafts it is left     untouched for 7 days and removed by us in hospital).
• Change a dressing if it gets wet or dirty. A wet dressing can lead to an infection. For skin grafts just change the outer dressing and do not disturb underneath, or contact us.
• Keep the wound clean. Wash it daily after dressings have been removed, but avoid the direct force of the shower on the wound.
• Apply petroleum jelly (e.g. Vaseline) from a new clean pot with a clean cotton bud several times a day.
• You may have self absorbing stitches. These usually fall out within 3 weeks. Otherwise, stitches are usually removed after 7 days, in hospital or at your GP practice. 

If you want to know more or have any questions or concerns, please contact us. 

If you have trouble with your wound in the days after surgery, the Dermatology nurses can be reached on  0117 414 8704 between about 9am - 5.30pm most weekdays, or call the secretaries on 0117 414 7621.

There is no Dermatology on-call service for wound problems out-of-hours, so there is a formal arrangement between Dermatology and Plastic Surgery to provide help instead.

• Between 5 - 8pm on Monday to Friday, and between 8am - 8pm at weekends, please call the Plastic Surgery coordinator on 0117 414 8300. 
• After 8pm, please call Southmead Hospital on 0117 950 5050 and ask to be put through to the Plastic Surgery SHO on call, quoting this leaflet.

Other options for problems out-of-hours include advice from your local out-of-hours GP service, walk-in centre, or the Emergency Department. If you must seek help show them this leaflet and please let us know what has happened as soon as possible afterwards.

If you cannot attend or no longer need your appointment, please phone 0117 414 7416 and tell us.

Appointments are precious. Enable another patient to take your place. Please give us as much notice as possible.

Not all patients with anti-synthetase syndrome are the same. It is a spectrum condition, where there can be a mixture of symptoms, or some symptoms are more prominent. Symptoms associated with anti-synthetase syndrome include the following:

Interstitial Lung Disease (ILD)

As many as 75% of those with anti-synthetase syndrome have ILD. This may be the first or only symptom of the condition. 

The ILDs are a group of lung diseases where there are varying degrees of lung inflammation or irreversible scarring (fibrosis) of the tissue around the air sacs (alveoli). In ILD it can be more difficult for the lungs to transfer oxygen into the bloodstream, and as a result, the body may not get the oxygen it needs to function properly. This can cause breathlessness and/or a cough from the irritation.  Patients may also complain of fatigue.  A ‘crackle’ sound is heard when listening to the chest with a stethoscope.

Muscle inflammation

Patients may experience muscle pain, fatigue and weakness. This typically affects the muscles across the shoulders and the pelvis/thighs.

Inflammatory arthritis

Patients may experience pain, stiffness, swelling, redness or warmth around joints. This typically affects small joints hands, feet but larger joints can be involved as well.

Fever

Some patients can present with a fever that is unrelated to infection or other causes. 

Raynaud’s phenomenon

This is when very small blood vessels can spasm or constrict leading to reduced blood flow, typically involving the fingers and toes. The nose and ears can also be affected. These episodes are usually triggered by cold or stress.  They can last several minutes to several hours and can cause the affected part to feel numb and cold and to turn white or blue.

Mechanic’s finger or hands

The skin on the sides of the fingers (usually just the thumb, index and middle fingers) becomes dry and cracked with characteristic thickening. It can be sore with broken areas. 

Your specialists will take a detailed medical history and perform a thorough physical examination. You may be asked to have the following investigations:

• Chest X-ray.
• Lung function tests – breathing tests which so how well your lungs are working. These are used later to monitor your lung disease and how it is progressing. You may also be asked to have a walk test where you will be asked to rate your degree of breathlessness and measure your walking distance and oxygen levels.
• A CT scan of your chest shows a detailed picture of your lungs. There are characteristic features on the CT scan that can allow your specialist to identify either scarring or inflammation of lung tissue.
• A series of blood tests including a screen for specific autoantibodies related to CTD-ILD.
• Some people may also have a bronchoscopy, where a small flexible tube is passed down into your lungs, allowing collection of cells which may help with diagnosis.
• If you have joint and muscle symptoms, additional tests will include joint X-rays, ultrasound scans, and muscle MRI scans.

Treatments may differ depending on the symptoms you have, and your specialist will discuss whether a particular treatment is right for you.

Medications

Steroids are produced naturally in the body by the adrenal gland. Additional steroids in the form of prednisolone can be given to attempt to reduce inflammation in some patients. They are usually given in tablet form but may be given intravenously. If you are prescribed steroid tablets on a long-term basis, you should not stop them abruptly. You will be given a ‘steroid emergency card’ which you should always carry with you.

The specialist may also assess the need for bone protection medication and anti-reflux treatment whilst on steroids.

Immunosuppressive medication

Cyclophosphamide, Mycophenolate mofetil and Azathioprine are medications that modulate the immune system to achieve disease control.

When used with a corticosteroid such as prednisolone, it can also allow the dose of the steroid to be reduced and in some cases, may allow the steroids to be withdrawn altogether. As a result, they are sometimes also called a ‘steroid-sparing agent’. You will require regular blood tests to monitor your response to treatment.

New treatments are becoming available, and your specialist will decide upon these treatments on an individual basis.

Other medications and therapies are used to relieve symptoms, such as cough, breathlessness, joint and muscle pain and Raynaud’s. Your specialist will discuss options with you on an individual basis.

Other treatments

Pulmonary rehabilitation is a supervised exercise and education programme that can help you to learn to manage your breathlessness and remain active. The programmes are multidisciplinary, meaning that the team includes respiratory physiotherapists, nurses, dieticians, doctors and others, and can help improve your energy, strength, and quality of life.

As fibrosis inhibits an adequate supply of oxygen into the bloodstream, some individuals may require supplemental oxygen therapy. Where the levels of oxygen are low, oxygen therapy may help with breathlessness and enable individuals to be more active. Corrected levels of oxygen in the blood are necessary for normal body functions and reducing additional health problems.

You should also discuss with your physician if there are any clinical trials in which you can participate. Clinical trials are voluntary research studies, conducted in people, which are designed to answer specific questions about the safety and/or effectiveness of medications.

A small minority of patients may require assessment for and be suitable for lung transplantation.

Have your seasonal vaccinations (COVID-19 and Flu) and the pneumonia vaccination (you only have this once).

You may be eligible for a variety of benefits such as Attendance Allowance or Personal Independence Payment if you need help with personal care or getting about.

Our specialist nurse runs a regular Pulmonary Fibrosis Support Group which is a space for discussion with other patients with ILD. Here we also aim to provide several presentations from a variety of guest speakers and charities.

Keep active and do what you enjoy!

Action for pulmonary fibrosis: 
Home (actionpf.org)

British Lung Foundation: 
Asthma + Lung UK (asthmaandlung.org.uk)

Versus Arthritis UK: 
Versus Arthritis | A future free from arthritis

Myositis UK: 
Home - Myositis UK
 

For ILD related queries:

Bristol Interstitial Disease Service
Respiratory admin 0117 414 7762
ILD@nbt.nhs.uk

For CLD related queries (not related to lungs/breathing):

Rheumatology advice 0117 414 0600
rheumatologyadviceline@nbt.nhs.uk