Spotlight on: Physiology Unit

Our Physiology Unit provides a diagnostic service for the whole of Norfolk and Suffolk and sees over 2,500 patients each year.

They take referrals from more than 50 consultants and a range of specialities including General Surgery, Gastroenterology, Respiratory Medicine, Urology, Gynaecology and Paediatrics.

The most common procedures they carry out are investigations of the upper and lower gastro-intestinal tract and bladder function.

Patients with symptoms of heartburn, non-cardiac chest pain and difficulty swallowing are referred for upper gastrointestinal investigations, and those with stress and urge bladder incontinence, faecal incontinence symptoms and constipation are referred for bladder and lower gastrointestinal diagnostic tests.

Yvette Wright, Lead Clinical Physiologist, has worked here for 22 years and heads the team of two clinical physiologists, one specialist nurse, one senior healthcare assistant and three administrative staff.

“We run three clinics each week and see a wide range of patients,” she said. “The diagnostic tests take from 45 to 90 minutes and are invasive treatments, so we understand patients might feel nervous. It’s really important for us to quickly establish a good rapport with them, making them feeling calm and relaxed.

“Some wait a long time, as much as five years with faecal incontinence symptoms, before seeking specialist help because they feel embarrassed, so it’s extremely important for people to know that we’re able to help.

“We also give them advice on how to manage heartburn and indigestion, particular swallowing disorders, bladder and bowel incontinence and constipation symptoms, which can make a big difference.”

Diagnostic investigations the unit provides include oesophageal manometry to diagnose swallowing disorders, tests to look at acid reflux, non-acid reflux and a persistent cough over a 24-hour period, tests checking either the strength or structure of the sphincter muscles in the anal canal, and they also provide a bowel retraining clinic for symptoms of constipation and incomplete emptying of the rectum.

“In the last couple of years, the biggest change has been the update in our diagnostic investigation methods,” said Yvette.

“For example we, set up a service in collaboration with Gastroenterology in 2019 looking at the amount of stomach acid that leaks back (refluxes) from the stomach into the bottom part of the gullet (oesophagus). A small capsule is placed, via the patient’s mouth, into the lower part of the gullet which transmits to a data recorder box measuring the amount of acid reflux that occurs over the next 96 hours.

“Via some buttons on the box, the patient can tell us when they are eating, drinking or having symptoms. They return the box after four days for the data to be analysed.

“I am also in the process of changing our anorectal physiology service to improve measurement of pressure in the sphincter muscles and analyse pelvic floor relaxation.

“Continually developing our service leads to better diagnosis – we are constantly evolving and, as Physiologists, continue to develop to provide the best possible care to our patients.”

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