Oral retinoids are a type of medicine used to treat severe acne. They’re sold under the brand name Roaccutane, among others.

While oral retinoids are very effective, they can have harmful effects if taken during pregnancy. These medicines can cause miscarriages and major congenital abnormalities (harm to unborn babies) including in the brain, heart and face. At least 30% of children exposed to oral retinoids in pregnancy have severe congenital abnormalities.

Neurodevelopmental problems (in learning, reading, social skills, memory and attention) are also common.

Because of these risks, the Australasian College of Dermatologists advises oral retinoids should not be prescribed a month before or during pregnancy under any circumstances. Dermatologists are instructed to make sure a woman isn’t pregnant before starting this treatment, and discuss the risks with women of childbearing age.

But despite this, and warnings on the medicines’ packaging, pregnancies exposed to oral retinoids continue to be reported in Australia and around the world.

In a study published this month, we wanted to find out what proportion of Australian women of reproductive age were taking oral retinoids, and how many of these women were using contraception.

Our results suggest a high proportion of women are not using effective contraception while on these drugs, indicating Australia needs a strategy to reduce the risk oral retinoids pose to unborn babies.

Contraception options

Using birth control to avoid pregnancy during oral retinoid treatment is essential for women who are sexually active. Some contraception methods, however, are more reliable than others.

Long-acting-reversible contraceptives include intrauterine devices (IUDs) inserted into the womb (such as Mirena, Kyleena, or copper devices) and implants under the skin (such as Implanon). These “set and forget” methods are more than 99% effective.

The effectiveness of oral contraceptive pills among “perfect” users (following the directions, with no missed or late pills) is similarly more than 99%. But in typical users, this can fall as low as 91%.

Condoms, when used as the sole method of contraception, have higher failure rates. Their effectiveness can be as low as 82% in typical users.

Oral retinoid use over time

For our study, we analysed medicine dispensing data among women aged 15–44 from Australia’s Pharmaceutical Benefit Scheme (PBS) between 2013 and 2021.

We found the dispensing rate for oral retinoids doubled from one in every 71 women in 2013, to one in every 36 in 2021. The increase occurred across all ages but was most notable in young women.

Most women were not dispensed contraception at the same time they were using the oral retinoids. To be sure we weren’t missing any contraception that was supplied before the oral retinoids, we looked back in the data. For example, for an IUD that lasts five years, we looked back five years before the oral retinoid prescription.

Our analysis showed only one in four women provided oral retinoids were dispensed contraception simultaneously. This was even lower for 15- to 19-year-olds, where only about one in eight women who filled a prescription for oral retinoids were dispensed contraception.

A recent study found 43% of Australian year 10 and 69% of year 12 students are sexually active, so we can’t assume this younger age group largely had no need for contraception.

One limitation of our study is that it may underestimate contraception coverage, because not all contraceptive options are listed on the PBS. Those options not listed include male and female sterilisation, contraceptive rings, condoms, copper IUDs, and certain oral contraceptive pills.

But even if we presume some of the women in our study were using forms of contraception not listed on the PBS, we’re still left with a significant portion without evidence of contraception.

What are the solutions?

Other countries such as the United States and countries in Europe have pregnancy prevention programs for women taking oral retinoids. These programs include contraception requirements, risk acknowledgement forms and regular pregnancy tests. Despite these programs, unintended pregnancies among women using oral retinoids still occur in these countries.

But Australia has no official strategy for preventing pregnancies exposed to oral retinoids. Currently oral retinoids are prescribed by dermatologists, and most contraception is prescribed by GPs. Women therefore need to see two different doctors, which adds costs and burden.

Rather than a single fix, there are likely to be multiple solutions to this problem. Some dermatologists may not feel confident discussing sex or contraception with patients, so educating dermatologists about contraception is important. Education for women is equally important.

A clinical pathway is needed for reproductive-aged women to obtain both oral retinoids and effective contraception. Options may include GPs prescribing both medications, or dermatologists only prescribing oral retinoids when there’s a contraception plan already in place.

Some women may initially not be sexually active, but change their sexual behaviour while taking oral retinoids, so constant reminders and education are likely to be required.

Further, contraception access needs to be improved in Australia. Teenagers and young women in particular face barriers to accessing contraception, including costs, stigma and lack of knowledge.

Many doctors and women are doing the right thing. But every woman should have an effective contraception plan in place well before starting oral retinoids. Only if this happens can we reduce unintended pregnancies among women taking these medicines, and thereby reduce the risk of harm to unborn babies.

Dr Laura Gerhardy from NSW Health contributed to this article.

Antonia Shand, Research Fellow, Obstetrician, University of Sydney and Natasha Nassar, Professor of Paediatric and Perinatal Epidemiology and Chair in Translational Childhood Medicine, University of Sydney

This article is republished from The Conversation under a Creative Commons license. Read the original article.

“Fart walks” have become a cultural phenomenon, after a woman named Mairlyn Smith posted online a now-viral video about how she and her husband go on walks about 60 minutes after dinner and release their gas.

Smith, known on TikTok as @mairlynthequeenoffibre and @mairlynsmith on Instagram, has since appeared on myriad TV and press interviews extolling the benefits of a fart walk. Countless TikTok and Instagram users and have now shared their own experiences of feeling better after taking up the #fartwalk habit.

So what’s the evidence behind the fart walk? And what’s the best way to do it?

Exercise can help get the gas out

We know exercise can help relieve bloating by getting gas moving and out of our bodies.

Researchers from Barcelona, Spain in 2006 asked eight patients complaining of bloating, seven of whom had irritable bowel syndrome, to avoid “gassy” foods such as beans for two days and to fast for eight hours before their study.

Each patient was asked to sit in an armchair, in order to avoid any effects of body position on the movement of gas. Gas was pumped directly into their small bowel via a thin plastic tube that went down their mouth, and the gas expelled from the body was collected into a bag via a tube placed in the rectum. This way, the researchers could determine how much gas was retained in the gut.

The patients were then asked to pedal on a modified exercise bike while remaining seated in their armchairs.

The researchers found that much less gas was retained in the patients’ gut when they exercised. They determined exercise probably helped the movement and release of intestinal gas.

Walking may have another bonus; it may trigger a nerve reflex that helps propel foods and gas contents through the gut.

Walking can also increase internal abdominal pressure as you use your abdominal muscles to stay upright and balance as you walk. This pressure on the colon helps to push intestinal gas out.

Proper fart walk technique

One study from Iran studied the effects of walking in 94 individuals with bloating.

They asked participants to carry out ten to 15 minutes of slow walking (about 1,000 steps) after eating lunch and dinner. They filled out gut symptom questionnaires before starting the program and again at the end of the four week program.

The researchers found walking after meals resulted in improvements to gut symptoms such as belching, farting, bloating and abdominal discomfort.

Now for the crucial part: in the Iranian study, there was a particular way in which participants were advised to walk. They were asked to clasp hands together behind their back and to flex their neck forward.

The clasped hands posture leads to more internal abdominal pressure and therefore more gentle squeezing out of gas from the colon. The flexed neck posture decreases the swallowing of air during walking.

This therefore is the proper fart walk technique, based on science.

What about constipation?

A fart walk can help with constipation.

One study involved middle aged inactive patients with chronic constipation, who did a 12 week program of brisk walking at least 30 minutes a day – combined with 11 minutes of strength and flexibility exercises.

This program, the researchers found, improved constipation symptoms through reduced straining, less hard stools and more complete evacuation.

It also appears that the more you walk the better the benefits for gut symptoms.

In patients with irritable bowel syndrome, one study increasing the daily step count to 9,500 steps from 4,000 steps led to a 50% reduction in the severity of their symptoms.

And just 30 minutes of a fart walk has been shown to improve blood sugar levels after eating.

What if I can’t get outside the house?

If getting outside the house after dinner is impossible, could you try walking slowly on a treadmill or around the house for 1,000 steps?

If not, perhaps you could borrow an idea from the Barcelona research: sit back in an armchair and pedal using a modified exercise bike. Any type of exercise is better than none.

Whatever you do, don’t be a couch potato! Research has found more leisure screen time is linked to a greater risk of developing gut diseases.

We also know physical inactivity during leisure time and eating irregular meals are linked to a higher risk of abdominal pain, bloating and altered bowel motions.

Try the fart walk today

It may not be for everyone but this simple physical activity does have good evidence behind it. A fart walk can improve common symptoms such as bloating, abdominal discomfort and constipation.

It can even help lower blood sugar levels after eating.

Will you be trying a fart walk today?

Vincent Ho, Associate Professor and clinical academic gastroenterologist, Western Sydney University

This article is republished from The Conversation under a Creative Commons license. Read the original article.