The Problem of Incontinence

The secret is out! For years, incontinence was considered the public’s “covert operation.” People furtively combed the store aisles looking for a containment product to “hide” their problem. Aunt Mabel was encouraged to go to the rest home because “she had a hard time getting around.” Nobody in the family dared to finish the sentence with, “to the bathroom on time.” Those with enough fortitude to discuss the issue with their health care provider talked about “problems down there.”

Fortunately, with the strides made in diagnostic capability, pharmaceuticals and surgical options for treatment, the layperson is now exposed to incontinence in a non-offensive manner through TV commercials and print ads. Even a minor celebrity or two has admitted to incontinence. A number of professional organizations with continence as a core objective have made deliberate efforts to educate colleagues. The goal? To increase primary care provider awareness and skill level in identifying patients who have a need but are too embarrassed to discuss incontinence. On the flip side, some more educated and less shy consumers will make requests of these clinicians as a result of having been exposed to media campaigns for pharmaceutical therapy; clinicians should be literate in the subject so that they can respond to such patients.

So, is all right in the world? No, not at all. Twenty-five million people suffer from incontinence. All age groups are affected. One-quarter of those suffering from stress incontinence are under the age of 40. Teenage females are increasingly reporting incontinent episodes during athletic activities. Twenty-five percent of men older than 50 with benign prostatic hypertrophy are as likely as their female counterparts to experience “wet” overactive bladder. More than 60 percent of men are incontinent for up to one year following prostatectomy. Yet only 1.1 million office visits were associated with incontinence. Imagine the public outcry that would occur if a health care system announced it would treat only 4.4 percent of the population with an illness that spanned all age groups, did not discriminate between men and women and befell 25 million people. The quiet continues. Where are all these patients? Why aren’t we seeing them?

As clinicians who practice in a number of different settings – acute care, home health, long-term and subacute care, and office settings – we’d like to think that the national silence is not due to our patients’ embarrassment or belief that incontinence is a normal and inevitable part of getting older. It may be the health care system that is to blame – a system not designed for continuity of care among different settings, but rather designed for the convenience of the settings themselves. This system encourages a veil of secrecy – the words “urinary incontinence” are rarely written or spoken in health care. It still isn’t “sexy” enough to sell to the public. Health care, in its present form, doesn’t place urinary incontinence in the top 10 issues facing us. Dare we even mention fecal incontinence?

Catherine T. Milne, APRN, MSN, CWOCN
Lisa Q. Corbett, APRN, MSN, CWOCN
Tracy L. Houle, APRN, MSN, CWOCN
Connecticut Clinical Nursing Associates, LLC
Bristol, Connecticut