Your browser is no longer supported

For the best possible experience using our website we recommend you upgrade to a newer version or another browser.

Your browser appears to have cookies disabled. For the best experience of this website, please enable cookies in your browser

We'll assume we have your consent to use cookies, for example so you won't need to log in each time you visit our site.
Learn more

Urinary incontinence: why women do not ask for help

  • Comment

VOL: 101, ISSUE: 47, PAGE NO: 47

Jeanette Haslam, MPhil, Grad Dip Phys, MCSP, is honorary visiting lecturer, University of Bradford

During the past decade, many medical conditions previously thought to be unmentionable are now being talked about more openly. Breast cancer, for example, has had a great deal of media attention, particularly when women in the public eye reveal that they have been diagnosed with it. This publicity helps to increase awareness of the condition. In comparison with breast cancer, the common female problem of urinary incontinence receives scant attention in the media, yet it has been estimated that there may be 4,000,000 women in the UK suffering from urinary incontinence at one time (Hunskaar et al, 2004).

 

During the past decade, many medical conditions previously thought to be unmentionable are now being talked about more openly. Breast cancer, for example, has had a great deal of media attention, particularly when women in the public eye reveal that they have been diagnosed with it. This publicity helps to increase awareness of the condition. In comparison with breast cancer, the common female problem of urinary incontinence receives scant attention in the media, yet it has been estimated that there may be 4,000,000 women in the UK suffering from urinary incontinence at one time (Hunskaar et al, 2004).

 

 

Urinary incontinence is not life-threatening, but it can certainly be life-changing, and it may leave those affected by the condition in social, emotional, and mental disarray (Hajjar, 2004). A survey by Fulz et al (2003), revealed that more than 75 per cent of women with stress urinary incontinence (SUI) reported that their symptoms were bothersome, while 29 per cent reported their symptoms to be moderately to extremely bothersome. On the basis of such figures, it would seem important that health professionals who meet with women on a daily basis are aware of their responsibility for identifying those who have not sought help for a continence-related problem.

 

 

Have attitudes changed to urinary incontinence?
Seventeen years ago, Norton et al (1988) carried out a study to determine the effect of urinary incontinence on women, and their reasons for delay in asking for help with the condition. They found that 33 per cent of women with troublesome symptoms of urinary incontinence waited one to five years before seeking help from a GP and that 25 per cent waited more than five years. The number of women aged 65 years and over who delayed asking their GP for help was twice that of women under the age of 35 years. Married women tended to delay more often than unmarried women.

 

 

One of the reasons the women gave for delaying seeking help was that they hoped they would get better without it. Forty per cent stated that they were embarrassed to discuss the matter with their GP. Older women were also frightened of having surgery.

 

 

The same study reported the women as saying that, as a result of being incontinent, they were less able to carry or lift things as part of their daily activities. In addition, many of the unmarried or older women avoided going far away from home and avoided public transport, while the younger women and those employed outside the home reported that their urinary incontinence affected their work. Nearly half the women reported feeling odd or different from other people because of their bladder problem, with 40 per cent feeling less attractive, and 25 per cent avoiding other people. Also of concern was that 66 per cent of women avoided sexual activity because of being incontinent (Norton et al, 1988).

 

 

Today, an increasing number of articles are published in women’s magazines and newspapers about urinary incontinence, but have attitudes to the problem changed in the 17 years since the study by Norton at al (1988)? In 2003, a study by Hagglund et al on urinary incontinence revealed that women continue to be reluctant to seek help for what they consider to be a minor problem that they believe they should be able to cope with themselves, and a study reported by Haslam (2004) showed that 60 per cent of women with SUI failed to contact a doctor.

 

 

Advertisements on the television advertise pads for ‘bladder weakness’, but the public still need to be made aware that continence is a symptom and that, in most cases, it can be cured.

 

 

So how can we engage with women who are incontinent so that we can offer them help and advise them about the services available to them?

 

 

Raising awareness
Many organisations concerned with policy now acknowledge that conservative treatments for women with urinary incontinence should be available in primary care from trained health professionals (SIGN, 2004; RCOG, 2002; DoH, 2000). Drug therapies are available from GPs for managing overactive bladder and for stress urinary incontinence, but GPs are not the only possible first point of contact for a woman with urinary incontinence. Continence advisory services in primary care, for example, run specialist nurse led-clinics, while practice nurses in GP surgeries, and women’s health clinics, are all possible points of contact. In addition, specialist continence physiotherapists can provide therapeutic conservative management. If surgery is eventually needed for stress urinary incontinence, a tension-free vaginal tape procedure is now a well-accepted surgical option (NICE, 2003).

 

 

Bladder health and pelvic floor muscle exercises
Schools would be an ideal place to begin education about bladder health and pelvic floor muscle exercises. Talking about these issues to pregnant women who have developed stress urinary incontinence during their pregnancy would also be valuable, as these women have double the risk of having the condition 15 years later (Dolan et al, 2003).

 

 

All health professionals who work with pregnant women should be competent to give appropriate advice about bladder health and to teach pelvic floor muscle exercises. The women should be informed not only about the effects that pregnancy and childbirth have on their pelvic floor but also that good pelvic floor musculature will contribute to their sexual health.

 

 

Any dietary advice that is given at this time should include information on the types of fluids that should be drunk daily, and how much. Although the amount drunk will depend on an individual’s activity, about one-and-a-half litres is usually the appropriate amount. The women should also be advised to avoid fizzy drinks (Dallosso et al, 2003) and to reduce their intake of caffeinated drinks, as these can affect the bladder and worsen frequency, urgency and nocturnal voiding activity.

 

 

The role of the midwife

 

 

Every woman sees a midwife during her pregnancy, and the visits provide an opportunity for the midwife to check that the woman is actually contracting her pelvic floor muscles when she thinks she is doing so. It is known that many women do not contract these muscles properly after being given just verbal and written advice (Bump et al, 1991; Bo et al, 1988). Equally, after a woman has given birth and while the midwife is examining the perineum, she could be asked by the midwife to try and contract her pelvic floor muscles.

 

 

The role of health visitors

 

 

Health visitors have an opportunity to explore bladder health when they take over responsibility for a mother and child, and they can make referrals for additional advice from a continence adviser if this is required.

 

 

Another important role for health visitors is ensuring that children are appropriately toilet trained. The practice of encouraging children to go to the toilet ‘just in case’ should be discouraged, and girls should be encouraged to sit down comfortably on the toilet to empty their bladder (Moore et al, 1991). These two everyday practices will ensure that the bladder is more likely to fill to a normal capacity and empty fully. Furthermore, it would seem sensible to suggest to women that before coughing or carrying out any activity that raises intra-abdominal pressure they should contract their pelvic muscles (known as ‘the knack’) (Miller et al, 1998).

 

 

Practice nurses
Practice nurses have an opportunity to discuss urinary incontinence and pelvic floor muscle exercises when women attend a clinic in primary care; for a cervical smear test, for example.

 

 

Nurses could ask questions such as:

 

 

- ‘Many women find that they leak urine when doing such activities as coughing or sneezing. Do you ever have a problem with this?’

 

 

- ‘Many women find that they have a sense of great urgency whenever they need to empty their bladder. Is this a problem for you’.

 

 

Asking women questions such as these gives them an opportunity to start talking to a heath professional about any bladder problem that they have.

 

 

In the course of their work, practice and community nurses will meet older people and people with disabilities, both of whom may have functional problems that need to be addressed, such as access to a toilet, or who need aids and adaptations. Referral of these people to a community occupational therapist for assessment can make the difference between their being incontinent or continent.

 

 

Conclusion
All health professionals should be aware of the continence service provision in their primary care trust and be competent to advise any women with whom they come into contact about the best way to access the service. Perhaps if health professionals were to increase awareness at every opportunity, women would feel more able to discuss their problems freely and be able to resolve - or at least manage - their urinary incontinence.

 

 

The day is yet to come when someone who is famous reveals how he/she solved the problem of a leaking bladder. I would therefore settle for more women being made aware that they can get advice and that they then take advantage of all the help that is available.

  • Comment

Have your say

You must sign in to make a comment

Please remember that the submission of any material is governed by our Terms and Conditions and by submitting material you confirm your agreement to these Terms and Conditions. Links may be included in your comments but HTML is not permitted.

Related Jobs