| 
| "When my patients become incontinent, a
little light goes out of their lives. I like to be part of the dimmer switch that turns
the light back on." Elisabeth Brown, R.N.
Continence Nurse
San Francisco, CA |
Women and their health professionals share one thing in common: a surprising number would
rather not talk about urinary incontinence (UI). Patients may hope their doctors bring up
the topic, while their doctors may hope their patients don't. All this silence can lead to
more serious medical and psychosocial problems.
The Agency for Health Care Policy and Research (AHCPR) cites studies
indicating that one in four women ages 30 to 59 has experienced urinary incontinence. If
this percentage stays constant, the number of cases will rise dramatically as the baby
boomers age. Incontinence, which usually can be cured or improved, causes unnecessary
social isolation, expense, and secondary medical conditions. AHCPR estimates that the
annual costs for caring for people with UI are $11.2 billion in the community and $5.2
billion in nursing homes. Most of this money is spent on management measures, such as pads
and diapers, rather than on treatment.
Breaking Down
Emotional Barriers
Incontinence can be a very uncomfortable topic for patients, as well
as for many physicians and nurses. The embarrassment can be so powerful that people buy
diapers instead of seeking treatment. Many will deny the condition even when it is
apparent.
Doctors and nurses can do their patients a great service by breaking
down this emotional barrier. Several strategies can be used to help patients overcome the
stigma and feelings of embarrassment.
Be repetitious
Use the "broken record" method. Ask about incontinence at regular visits,
especially with women who have recently given birth and with postmenopausal women.
Forewarn
Warn young mothers and menopausal women that incontinence may occur. Emphasize the
commonness of the problem. That way, they'll be less embarrassed to talk about it if
incontinence occurs. Warn patients facing visual or mobility limitations that their
continence may be affected. Make sure that wheelchair users can reach the toilet easily.
Destigmatize
Demonstrate a problem-solving attitude to incontinence by making discussion of
incontinence part of routine exams. Mention that bladder control problems will occur now
and then, and that usually there is an effective treatment.
 Offer optimism
Some patients may remain silent about bladder control because they believe it cannot be
cured or improved. They may believe that it's a moral weakness, or a "natural"
part of aging--not a medical issue. You can tell these patients that 80 percent of all
incontinence cases can be significantly improved. Given hope for improvement, patients may
take the risk of telling you about bladder control problems.
Treat proactively
Doctors and nurses who treat incontinence early in its course can avert significant social
and financial consequences. Encouraging Kegel exercises in midlife, for instance, can
reduce the chances of incontinence later on. The use of diapers, by contrast, can be very
costly. More than 50 percent of all nursing home admissions result from incontinence. In
turn, these admissions cost millions of dollars to families and medical assistance
programs. They also separate loved ones from each other.
You can help your patient see continence treatment in a positive
light. It can be seen as part of her strategy to prolong independent living with family
and community.
Let's Talk About
Bladder Control for Women
The materials in this package are part of a national campaign by the
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) and partner
organizations. The campaign has two goals:
- Increase the number of women reporting and seeking treatment for
urinary incontinence
- Raise health professionals' awareness of and knowledge about urinary
incontinence.
The campaign's materials for patients are designed to serve several
purposes:
- Facilitate communication between patients, doctors, nurses, and other
health care providers
- Provide educational materials for patients newly presenting with
incontinence
- Provide easy-to-read materials that can be used by patients with
limited literacy skills and others
- Link patients, doctors, and nurses with patient and professional
health organizations.
The materials should help patients become more comfortable talking
about incontinence. In addition, pre-visit questionnaires will guide patients in gathering
appropriate information to bring to the clinic.
Doctors, nurses, and other professionals can order bulk quantities
of materials for patients or sets of reproduction masters.
The following publications are available in the series:
- Your Body's Design for Bladder Control
- Your Daily Bladder Diary* (voiding diary)
- Talking to Your Health Care Team About Bladder Control*
- Your Medicines and Bladder Control
- Pregnancy, Childbirth, and Bladder Control
- Menopause and Bladder Control
- Bladder Control for Women*
- Exercising Your Pelvic Muscles
- 1997-1998 Educational Resource Guide: Urinary Incontinence
* Items with an asterisk are meant to be given to patients when they first
present or hint of incontinence. The others serve for more specific complaints as
assessment continues.
National Kidney and
Urologic Diseases Information Clearinghouse
3 Information Way
Bethesda, MD 20892 3580
E-mail: nkudic@aerie.com
The National Kidney and Urologic Diseases Information Clearinghouse
is a service of the National Institute of Diabetes and Digestive and Kidney Diseases, of
the National Institutes of Health, under the U.S. Public Health Service. Established in
1987, the clearinghouse provides information about diseases of the kidneys and urologic
system to people with these disorders and to their families, health care professionals,
and the public. The clearinghouse answers inquiries; develops, reviews, and distributes
publications; and works closely with professional and patient organizations and government
agencies to coordinate resources about kidney and urologic diseases.
Publications produced by the clearinghouse are reviewed carefully
for scientific accuracy, content, and readability.
This publication is not copyrighted. The clearinghouse encourages
users of this fact sheet to duplicate and distribute as many copies as desired.
Let's Talk about Bladder Control for Women is a public health
awareness campaign conducted by the National Kidney and Urologic Diseases Information
Clearinghouse (NKUDIC), an information dissemination service of the National Institute of
Diabetes and Digestive and Kidney Diseases (NIDDK), National Institutes of Health.
1-800-891-5388
NIH Publication No. 97-4183
January 1997 |
