been inadequately treated and poorly addressed by health care professionals,
despite the substantial impact on individual health, self-esteem and quality of
has also been considered as a 'taboo', and surveys have shown that less than
40% of the affected have mentioned their inability to control to a doctor.
affect more than 400 million people worldwide and the incidence is likely to
rise sharply in the coming years.
the deleterious effect on sufferers and their caregivers, experts advocate placing a greater
focus on incontinence as a health and social care issue.
A new report by
Svenska Cellulosa Aktiebolaget (SCA), a leading global hygiene company, demonstrates
a number of weaknesses in the current approach to continence care and
recommendations to improve the diagnosis and treatment for
"Incontinence care is not
receiving the deserving focus and sufficient funding. There could be
significant benefits for patients and the health care system if greater
emphasis is placed on continence by policy makers and payers and a more
integrated approach is taken to assessment and treatment," said Mansoor
Parvaiz, Vice President of SCA.
- More than 90
percent of continence sufferers are relying on primary care physicians for
treatment. Primary care physicians have very general and limited knowledge
about this condition and often feel quite uncomfortable making diagnoses in
Incontinence can have many different root causes and it is not
easy to detect the principal cause of incontinence. It can be related to the
bladder, the lower urinary tract, the pelvic floor muscles, prostate, bowels,
nerves, brain, functional or cognitive impairment, neurological diseases
or any combination of these.
Evidence reveals that general practitioners do not actively ask
people at risk of incontinence about incontinence and
people find it difficult to talk about incontinence in general.
- There is insufficient
emphasis on appropriate professional training to enable initial assessment and
treatment to be delivered in the community. Also, there is insufficient
emphasis on self-management of the condition alongside specialist support,
which could be used to empower sufferers.
- Finally, advancements in
technology have seldom been harnessed to enhance delivery of care, when they
have the potential to make a real difference to professionals and patients
These recommendations can be adapted to suit
local variations in practice, resources and culture around the globe.
- Shift the responsibility
for initial assessment and treatment away from general primary care physicians
to professionals with specialist continence training, such as continence nurse
specialists, or other clinicians as available, in primary care.
Studies show that the bestperforming healthcare services are locally led in primary care by healthcare professionals with specialist continence training rather than general primary
"By having health care
practitioners, like nurses, with specialist knowledge in the area of incontinence, we make it
easier for people to talk about incontinence and at the same time get a better
initial assessment and treatment," experts said.
- The establishment of
robust referral pathways to detect and treat incontinence
to provide timely and effective care. Adopt an
integrated approach to incontinence care where specialists are fully integrated
with other parts of the care pathway.
Experts suggest that policy makers
have a role in introducing specific legislation or promoting adherence to
clinical guidelines for a complete care pathway.
"Governments can promote
incontinence as a public health and social care issue that needs to be
addressed. They can also incentivise performance indicators (KPI's) and patient
related outcomes in order to monitor the quality of care. These outcomes can be
made publicly available. Policymakers /governments could stimulate promotion of
specialist continence care education for nurses," they said.
- Establish accredited
training programmes for people wanting to become continence nurse specialists
and other health or social care professionals who want to improve their
competence in delivering continence care.
- Promote the use of
self-management tools and techniques and provide information on the use of
- Establish standardised
assessment processes to meet the requirements of patients and caregivers with
regards to the prescription of containment products. Make the use of technology integral
to the delivery of continence care to enable self-care, connect sufferers and
caregivers and enable providers to monitor progress and troubleshoot issues.
Mobile phone technology or use of the internet as online support for
behavioral or conservative therapies can be extremely useful in the area of
incontinence, especially for those living in remote areas where people do not
have easy access to especially trained health care professionals.
"It can help people for example with bladder or pelvic floor muscle
training or with exercise programmes coaching to achieve life style changes.
These are initial treatment options which could be very valuable for countries
where health care structures are less developed or where there is a shortage of
trained health care professionals," say experts.
a very significant and a growing issue in India. The country's five percent
population is affected with the issue. India has a great opportunity to arrange
for this care in an effective and efficient way starting with making
effective provision in primary care.
By educating health and social care
workers (specialized nurses if possible) in primary care, it will be
possible to deliver a higher standard of initial assessment and treatment to
avoid further needs for specialized care and the need for specialized