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Report of a Mail Survey of Women With Bladder Control Disorders

Posted on: Wednesday, 22 December 2004, 03:00 CST

Bladder control disorders are a significant health issue for aging women. However, despite the growing prevalence of these disorders, very little is known about a patient's perception of the severity of incontinence, associated absorbent product use, and interaction with health care professionals. A survey was conducted to look at these issues. Limitations in communication between women and health care professionals regarding incontinence were identified.

Bladder control disorders such as urinary incontinence (UI) and overactive bladder (OAB) have been referred to as the "last real taboo of the 20th century" (World Health Organization [WHO], 1998). The WHO estimated that these conditions affect nearly 200 million people worldwide, and estimates in the United States range from as low as 13 million persons to as high as 33.3 million persons (Stewart et al., 2003; Thom, 1998). These disorders affect more than twice as many women as men, and are believed to be a significant health issue for aging women. Studies have shown that bladder control problems are first seen by women in childbearing years. One out of three women, 2 years post childbirth, report drops or small amounts of urine leakage with certain activities such as coughing, laughing, sexual intercourse, and high-impact exercises. As women approach menopause, the quantity of urine leakage increases to severe or large amounts, soaking entire clothing. With aging, UI and OAB become more frequent and burdensome. However, despite the growing prevalence of these disorders, very little is known about a patient's perception of the severity of incontinence, associated absorbent product use, and interaction with health care professionals.

PURPOSE

The author, in partnership with a mail order medical product company (HDIS, St. Louis, Missouri), was interested in learning about the UI and OAB history, habits, attitudes, and lifestyle issues of persons who live with these conditions. As the literature notes, most persons with UI do not seek treatment. An area of interest was identifying barriers (both physical and psychological) that prevent patients from seeking professional advice/assistance for incontinence. The ultimate objective of this survey was to understand the current patient-professional relationship in order to evaluate different vehicles that might effectively increase communication between patients and their health care providers regarding incontinence issues.

LITERATURE REVIEW

Types of Bladder Control Disorders

Loss of bladder control is either related to detrusor muscle or urethral sphincter dysfunction. Urinary incontinence is the involuntary leakage of urine that can occur with physical exertion (called stress urinary incontinence or SUI) or secondary to bladder overactivity (called urge urinary incontinence or UUI). Women with SUI will have a damaged or weakened urethral sphincter and urine loss is usually accompanied by a loss of support of the urethrovesical junction (angle between the bladder and urethra). Women will report mild or small amounts of urine leakage that occurs immediately following activities that increase intra-abdominal pressure (for example, sneezing, laughing, coughing, bending, exercising, lifting heavy objects, or while participating in certain sports such as tennis). Stress UI has many causes, including weakening of pelvic floor musculature, which is often associated with multiparity or direct anatomic damage to the urethral sphincter (Newman, 2003). Urge urinary incontinence is the involuntary leakage of urine usually proceeded by a sudden intense urge to urinate and is characterized by involuntary detrusor muscle contractions as the bladder fills (Newman & Giovanni, 2002). Another common bladder disorder that can usually include UUI is OAB. Overactive bladder is characterized by urgency, with or without urge incontinence, usually with frequency and nocturia (Newman & Wein, 2004). Urinary frequency generally refers to more than eight micturitions within a 24-hour period. Urgency is the complaint of a sudden compelling desire to urinate which is difficult to defer (Abrams et al., 2002). OAB and UUI can coexist with SUI. Approximately 35% (5% to 60%) of patients have both stress and urgency incontinence, often referred to as "mixed incontinence."

Quality-of-Life Issues

Quality-of-life (QoL) assessments are critical for conditions such as UI and OAB, which often go untreated and have consistently been shown to have a deleterious effect on health-related quality of life. Studies show that both women and men with these conditions have significantly poorer QoL than age and gendermatched populations (Stewart et. al., 2003; Wyman, 1994). In addition, OAB and UUI have a greater impact on QoL, particularly social and psychological functioning, than SUI. The impact on QoL is associated not only with the severity of UUI, but also by the individual's coping abilities. For example, elderly women appear to be less affected on QoL domains than their younger counterparts, and limitations in mobility resulting from UI appear to be especially distressing to younger women.

Quantity of urine lost is an indicator of impact on QoL as severe urine loss appears to have greater social and emotional consequences than does mild loss (Fultz & Herzog, 2001). OAB symptoms of urgency and frequency are exacerbated when patients have difficulty with their mobility or are recovering from an illness, causing additional problems reaching the restroom (Newman & Giovanni, 2002). At night, bladder contractions may disrupt sleep. Weekly or more frequent urge incontinence with associated urgency increases the risk of falls in elderly women and contributes to the caregiver burden (Brown et al., 2002; Fantl et al., 1996).

Associated Risk Factors

The medical and psychosocial morbidity associated with UI and OAB is significant. Patients with UI have more outpatient visits and more urinary tract infections (UTIs) than people without UI. The OAB symptoms of urgency and frequency especially during nighttime hours, nearly double the risk of being injured in a fall, and increase the risk of fall-related nonspine/nontraumatic bone fractures (Brown et al., 2002). UI is a leading cause for admittance to long-term care facilities, and it is associated with skin rashes, infections, and pressure sores, as well as depression and sexual dysfunction.

Age, diabetes, a history of recurrent UTIs or childhood enuresis, obesity, restricted mobility, and race have all been identified as risk factors for OAB in women. The Heart & Estrogen/Progestin Replacement Study Research Group reported an increased risk of urge UI among postmenopausal women with diabetes or frequent UTIs (Brown et al., 1999).

Barriers to Seeking Treatment

Urinary incontinence usually comes to a health care professional's attention only when the patient complains of specific symptoms. However, this is not often. Recent research has reported that only 38% of surveyed women initiated conversation with a physician about incontinence (Kinchen et al., 2003). Those who seek treatment tend to have more significant symptoms. Older people may think incontinence is part of the normal aging process and health care professionals may dismiss it as not worthy of investigation and treatment. Unless specifically addressed by clinicians, most patients are too embarrassed by their symptom of UI to seek medical help. Even patients reporting with associated symptoms such as urgency and frequency may still be too embarrassed to mention urinary leakage. Patients are often unaware that there are effective behavioral and pharmacologie therapies that can significantly reduce and even eliminate their symptoms. Instead, patients will self- manage their urine leakage by using absorbent products. Consequently, while patients with severe symptomotology inevitably seek treatment, the majority of patients with mild or moderate symptoms of UI are often overlooked.

According to a survey reported in the Morbidity and Mortality Weekly Report, many primary care physicians feel unprepared to evaluate and/or treat urinary incontinence (Centers for Disease Control, 1995). The survey further showed that most clinicians do not routinely ask their elderly patients about UI, and they are even less likely to routinely elicit bladder health information from their treatment of younger patients. Instead, UI is perceived as a diagnosis necessitating immediate referral to a specialist. By incorporating a few questions concerning bladder health into a structured intake assessment, clinicians can offer hope for the large population of patients with UI who have unnecessarily been suffering quietly.

Table 1.

Age of Respondents

METHODOLOGY

After conducting a test survey in late 2002, a 33-item questionnaire was mailed in early 2003 by the mail order catalog company HDIS to 1,500 women. Fifty percent of the sample randomly selected were "leads" (for example, they had identified themselves as incontinent but never purchased from HDIS). HDIS obtains their leads through TV commercials, print ads, list rentals, and personal referrals. The other half of the sample randomly selected were HDIS customers. The entire sample was selected with the criteria of "incontinent, female and aged 55 or older," and their information was validated as no older than 2002 by referencing the medical product company dated listings. That is, 50\% of mailings were to individuals who had purchased products from the company in 2002, and the rest were mailed to those who had never purchased products, but were new leads in 2002. The questionnaire consisted mostly of multiple-choice questions. Persons were informed that the questionnaire originated from the mail order product company. Each survey mailed contained a dollar bill as an incentive to complete and return the survey. Actual number of respondents were 405 (<33% of total) but it is not known from which list respondents originated. It should also be noted that persons surveyed may have included caregivers (particularly family members) of persons with incontinence, so it is conceivable that those surveyed who did not respond did not have UI or OAB. Survey data were tabulated by Idiosyncrasies, a research firm which conducts and analyzes consumer surveys, research and focus groups, using standard consumer research protocol. The author reviewed the raw data from the respondents and directed analysis of the survey.

FINDINGS AND DISCUSSION

Description of Sample

The final sample consisted of 422 responses, with 405 women aged 56 and older (see Table 1). The 17 respondents under the age of 56 were excluded from the analysis. The highest responses were from persons residing in California (n=35), Florida (n=31), New York (n=28), or Pennsylvania (n=24), Michigan (n=22), Texas (n=20) with 24 respondents not answering this question. As the questionnaires were self-administered, not all respondents answered every question. Also, respondents may have checked more than one answer.

Locher et al. (2002) found that women attributed their UI to aging so the survey asked respondents about their understanding of UI and if they thought UI was normal. Over half (56%) of the respondents think incontinence is normal and a part of aging with 59% noting they are not embarrassed to discuss it with health care providers.

Approximately two-thirds (62%) of the respondents said their UI was related to at least one medical condition or disease. Loss of pelvic support from childbirth/pregnancy (27%) and diabetes (17%) were the most frequently mentioned medical causes of UI.

It has been suggested that when promoting awareness of bladder control disorders, simple language and terminology (such as bladder health, bladder control, and overactive bladder) should be used (Newman et al., 2002a). However, when asked to "check the box that best indicates your comfort level (confortable, very comfortable, not comfortable) with the words that are often used to discuss loss of bladder control," respondents were comfortable (51%) using the terms ovemctive bladder and incontinence when discussing this condition. When provided with additional terms, 39% said they were very comfortable with loss of bladder control, 33% with leaks, 26% with accident, and 23% with incident. However, roughly one-fourth (23%) of respondents said they were not "very comfortable" using any of the terms listed above when discussing their condition/ situation.

Table 2.

Survey Questions Relating to UI and OAB

Incontinence History and Habits

Two critical components of these disorders are the severity or volume of urine loss and the activity associated with symptoms necessary to identify causation. The survey attempted to determine onset of UI and to differentiate OAB and UUI symptoms from SUI symptoms by asking specific questions about the nature of their condition and its impact on daily life (see Table 2). The survey also attempted to determine severity by having respondents subjectively note if urine leakage was mild, moderate, or severe.

Onset of incontinence. Approximately one-third (34%) of the respondents had experienced incontinence 2 years or less, one-third (31%) had experienced incontinence between 3 and 5 years, and one- third (35%) had experienced incontinence 6 years or more, with 10% of those experiencing incontinence for over 20 years.

Frequency of incontinence. When asking respondents about urinary frequency, the majority said they typically use the bathroom between 5 and 8 times per day (52%), and 2 to 3 times per night (53%). As would be expected, those who describe their incontinence as mild use the bathroom significantly less often (both during the day and at night) than those who describe their incontinence as severe. The number of times the bathroom was used (both day and night) was not directly related to a respondent's age or length of time incontinence had been experienced. The survey indicated that over half of respondents (53%) experienced UI several times a day, with 15% reporting UI once daily. Eighty-two percent of the respondents leaked urine during the day, and 80% leaked urine at night. The frequency of leakage of urine (both day and night) increased as the degree of incontinence increased. Nocturnal enuresis was seen in this group, with 53% saying they leak urine during the night at least once a week, and 390% saying they leak urine every or almost every night.

Nature of incontinence and urinary symptoms. When questioned about symptoms associated with UI, most respondents checked more than one answer. This was interpreted as an indication of more than one symptom, mixed UI. Over half of the respondents said they "leak on the way to the bathroom" (68%), and "with physical activity such as coughing, laughing, bending, exercising" (58% n=236). UUI or "leakage with strong urinary urge" was noted in 38% (n=152), and only 21% (n=86) noted "leakage without awareness." The results of this survey were similar to other surveys in that urge and mixed were the most common clinical types of incontinence in older women (Sampselle, Harlow, Skurnick, Brubaker, & Bondarenko, 2002).

Degree of incontinence. Respondents were asked to describe the degree or severity of urine leakage. Approximately half of the respondents (47%) described their incontinence as moderate, 28% described their incontinence as mild, and 18% as severe. The amount of urinary leakage was directly correlated to the degree of incontinence (those with mild incontinence leaked less, and those with severe incontinence leaked more). However, there was no difference between symptoms and degree of urine leakage. Of those respondents (n=276) who reported "leakage on the way to the bathroom," 50% (n=139) reported their incontinence as moderate, and 47% of respondents (n=236) who "leak urine with activity" described their UI as moderate. The degree of incontinence was not correlated to age but it was directly related to the length of time that the respondent had experienced incontinence. That is, those experiencing mild incontinence were more likely to have been incontinent 2 years or less, while those experiencing severe incontinence were more likely to have been incontinent over 10 years. When UI was quantified as moderate as opposed to mild, it was not surprising that 49% said they leak enough to wet through their underwear. It is worthwhile to note that "leaking with activity" decreases as the respondent ages. Those who described their incontinence as severe experienced the complaints of "leaking without awareness" and "continuous leakage" more often.

Impact of incontinence on QoL. Overall, 58% of the respondents (n=244, 58% of 422) said incontinence had a negative impact on their lives. Of these respondents, 38% said incontinence negatively affected their lives on a daily basis (22% of the total sample, n=95 respondents) and 23% said the negative impact began immediately after the onset of incontinence (15% of the total sample).

Respondents' frustrations with UI have been segmented into four main areas that were all fairly equal in representation:

1. Mental frustrations (embarrassing, no control).

2. Inconvenient (difficult to be away from home/bathroom, have to go all the time).

3. Discomfort (wet pants, need to change pad often, and odor).

4. Problems with protection/ products (have to wear, carry extra).

Table 3.

Description of Initial Episode of Loss of Bladder Control

Since initial experiences may have some impact on motivation to intervene, the survey asked respondents to describe the first experience with loss of bladder control. Many stated that it occurred so long ago they could not remember, while others reported finding themselves losing urine in very public and embarrassing experiences. Table 3 provides the most recurring revelations about these episodes. Additionally respondents were asked to share thoughts and experiences related to loss of bladder control, the most frustrating part of being incontinent and what they would like health care professionals to know. Several recurrent themes were detailed which included urine leakage on the way to the bathroom, feelings of embarrassment, and disgust. Table 4 lists some of these recurring themes. The described social restrictions have definite impact on the treatment strategies investigated and enacted by women (Wyman, 1994].

Management Strategies

Most surveys report that women do not actively seek treatment for incontinence (Hunskaar et al., 2000; Kinchen et al., 2003). In this survey, respondents were specifically asked to indicate if a doctor had discussed treatments. A list of possible treatments including diet, nutritional supplements, surgery, medications, pelvic floor muscle exercises, etc. were provided. Over 50% (n=279) of the respondents had discussed medications (51%) and pelvic floor muscle exercises (50%) with their doctors, 27% had discussed surgery, 22% had discussed diet/foods effect on the bladder, and only 6% had discussed nutritional supplements and skin care. Respondents generally believed that health care professionals should be discussing these treatment options with them to a greater extent than they currently are.

Table 4.

Things They Would Like Professionals to Know

Use of Incontinence Products

Several studies have shown that the major method of managing UI among communit\y-dwelling adults is the use of absorbent products (Herzog, Fultz, Normolle, Brock, & Diokno, 1989; Hunskaar, Lose, Sykes, & Voss, 2004; Sandvik & Hunskaar, 1993). Of interest was what specific products were being used, so questions on the use of absorbent incontinence products, including differentiation between types of products (for example, perineal pad vs. an adult brief) and correlation between type of product and degree of UI severity, were included. In this survey, respondents were asked about disposable incontinence products (Newman, 2002b) that include (a) perineal pads, panty liners, inserts, and shields that attach to underwear with adhesive strip and side gathers for mild leakage, (b) undergarments and protective underwear with a wide front or back for moderate-to-severe leakage, and (c) adult briefs (traditional diaper- style) for more severe loss. see commonly used incontinence products in Figure 1.

Perineal pads are preferred by patients because of their discreetness (Baker & Norton, 1996). Studies have shown that pad usage preference varies for women with SUI and other types of UI. McClish et al. (1999) reported that 77% of women who enrolled in a clinical trial for Uf used a protective perineal pad at least once per week. This study (McClish et al.,1999) also showed that women used lower-cost products such as menstrual pads rather than specific incontinence pads. Undergarments are very popular since they are form- fitting large pads that extend to the waist and are held in place by elastic side straps using Velcro or buttons. Protective underwear are disposable products similar to cloth underwear with added absorbent protection. When choosing or recommending a product, both the patient and healrh care professional often have little information about product performance on which to base their choice (Fader, Cottenden, & Brooks, 2001).

In this survey, 60% (n=249) of the respondents said they use the same bladder protection products during the day as at night, while 12% said they use different products during the day and at night. Only 18% said they use bladderprotection products during the day but not at night, and 3% said they use products during the night but not during the day.

For the total sample, as well as all subsamples analyzed (respondent's ago, length of time incontinence experienced, or the degree of incontinence), "bladder control pads" were the product used most frequently. The typo of pad did relate to Ul severity since "no protection and panty liners" were worn more often by those experiencing mild incontinence; "disposable underwear/pull ups and diaper type products" were worn more often by those experiencing moderate and severe incontinence. "No protection panty liners" were 12% of the total sample, but 28% for those with mild incontinence. "Disposable underwear/pull ups" were 17% for the total sample, but 27% for those with severe incontinence. "Diaper type produces" were 6% for total sample, but 15% for those with severe incontinence.

The relationship of symptoms to product use was analyzed. Respondents (n=276) who reported "urine leakage on the way to the bathroom" used two or more pads with the majority using bladder control pad (n=122), feminine hygiene pad (N=34), and protective underwear (n=50). Respondents who reported the symptom "leakage with activity" (n=236) used only two or more pads with the majority using bladder control (n=108) and feminine hygiene pads (n=30).

Figure 1.

Commonly used incontinence products.

The survey attempted to quantify the number of products used on a daily basis. The average number of bladder control products used in a typical day increased with age, length of time incontinence experienced, and with the degree of incontinence. During a 24-hour period, those using disposable diaper type products (6% of the total, 3.1 per day) and disposable underwear (18% of the total, 3.0 per day) tended to use the most products. Those using bladder control or perineal pads most often (42% of the total) used an average of 2.6 per day and those using both feminine hygiene (13% of the total, 2.39 per day) and panty liners (12% of the total, 1.9 per day) used somewhat fewer products each day.

Consultation with Doctor/ Health Care Professional

Although literature indicates that most persons with UI do not seek help, 65% of respondents in this survey had sought professional advice concerning their UI and OAB. This is not surprising since the population surveyed may have heard about the mail order medical product company from their doctor or other health care professional. As most respondents had fairly large urine leakage (moderate or severe), severity of urine loss may be the reason such a large number sought professional advice. Research indicates that women who are most likely to seek help usually report greater social restrictions, daily incontinence, large volume accidents, and absorbent pad use (Wyman, 1994). This group had tended to seek help from their physicians fairly quickly after onset of UI. Nineteen percent sought professional advice within the first 3 months, 12% within 4 to 6 nioiilhs, 5% within 7 months to a year, and for 15% it was over a year before they sought professional advice. Only 14% said they sought professional advice immediately after their first loss of bladder control incident.

Most respondents were aware of treatment options, but still sought additional information; 60% disagree that surgery is the only treatment, and 68% say information about others living with incontinence would be helpful. Most were satisfied with their doctors; 72% agreed that their doctor was sensitive, 64% agreed their doctor was well-informed concerning incontinence, and 60% would have liked to discuss the personal and social issues of incontinence with their doctors.

Survey respondents noted that the family doctor/general practitioner was the doctor consulted first for almost two-thirds (64%) of those who sought professional advice. A urologist was consulted second for almost 50% of the patients. It appears the typical scenario is for a person to consult with the family doctor who then often refers the patient to a urologist. Neither doctor, family doctor/general practitioner, nor the urologist was considered significantly more helpful concerning UI problems.

When the respondent decided to discuss UI with a professional, approximately equal numbers waited to discuss the condition during a regular visit (41%) while others scheduled a specific appointment to discuss incontinence (23% with current doctor, 15% with new doctor). Those who discussed their UI during a regular appointment primarily visited the family doctor or OB/GYN while those who scheduled a specific appointment were more likely to see a urologist.

It seems as though women prefer women, as respondents (71%) noted that a female doctor was the health care professional with which women were most comfortable discussing UI, 54% with a female nurse, 45% with a male doctor, and only 14% with a male nurse. However, there were still a number of respondents (11%) who were not "very comfortable" discussing UI with any of these health care professionals.

Regardless of the type of doctor consulted, respondents indicated that they initiated the discussion on UI the majority of the time (57% of the time). A doctor initialed the discussion about one- quarter of the time (27%), and a nurse or other health care professional 4% of the time. The topic of UI generally came up when discussing the respondent's medical condition (47% of the time). Only about one-third of the time (37%) was the respondent specifically asked about bladder control.

A surprising finding, considering the availability of self- administered screening questionnaires to health care professionals, only 18% of respondents said they filled out a form that contained questions about bladder control. The best way for health care professionals to broach the subject of UI appeared to vary by the individual situation and type of doctor with whom they were consulting. A majority (69%) of the respondents said they thought it would be very helpful in prompting discussion if their doctor or health care professional provided a form for them to check off symptoms of incontinence (leaking with sneeze or laugh, waking at night to urinate, etc.). Twenty-four percent thought the form would be somewhat helpful, und only 6% felt it would not be helpful.

This survey supported other surveys in that respondents looked to their doctors for answers (Roe, Doll, & Wilson, 1999). The one thing the majority of patients (53%) wanted their doctors to do was to take action (fix the problem and provide information, medication, samples, and options). Twenty-six percent wanted their doctors to show more concern (ask/talk about it, explain, listen, show support), while 25% felt there was nothing more that their doctor could do.

Patient Education

The preferred methods for dispersing information on UI were brochures/handouts (74%) and educational videos (39%) distributed by health care providers. Respondents would like to see specific information addressed in these materials including information on treatments (68%), information on products (50%), guidelines for normal urinary frequency (45%), guidelines for assessing results of various treatments (39%), incidence/expectations for incontinence as a result of other diseases/conditions (38%), and information on medical research (37%).

Respondents were asked where they primarily learned about incontinence or bladder control products. Television, magazine, and other advertising (48%) wore the predominant sources, followed by seeing and reading information on store shelves (42%), hearing from a friend or relative (29%), from a doctor or health care professional (23%), and from a mail order company (6%).

When asked who should bo responsible for information on incontinence products, 40% of responden\ts felt it was primarily the manufacturer's responsibility. Not surprising, although not often seen, 60% thought it was the medical community's responsibility (32% felt it was the doctor's responsibility, 24% the nurse's responsibility, and 11% the pharmacist's responsibility) to assist patients in selecting the most appropriate absorbent product. Almost 90% felt product samples would be helpful. Additionally, approximately 60% felt educational materials (such as product brochures) would be helpful, while only 36% felt a toll-free number and only 11% thought a list of Web sites would be helpful.

LIMITATIONS

There are some limitations to this survey. One limitation is that all respondents were required to be incontinent so this is a very select and defined group. Also, this may be a more informed group as they admit their incontinence problem. A second limitation is the uncertainty about differences between consumers who purchase their products via retail as opposed to those who purchase via mail order. Customers may also have made purchases on behalf of a client or family member, and distinction of information from these sources versus the actual incontinent individual is not defined. Race, although a risk factor, was not included in the questionnaire. Economic and educational background, not addressed in the survey, may also have influenced information sources available to a consumer, and the small sample size could limit general application. The survey also used percentages of a total, and not a defined statistical tool for validation.

Conclusions

Those suffering from UI appeared to belong to two separate groups of thought. The first group had the attitude that incontinence was a normal part of aging, and they were not embarrased to discuss it with their doctor. Somn felt incontinence often had a negative impact on their daily life, while others did not. The second group, which appeared to be somewhat smaller, was much more reserved. Many of these women were reluctant to seek professional advice and were uncomfortable speaking about incontinence. They suffered from not only the physical discomforts of incontinence, but also the mental frustrations. They definitely felt that incontinence had a negative impact on their daily lives.

In this survey, the typical scenario was for the woman to first seek professional assistance from the family doctor, who then referred the woman to a specialist who was usually a urologist. While the majority of respondents who sought professional assistance were satisfied with their doctors and aware of treatment options, they still desired more information about the causes and treatments, as well as coping with the situation and learning how others cope. Most felt they would benefit from more communication or interaction with their doctor. Additionally, most wanted their doctor to be more proactive; that is, to take action by initiating the discussion on incontinence, by providing information and educational materials, and by providing product samples. Medical education, both for physicians and nurses, is lacking (Newman et al., 200Oa) because programs to assist doctors (primarily family doctors/general practitioners) and nurses in communicating and discussing UI are not currently included in educational curricula.

From this survey, it is evident that respondents want more information. They want this information to be available through doctors and medical professionals, as well as retail outlets where incontinence supplies are sold, through mail order, on a Web site, etc. Since respondents are getting incontinence information through consumer advertising, which is usually funded by pharmaceutical companies and manufacturers of products, a partnership between the health care community and these sources to produce this information would be ideal.

Introduction

Very little is known about a patient's perception of the severity of incontinence, absorbent product use, and interaction with health care professionals despite the growing prevalence of bladder control disorders such as urinary incontinence (UI) and overactive bladder.

Purpose

Using a simple mail-in questionnaire, this survey was meant to evaluate the limitations in intervention for UI in women due to communication shortfalls. It cites common resources utilized once a woman finds significance to her bladder control problem. The survey explores the adequacy of intervention relative to the effective availability of information, materials, and treatment. The objective was to understand the current patient-professional relationship in order to evaluate different vehicles that might effectively increase communication regarding incontinence issues.

Methods

In partnership with a mail order medical product company, the author formulated a questionnaire that was mailed by the company to 1,500 women. Half of the sample was derived from randomly selected "leads" from advertising sources and personal referrals who had identified themselves as incontinent but had never purchased incontinence supplies from them. The other half were randomly selected customers who had purchased the company's incontinence products. The 33-item multiple-choice questionnaire had 422 responses; of these, 405 women, aged 56 and older were evaluated. A research firm that conducts and analyzes consumer surveys using standard consumer research protocol tabulated results.

Findings

Of those suffering from UI, two groups emerged. The first felt that incontinence was related to aging, and were not embarrassed to discuss it with their physician. They had mixed feelings regarding impact on quality of life. The second group was reluctant to seek professional advice and was uncomfortable speaking about it. They felt strongly about its negative impact on daily life. Respondents from both groups who seek professional assistance still desired more information about the causes, treatments, and coping mechanisms. Most wanted more provider interaction and wanted their doctor or health care provider to proactively initiate discussion on incontinence and provide information, educational materials, and product samples.

Conclusion

Respondents indicated that they want more information regarding incontinence. While they may not be equipped to fully understand the problem, they expect doctors, nurses, medical professionals, retail outlets, medical supply companies, and mail order houses to provide the information. Since respondents are receiving information through consumer advertising, which is usually commercially funded, a partnership between the health care community and these sources to produce this information would be ideal.

From this survey, it is evident that respondents want more information.

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Diane K. Newman, MSN, RNC, CRNP, FAAN, is Co-Director, Penn Center for Continence and Pelvic Health, Division of Urology, University of Pennsylvania Health System, Philadelphia, PA.

Acknowledgment: The author would like to thank Jean Wyman, PhD, RNC, University of Minnesota, for her review of this article.

Note: This study was supported with funding from Home Delivery Incontinent Supplies Co., Inc. (HDIS), St Louis, MO.

Copyright Anthony J. Jannetti, Inc. Dec 2004

Source: Urologic Nursing

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