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A Qualitative Approach

Dr Jackie Smalldridge.

The International Continence Society (ICS) defines incontinence as 'a condition in which involuntary loss of urine is a social or hygienic problem and is objectively demonstrable'.

The Main aims of this study were:

  1. To understand more about the dynamics of urinary incontinence in women by finding out what incontinence means to women and the impact on their lives.
  2. To pinpoint factors which may be seen as barriers to the uptake and delivery of continence services.
  3. Formulate recommendations to health care professionals and policy makers regarding the approach to the management of urinary incontinence and services to the community.

Fear of having an"accident"...

Urinary incontinence disrupts the lives of many New Zealand women in a variety of ways and is often a debilitating condition that generally remains well concealed in our society.

Incontinence may have far-reaching consequences for a woman's psychological, social and medical well-being, as well as impacting on her employment which can in turn have financial implications. This may impact on her confidence and self esteem. Some felt unable to leave the house for fear of having an 'accident'. For such women the impact was enormous. The fear of having an 'accident' affected their confidence in everyday situations, with some becoming virtually housebound.

Younger women with children felt unable to participate in physical activities for fear of having an accident. Consequently they became spectators instead of participators in many aspects of their families lives.

The relationships women had with husbands/partners/families and friends were affected by their incontinence. Most women had supportive husbands who did not want to know too many details of the condition. Some women spoke of having incontinence during sexual intercourse. Several were unwilling to enter new relationships due to the risk of this happening again. One sought help because of a desire for a new relationship

Talk about it with others

Because of the hidden nature of incontinence and its implications many women had difficulty in talking about it with others. Some women told their families, especially their daughters, who they felt needed to know about incontinence and doing pelvic floor exercise during pregnancy and after the birth of their children, so that it wouldn't happen to them. Some felt their incontinence was something they had to live with because they were women and given birth. Some felt confident talking to their friends while others hid it. Only a few told friends the extent of their problems. Where it arose in a joking situation and friends also admitted to being leaky, this was sometimes the catalyst for a woman to decide seek help.

For Pacific Island women incontinence created a sense of shame that often prevented them from discussing it with anyone, including husbands and children. They feel that if would bring shame to their families as well as themselves. They were also reluctant to discuss it with other Pacific Island women because they did not think their confidentiality would be respected. Women educated in NZ were more likely to be open about the problem and were keen to see other women discuss incontinence. Pacific Island women also found it hard to trust that what she told her doctor would remain confidential because of concern that either the nurses or the office staff would discuss her business outside of the surgery. This would appear to be a major issue in relation to all forms of healthcare for Pacific Island people and one that should be addressed at management level in private and public institutions.

Therapy and treatments

Women who had treatment that they found effective had a renewed sense of self and a return of confidence as a result. Most women had conservative treatments, usually pelvic floor exercises while several had surgical procedures. Pelvic floor exercises met with a mixed reaction from women. Those women who had attended a specialist physiotherapist/and/or specialist felt they knew what they were doing. Most other women expressed dissatisfaction with the exercises, mainly because they were unsure whether or not they were doing them correctly. Most women did not realise they had to do the exercises over a period of months for them to be effective therefore often producing a sense of failure and disillusionment in women.

Several women had tried alternative therapies or treatments in an attempt to control their incontinence. One woman used acupuncture combined with pelvic floor exercises and was thrilled with the outcome. Other alternative treatments resulted in a decline in the level of incontinence.

Barriers with doctors

One barrier that was identified by women was feeling disempowered as a result of their consultations with general practitioners. Some did not seek help from anyone else. The doctor's attitude was what usually decided the women not to return. These participants talked about the frustration and humiliation they experienced consulting a doctor who had no idea or knowledge about their incontinence and their symptoms. Many were told that it was because they were under stress and others were told that there was nothing that could be done and they would have to live with it. With their symptoms dismissed, they were given inappropriate treatment, if any. Women often found it difficult to approach a male doctor and it is unfortunate that most of the gynaecologists and urologists who specialise in incontinence are male.

Maori and Pacific Island women identified gender as an issue, particularly Pacific Island women who found it hard to trust a male doctor and when they did , if that doctor was also from the same Pacific Island country, then the relationship resembled brother and sister, making it taboo to discuss an issue like incontinence.

You are not the only ones

Better public awareness of incontinence is needed if it is to become an issue which women can speak about without feeling shame or embarrassment. It is also necessary so that women are aware that they are not the only ones with this problem and that there are ways for it to be treated. Resources for such promotion currently fall well short of the need and this situation does not look likely to change in the near future. In the meantime women continue to experience the effects of incontinence which may impact greatly on the quality of life.