Prevalence of undiagnosed urinary incontinence in women is 53% in the preceding year and 39% in the preceding week in a US managed-care population
- Correspondence to Monique Du Moulin
Department of Health Care and Nursing Science, Medicine and Life Sciences, School for Public Health and Primary Care (CAPHRI), Maastricht University, PO Box 616, 6200 MD Maastricht, The Netherlands;
Urinary incontinence (UI) is highly prevalent, especially in older people and women, and can have a tremendous effect on quality of life.1 2 With the ageing of the population, the number of people with UI will increase rapidly. To date, research on UI has focused on prevalence, risk factors and treatment options. UI is still considered a taboo topic, and patients and healthcare workers are reluctant to discuss the problem, for different reasons.3 The study by Wallner and colleagues is one of the few that describe the prevalence and severity of undiagnosed UI in community-dwelling women.
This study aimed to determine the prevalence and severity of undiagnosed UI in women aged 25–80 years. Data from the Kaiser Permanente Northwest managedcare population were used. A questionnaire on demographic and UI information (type, frequency and amount) and quality of life was sent to a random sample of 2118 women. The response rate was 41%. The prevalence of undiagnosed UI was 53% in the past year and 39% in the past week, with the majority of the women reporting moderate to severe symptoms. From a chart review, the researchers found that UI symptoms were documented for only 5% of the women. In addition, the women reported lower quality of life with increasing severity of UI. The authors conclude that many women are suffering from clinically relevant UI that remains undiagnosed. They recommend that these women and their physicians be encouraged to discuss UI to treat this problem.
This study was conducted well, and the limitations are adequately addressed by the authors. However, some points require discussion. According to the authors, the low response rate may have resulted in an overestimation of prevalence; however, the opposite may be true. First, the women included in the study had consented to being contacted for research purposes; thus, it is possible that these women were healthier than women who did not want to be contacted. Second, as UI remains a taboo topic, it is questionable whether women suffering from UI participated in this study. Finally, it is somewhat surprising that medical records were reviewed only for women with moderate or severe incontinence; the authors should also have checked the records of the women with slight UI.
Wallner and colleagues' study reveals that UI is an unrecognised problem that severely affects quality of life. Other research has shown that there are several treatment options for UI, even in older patients.4 However, adequate treatment requires that UI be diagnosed and the subtype of incontinence be assessed. Only then can patients be advised on the therapy that best addresses their symptoms (eg, pelvic floor muscle exercises in cases of stress incontinence or bladder training in cases of urge incontinence). Unfortunately, especially in the older population, assessing the subtype of UI may be difficult given its multifactorial character.
Treatment of incontinence is extremely important, in particular for community-dwelling older people, as incontinence increases the risk of institutionalisation and social isolation.5 There is a clear need for healthcare workers who have the specific knowledge about UI to assess patients and advise them on suitable therapy and other issues (eg, skin care, odour and shame). Nurses specialised in continence care have a pivotal role in the care of incontinent patients. Research has shown that making use of the knowledge and experience of these nurses has a positive effect on incontinence episodes and quality of life.6
Few previous studies have been conducted on undiagnosed UI in the community. These studies seem to support the findings of Wallner and colleagues. Du Moulin and colleagues, for example, found that only 50% of older people with UI receiving home care had been diagnosed. Absorbent products were used in most cases, and only a few were actively treated for UI.7 Another study, conducted by Specht and colleagues, revealed that only 55% of UI sufferers had received at least one continencerelated nursing diagnosis (though their study was conducted in special care units).8
More research is needed into why patients with UI are not properly diagnosed and why UI is not discussed. One reason may be a lack of knowledge among healthcare workers: research has shown that physicians and nurses sometimes lack sufficient knowledge – and thus perhaps motivation – to address UI. Structural factors such as lack of time or personnel may be another reason. Patients may lack knowledge on treatment options for UI and may think that nothing can be done about it. They may also think that UI is a typical part of the ageing process and thus not worth bothering their physician about.3 More insight into these factors could improve communication between incontinent patients and physicians, resulting in better continence care.
Competing interests None.