The problem of incontinence


First published in 1982: Smith J.P. (1982) The problem of incontinence. Journal of Advanced Nursing 7, 409–410

There are an estimated 3 000 000 people in the UK who are incontinent and no more than 10% of them receive any kind of specialist help at all. Some 87 surgical equipment companies produce equipment of one kind or another, but the choice to the individual is based on what the prescriber knows about them.

The multidisciplinary participants at a residential workshop on incontinence resource facilities held at St George's House, Windsor Castle, 18–20 December 1981, noted that there appeared to be a singular lack of information among members of the health care professions about the incidence or state of knowledge relating to urinary incontinence among the British population. As a result they have very little idea of the extent of the problem or how to cope with it.

Recent research findings were cited which indicated that in the British population aged 70 years and over, living at home, 7·3% of the males and 18·1% of females suffer from incontinence.

About £36 000 000 per year is spent on incontinence equipment in the NHS, of which £24 000 000 is spent on pads and pants. In addition many individual patients are often paying for the equipment themselves. With the vast amount of money spent each year by the NHS there could well be some cost benefits which would accrue from identifying the problem more clearly and identifying more appropriate care and more appropriate equipment as aids to this care.

Incontinence laundry facilities are available only to a minute proportion of incontinent people, probably about 0·1%. But there appears to be an indiscriminate distribution of incontinence pants and pads. Furthermore, nurses and doctors are often very ill-informed about the relative advantages of different types of body-worn and bed protection items which are available for incontinent patients. This leads to the suspicion that very little practical advice is given to patients, causing many of them to obtain inappropriate and expensive products.

Because women do not like to use pants, they often use sanitary pads instead. It is interesting to note that about 80 000 000 sanitary pads per year are sold in the UK.

At present there is little contribution to informed debate available from industry or commercial firms. Although there is a potential source of research money among the manufacturers of equipment, there is an understandable reluctance on their part to invest in capital or research if the NHS is unwilling finally to pay for quality products. Indeed, there is good reason to believe that most manufacturers aim to identify a need that they can fulfil, as well as identifying specific key areas in which they can facilitate research.

The workshop participants made a number of recommendations. These have been documented in a full report of the deliberations at the workshop which have been used as the basis for further discussion at the regional study days organized throughout the UK by the Royal College of Nursing of the UK, who, with the generous sponsorship of Squibb Surgicare Limited, convened The Windsor Workshop.

In due course, a comprehensive report embracing the findings of the workshop and subsequent study days will be prepared by the joint sponsoring organizations. This should prove to be a most illuminating document and very pertinent for health service policy makers.

Those 3 000 000 British citizens who are incontinent deservemore attention. A little more interest from healthcare practitioners, coupled with improvements in the education and training of healthcare students, would do a great deal to alleviate the lot of persons suffering from incontinence. It would certainly do a great deal towards improving the quality of their lives.

The report of the workshop contains many important statements not least that: ‘it is important to stress that in the management of the care of incontinent patients, recognition should be given to the different needs of individuals and also to the very different needs of the major groups of individuals with long-term incontinence problems, a group whose numbers are likely to increase in the future, among them being psychogeriatric patients and mentally handicapped patients’.

‘The projected increase in the numbers of individuals over 80 during the next decade needs careful consideration, especially as in this age group up to one in three of them could suffer with a degree of dementia. This increasing number of psycho-geriatric individuals, of whom a high percentage have incurable incontinence...highlights the need for effective management and care as well as for further research into incontinence and its management.’

The need for continency is surely a very human need.