Urinary (UI) and fecal incontinence (FI) are troublesome conditions for many in society; both UI and FI increase in prevalence with increasing age. Despite well-recognized effects on health, well-being and quality of life, incontinence is often seen by care providers and payers as a social problem, rather than a health related one. Nurses are in a key position to assist those affected by UI. Nurses have the potential to identify people with incontinence, establish appropriate interventions and provide valuable education to empower patients. Indeed, nurses are ideally placed to perform the initial assessment and management of incontinence, that portion of the care pathway which is crucial, but often poorly done. Unfortunately, this is not always easily implemented; nursing staff have identified environmental barriers, such as lack of time at work, and consider UI a low priority that prevents the facilitation of interventions. This article reviews the evidence on nursing involvement, or lack of it, in continence care and suggests a strategy to improve the situation, involving a complex intervention of knowledge translation.
The problem and its current stateConstituting one of the more common features of later life, urinary (UI) and fecal incontinence (FI) are troublesome conditions for many in society; both UI and FI increase in prevalence with increasing age. 1,2 Current prevalence estimates suggest that UI affects the lives of an estimated 400 million persons worldwide. 3 The prevalence of FI among community-dwelling US adults was recently estimated at 8.39%, with FI being more common in women when they also had UI. 2 Despite well-recognized effects on health, well-being and quality of life, incontinence is often seen as more of a social problem by care providers and payers, rather than a health-related problem.Published data reveal that the proportion of persons with UI who express a felt need for care is far below the proportion of people with the condition; the same is also true for FI. Incontinence is a stigmatized condition; people with the problem go to great lengths to hide their incontinence from others, adopt changes in lifestyle to accommodate to a new "normal" existence and delay seeking appropriate help. In fact, symptom severity and the extent to which the symptoms become "disabling" appear to precipitate health care seeking. Lagace et al found that 72.0% of those currently afflicted with UI had not spoken to physicians about the problem, whereas 37.0% indicated that they would have sought care if they had been aware of the available tests and effective treatments. 4