Incontinence - A delicate subject to discuss

Incontinence can be a delicate subject for all of us, not just for the people affected. Together, let us remove the stigma of embarrassment and make them feel more at ease and ready to accept treatment.

A common health issue

Incontinence can be a difficult subject for your patients/clients to discuss, because there is such a societal taboo around this subject. It is also a very “private” aspect of one’s life. 

The truth is that it's a very common condition, and in most cases is manageable once the problem is identified. 

According to the Continence Foundation of Australia, 65% of women and 30% of men report some type of urinary incontinence, yet only 31% of these people report having sought help from a health professional (1)

Anecdotal evidence has also shown that it takes 7 years for a person with incontinence to raise the topic with a healthcare professional. 

Once you do open the conversation, emphasising that it is common and informing them of some well- known statistics and reasons for it, may help them feel they are not alone and can do something about it.

Bring up the subject regularly

Often incontinence is not part of a routine assessment, and is therefore not “flagged” on an assessment tool, and healthcare professionals need to discuss more critical issues and there may be little time left to discuss this topic.

Treat incontinence just as you would treat any other discussion about the individual’s health. Bladder control issues are common and treatment is often available.

Incontinence can affect people of all ages, not just the elderly. Prostate conditions, pregnancy and menopause can all cause bladder weakness issues. Read more about the common causes of incontinence

Be optimistic

As the healthcare professional be optimistic and offer hope. This will help to allay anxiety and may promote the patient/client/carer to open up about the subject.

Often treatable

Incontinence conditions are often manageable but many people believe it’s a natural sign of ageing or simply can’t be cured. By telling them that the majority of incontinence cases can be significantly improved, it is far easier for them to face their condition and to start discussing treatment.

Early interventions

Losing bladder or bowel control can be very upsetting, so excusing it as a ‘one-off’, even when it becomes increasingly regular is not uncommon. Some well-meaning carers go along with the pretence, but recognising and actively managing frequent urination or continence issues, rather than dealing with “accidents”, is more dignified for everyone.

Address the subject and start any treatment as early as possible. Of course this helps the affected individual to avoid continued emotional and physical strain from their condition, but it can also prevent even more severe social consequences. Incontinence is an all too frequent reason for admission into a nursing home – a drastic step for the individual, their families and society as a whole. With early treatment and effective management, you can help those who are living with incontinence to stay in their own homes longer.

Be proactive

Tell those in the risk zone such as men with prostate problems, young mothers and menopausal women that incontinence might occur. Similarly individuals with mobility difficulties can then experience incontinence problems that can often be helped by making toilet access easier. In all cases, by preparing those at risk of becoming incontinent, you help them quickly come to terms with any eventual problem and make it easier to ask for treatment.

Use easy to understand language to start the conversation

Language is powerful and different words can make a real difference when raising this topic. Many patients are confused or in denial or do not understand the word “incontinence”. 
These are easy phrases and words that can be less daunting, less “clinical” and more easily understood: 
• I have noticed some changes….an open statement to initiate discussion 
• how are the waterworks?
• do you feel any bladder weakness or leakage?
• any bladder problems or accidents?
• do you feel you need to go to the toilet often?
• going more than once overnight?
• rushing to the toilet?
• (men) having any dribbles or problems with the flow?
Identify words they have used for toileting for a long time - so as to speak “their language”

Use Empathetic phrases

Once you have started the topic, you could use these non- judgmental statements which could open up the conversation:
• It can be difficult to live with
• It can be embarrassing
• It can be on your mind all the time
• It can affect confidence and self esteem
• It can affect your desire to socialize or exercise
• It can be very frustrating and make you angry
• It can make you feel “unclean or unsexy”

Signs that someone could be hiding Incontinence

These issues could be a way to introduce the topic of incontinence
• odour in the home (on carpet, bedlinen, clothes)
• a reluctance to go out
• laundry washing that is extremely frequent
• discoloured underwear or clothing
• plastic on couches, armchairs or on the bed 
• evidence of toilet paper in underwear  

Create the right environment to have the conversation

• If possible, wait for a time when it’s just the two of you and you can give your full attention and you have the time to discuss the topic properly
• Make the questions part of normal questions, in a casual manner.
• Determine if it is beneficial or a hindrance if a family member or carer is present 
• Explain that it is not a normal part of ageing and it can be managed
• Reinforce that by addressing the issue it will improve their quality of life- ability to be more social, improve dignity and comfort, reduce shame and anxiety, improve sleep
• An interpreter may be useful to gather very accurate information
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