NEW YORK (Reuters) -- Healthcare workers focus on the functional impact of urinary incontinence, but elderly patients consistently rate the emotional consequences of urinary incontinence as the most burdensome aspect of their condition, according to a study in the June issue of the Journal of the American Geriatrics Society.
The researchers say their findings underscore "the tremendous psychological burden of urinary incontinence, as defined by patients in their own words."
There are many potential causes of urinary incontinence, including urinary tract infection, neurological disease affecting the bladder, and weakening of muscles in the pelvis. The disorder is thought to affect nearly a third of all individuals over the age of 65. Geriatricians and primary care physicians most often focus on the functional impairments triggered by the condition -- difficulties in carrying out the normal tasks of daily living.
But a study led by Dr. Catherine DuBeau of Brigham and Women's Hospital in Boston, Massachusetts, finds that the shame, low self-esteem, frustration, and embarrassment that often accompany urinary incontinence may exact an even greater toll. In small focus group discussions conducted with 30 incontinent, elderly patients, her team discovered that "whereas experts focus more on functional impact, patients more often cite the impact of urinary incontinence on their emotional well-being and on the interruption of activities."
Many patients felt that their condition had robbed them of control over their daily lives. "I have to stop living my life the way I would ordinarily," one patient said, while another complained, "Wherever I go, whatever I do, I always have to know right away where the bathroom is."
Others focused on the "taboo" aspect of urinary incontinences, labeling their affliction as "unclean," "embarrassing," or "mortifying." "I'm sure (urinary incontinence) must have affected my self-image," one patient said. And, in keeping with previous studies that found that over half of sufferers keep their incontinence a secret, even from their doctors, patients in the focus groups said they considered the condition "a hush-hush subject," one they "wouldn't want to burden anyone with."
In a related study, also appearing in the same issue of the Journal, researchers at the University of North Carolina, Chapel Hill, found that elderly patients suffering from urinary incontinence were twice as likely as non-afflicted individuals to rate their health as "poor," even when they were otherwise fit and able to perform the tasks of daily life. They believe physicians must do all they can to help each patient cope with the psychological burden of incontinence, and urge that "the focus should be on the patient and not the disease."
SOURCE: Journal of the American Geriatrics Society 1998;46:683-692, 693-699.
