Incontinence: Current Treatment Approach Needs Revamping

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Incontinence has been inadequately treated and poorly addressed by health care professionals, despite the substantial impact on individual health, self-esteem and quality of life.

The condition has also been considered as a �taboo', and surveys have shown that less than 40% of the affected have mentioned their inability to control to a doctor.

Urinary incontinence and bowel incontinence affect more than 400 million people worldwide and the incidence is likely to rise sharply in the coming years.

Considering the deleterious effect on sufferers and their caregivers, experts advocate placing a greater focus on incontinence as a health and social care issue.

A new report by Svenska Cellulosa Aktiebolaget (SCA), a leading global hygiene company, demonstrates a number of weaknesses in the current approach to continence care and recommendations to improve the diagnosis and treatment for incontinence.

"Incontinence care is not receiving the deserving focus and sufficient funding. There could be significant benefits for patients and the health care system if greater emphasis is placed on continence by policy makers and payers and a more integrated approach is taken to assessment and treatment," said Mansoor Parvaiz, Vice President of SCA.

Weaknesses

• More than 90 percent of continence sufferers are relying on primary care physicians for treatment. Primary care physicians have very general and limited knowledge about this condition and often feel quite uncomfortable making diagnoses in this area.
  
  Incontinence can have many different root causes and it is not easy to detect the principal cause of incontinence. It can be related to the bladder, the lower urinary tract, the pelvic floor muscles, prostate, bowels, nerves, brain, functional or cognitive impairment, neurological diseases or any combination of these.
  
  Evidence reveals that general practitioners do not actively ask people at risk of incontinence about incontinence and people find it difficult to talk about incontinence in general.


• There is insufficient emphasis on appropriate professional training to enable initial assessment and treatment to be delivered in the community. Also, there is insufficient emphasis on self-management of the condition alongside specialist support, which could be used to empower sufferers.


• Finally, advancements in technology have seldom been harnessed to enhance delivery of care, when they have the potential to make a real difference to professionals and patients alike.

Recommendations

These recommendations can be adapted to suit local variations in practice, resources and culture around the globe.

• Shift the responsibility for initial assessment and treatment away from general primary care physicians to professionals with specialist continence training, such as continence nurse specialists, or other clinicians as available, in primary care.
  
  Studies show that the bestperforming healthcare services are locally led in primary care by healthcare professionals with specialist continence training rather than general primary care physicians.
  
  "By having health care practitioners, like nurses, with specialist knowledge in the area of incontinence, we make it easier for people to talk about incontinence and at the same time get a better initial assessment and treatment," experts said.


• The establishment of robust referral pathways to detect and treat incontinence to provide timely and effective care. Adopt an integrated approach to incontinence care where specialists are fully integrated with other parts of the care pathway.
  
  Experts suggest that policy makers have a role in introducing specific legislation or promoting adherence to clinical guidelines for a complete care pathway.
  
  "Governments can promote incontinence as a public health and social care issue that needs to be addressed. They can also incentivise performance indicators (KPI's) and patient related outcomes in order to monitor the quality of care. These outcomes can be made publicly available. Policymakers /governments could stimulate promotion of specialist continence care education for nurses," they said.


• Establish accredited training programmes for people wanting to become continence nurse specialists and other health or social care professionals who want to improve their competence in delivering continence care.


• Promote the use of self-management tools and techniques and provide information on the use of containment products.


• Establish standardised assessment processes to meet the requirements of patients and caregivers with regards to the prescription of containment products. Make the use of technology integral to the delivery of continence care to enable self-care, connect sufferers and caregivers and enable providers to monitor progress and troubleshoot issues.
  
  Mobile phone technology or use of the internet as online support for behavioral or conservative therapies can be extremely useful in the area of incontinence, especially for those living in remote areas where people do not have easy access to especially trained health care professionals.
  
  "It can help people for example with bladder or pelvic floor muscle training or with exercise programmes coaching to achieve life style changes. These are initial treatment options which could be very valuable for countries where health care structures are less developed or where there is a shortage of trained health care professionals," say experts.

Indian Perspective

Incontinence is a very significant and a growing issue in India. The country's five percent population is affected with the issue. India has a great opportunity to arrange for this care in an effective and efficient way starting with making effective provision in primary care.

By educating health and social care workers (specialized nurses if possible) in primary care, it will be possible to deliver a higher standard of initial assessment and treatment to avoid further needs for specialized care and the need for specialized hospitals.

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