Abstract
Previous surveys on
Introduction
Urinary incontinence (UI) is common, affects women of all ages and can impact on physical, psychological and social health. Some women may not see their UI as a concern and do not report it. However, for those with a problem, women can delay receiving help for >5 years. 1 Reasons given include embarrassment, not wanting to bother the doctor, the belief that incontinence is part of ageing and not being aware of effective treatments 2 – reasons very similar to why women avoid seeking help for loss of libido, vaginal atrophy and dyspareunia. 3,4 Since 1997, approximately 1310 public toilets have closed and it is possible that more closures will follow. An unfortunate consequence of this is that it will keep many women on a ‘bladder leash’, – resulting in shrinking social involvement and increased isolation an inevitable and dangerous effect. 5
Method
The method employed is an online survey on
Results
A total of 516 responses were obtained. Of those who completed the survey, 12% were premenopausal, 47% perimenopausal and 42% postmenopausal. Three-quarters reported suffering from UI (70% premenopausal, 74% perimenopausal and 77% postmenopausal). Menopause was a factor in developing incontinence with 62% saying that the problem began peri-/postmenopausally and 76% said that their incontinence worsened in the peri-/postmenopause years. Sixty-nine percent said that the incontinence affected their lifestyle and, in 51% of women, it stopped them doing what they wanted to do. Twenty-nine percent said that it affected their work and in 45% it stopped them going out. Nine percent said that it put a strain on their relationships and 68% admitted to it affecting their confidence. Seventy-seven percent of women either wear a pad all or some of the time, with 85% carrying a change of clothes some or all of the time.
Overall, only 36% of women had sought help (37% premenopausal, 33% perimenopausal and 39% postmenopausal). Of those who did seek help from a doctor, fewer than half (45%) found this advice useful. In those who did not seek help, 42% did not do so because they were too embarrassed but more than half (58%), did not seek help because they did not see their incontinence as enough of a problem. Overall, 92% of women who answered the survey use public toilets but only one-third describe them as adequate. Forty-three percent of women plan journeys around availability of public toilets and 75% look for toilets when in a new area.
Discussion
The advantages and disadvantages of online surveys have previously been discussed. 3 Incontinence affects women at all stages in their life. For some it is not enough of a problem to seek treatment. When it is a problem it can affect many aspects of their life. Many women are too embarrassed to seek help and for those that do, the advice is often not useful. The majority of women with incontinence carry spare clothes and the majority plan trips round the availability of public toilets, most of which are inadequate. Incontinence and public toilets are issues that must be addressed, women need to be empowered to seek help from their doctors about incontinence and doctors need to ask women directly and be able to give advice and treatment. These recommendations are similar to those we put forward for libido, vaginal atrophy and dysparunia. 3,4 Finally, public toilet provision must be taken seriously with investment and, if necessary, rationalization should be looked at in a strategic manner. The bladder leash is a problem and in minimizing its effect contributions can be made to wellness, self-care and quality of life.