Urinary incontinence in women.

The majority of 200 women in community living between the ages of 55 and 90 described themselves as having some degree of uncontrolled urine loss. They reported severe wetting (63%) on a daily basis (69%), and most (56%) had had the problem for more than five years. These women completed the diagnostic phase of a treatment-evaluation program currently in process. Although urinary incontinence is common particularly among women, little is known about self-management and beliefs with respect to the problem. A British community survey found 30 percent of women compared to 8 percent of men over age 35 years with uncontrolled urine loss (Thomas, Plymat, Blannin, & Meade, 1980). Of those women who experienced urinary incontinence on a regular basis, 40 percent were reported to be 55 years of age and older. Thirty-eight percent of noninstitutionalized women over age 60 years were reported to have urinary incontinence symptoms in a University of Michigan study (Diokno, Brock, Brown, & Herzog, 1985). So far, little attention has been given to the significance of this problem for a group of basically healthy, ambulatory, older female individuals living at home. Relevant prior studies focused primarily on the prevalence and characteristics of urinary incontinence. Table 1 provides detail of five of such studies that reported to varying degrees the effect of urinary incontinence on the social, mental, or domestic lives of the women Carol A . Brink and Thelma J . Wells are faculty in the Center for the Development of Gerontological Nursing at the University of Michigan, Ann Arbor, Michigan. Ananias C. Diokno is Chief of Urology at William Beaumont Hospital, Royal Oak, Michigan, and Clinical Professor of Medicine at the university of Michigan, Ann Arbor, Michigan. Address correspondence to Carol A . Brink, M.P.H., School of Nursing, 400 N. Ingalls, Ann Arbor, MI 48109-0482. involved (Campbell, Reinken, & McLash, 1985; Iosif, Henriksson, & Ulmsten, 1981; Thomas et al., 1980; Vetter, Jones, & Victor, 1981; Yarnell, Voyle, Richards, & Stephenson, 1981). Sample sizes and age ranges varied, with only two studies focusing exclusively on women (Iosif et al., 1981; Yarnell et al., 1981). Data were obtained by interview (Vetter et al., 1981; Yarnell et al., 1981), written questionnaire forms (Campbell et al., 1985; Iosif et al., 1981), or a combination of methods as in Thomas et al., who interviewed a subsample (n = 178) of those responding to a large (n = 18,084) postal survey. In these studies, only 5 percent of incontinent women reported disruption in their social or domestic life because of urine-control problems (Iosif et al., 1981; Yarnell et al., 1981). Only 9 percent had sought help from available community resources and most of those with minimal wetting did not consider it a medical problem (Thomas et al., 1980; Yarnell et al., 1981). Urinary incontinence was generally considered an embarrassing problem, as evidenced by 84 percent of women in one study who later admitted to being incontinent while initially having denied it (Yarnell et al., 1981). Severe embarrassment was reported to be minimal, however, with only 3 percent so acknowledged (Yarnell et al., 1981).. Nonetheless, anxiety and depression increased significantly with increased seventy of incontinence (Vetter et al., 1981). The physical stress of wetting was noted in one study where 86 percent of elderly incontinent individuals reported extra laundry, usually done by the person herself (Vetter et al., 1981). In contrast to the preceding studies, Norton (1982) questioned 55 women with a diagnosis of established incontinence who attended a urodynamic clinic, most of whom had received some form of treatment. Their ages ranged from 22 to 78 years (mean 50 years). This study differentiated degrees as mild, moderate, or severe based