What stops women seeking help? (Incontinence)

Although stress incontinence can have a profound impact on daily routine and can result in psychological effects, there are still many women who do not seek help.

Dr Mason and colleagues in the United Kingdom investigated why some women who experience stress incontinence during pregnancy or after the birth chose not to seek help. They found that the nature of the condition itself played a part in their reluctance, but the relationship the woman had with her health care professional was also a consideration.

Health care professionals should raise the issue
The study found that women wanted health professionals to seek out information about symptoms, rather than the women themselves having to broach the subject. While all the women
interviewed for the study had experienced stress incontinence in the early post-partum period, few had sought advice from a health care professional, including some women with severe symptoms.

The authors say, “One of the key findings of the study was that women felt that they should be warned that stress incontinence could occur during pregnancy or following childbirth. This caution would lessen the shock that some women felt when it first occurred. Knowledge of the condition would enable them to realise that it did happen to other people, possibly contribute to lessening the taboo and the embarrassment associated with it, and diminish the reluctance to seek help, another key finding of the study. Whilst this would only require a minor intervention to the health-care system, it could have far-reaching benefits to future sufferers.” (See table 1)

Ongoing communication the key

An increased awareness of the risk of urinary incontinence goes some way to reducing the effects of urinary incontinence. However, it appears that ongoing assessment and advice is
also required to prevent long-term incontinence. A study by Dr Chiarelli and colleagues found that, even when women have been educated about interventions such as pelvic floor exercises, many perceive it as relevant only in relation to pregnancy and childbirth.11

The study found that, despite most post-partum women being aware of the required frequency of pelvic floor exercises, just over half of them had done them at this level before pregnancy and less than half knew that exercises should be carried out indefinitely over their lifetime.

Perhaps the management approach adopted for urinary incontinence is not the most critical
factor for success. The results of a study comparing the efficacy of different behavioral interventions for female urinary incontinence suggest that the specific treatment may not be as important as having a structured intervention program with education, counseling and frequent patient contact.12

Table 1: Health care changes to improve stress incontinence management during and after pregnancy

• Provide information to women about stress incontinence during pregnancy and following delivery.
• Ensure that women are aware that treatment is available for their condition.
• Publicise the condition to promote general awareness.
• Provide a follow-up service for women later in the post-partum, to identify persistent problems.
• Routinely ask whether a woman experiences stress incontinence, rather than leaving it to the woman herself to make it known.
• Enable the woman to identify a key professional whom they could approach regarding her own
health concerns.
• Ensure there is provision for the woman’s health needs.

11. Chiarelli P et al.Women's knowledge, practises, and intentions regarding correct pelvic floor exercises. 2003,
22(3):246-9. 12.Wyman J. et al. Comparative efficacy of behavioral interventions in the management of female urinary incontinence. Continence Program for Women Research Group. 1998, 179(4):999-1007.