My call to action: the hidden problem of urinary incontinence: you can make a difference!

Home Healthcare Nurse 461 H ow did you get into this? ” is a common question from friends, patients, and colleagues when they learn of the specialty I practice in physical therapy (PT) in home healthcare. I first learned about PT when I was 12 and observed my great grandmother recover from a severe stroke with the assistance of a physical therapist. That was when I knew I wanted to become a PT. Because of this, my entire high school course elective selection, extracurricular activities, and volunteering/employment were structured with that goal in mind. I wanted to specialize in geriatrics to help others, like my great grandmother. However, during my last year of PT school, my specialty changed. It was during my last clinical rotation while at Johns Hopkins University that the world of pelvic floor dysfunction was presented. I will never forget my clinical instructor introducing herself and telling me that I would be practicing under her guidance to treat patients with bowel, bladder, and sexual dysfunction. An integral role of this therapy was performing internal vaginal and rectal neuromuscular examinations. As this specialty in PT had never been mentioned during PT school, I was horrified at this prospect and wondered what role PT could have in these diagnoses. Physical therapists, I quickly learned, play an important, critical role in treating conditions associated with pelvic floor dysfunctions. In fact, this role is so extensive, with so much evidence to support it, that it is beyond the scope of this editorial. (We hope to bring you an in-depth CE article on this topic in 2012! ) In the home care environment, urinary incontinence (UI) is a prominent diagnosis healthcare providers encounter. In fact, research has shown that UI has greater annua l costs than ovarian, cervical, breast, and uterine cancers combined (Subak et al., 2007). So why, then, do we not have some kind of walk/run/bike ride to end incontinence? The most common response is that UI, unlike cancer, is a quality-of-life issue and not a medical emergency. Sadly, many healthcare providers do not even ask their patients whether they are experiencing issues with incontinence. Some healthcare providers, when asked why they do not ask about these symptoms, state either they are embarrassed to discuss them with their patients or they do not know how to treat incontinence and so do not want to bring up the topic. Of course, this needs to change. Many patients believe UI is a “normal” part of aging and, as such, they do not bring up these issues to their providers. In addition, unlike a physical disability, which is common and easy to discuss, many with incontinence feel it is an embarrassing and shameful condition and so do not mention these symptoms/concerns to their healthcare providers. Even worse, some individuals actually deny that they have incontinence issues when asked. I have observed this numerous times within the home care environment when I see incontinence padding in the patient’s bathroom, yet he or she denies experiencing symptoms. It is easy to talk to someone about paralysis from a My Call to Action: The Hidden Problem of Urinary Incontinence—You Can Make a Difference!