Guest Editorial: Double Taboos: Urinary and Fecal Incontinence. The State of the Science

  As is customary, the December issue of OWM presents articles elevant to incontinence. Fecal and urinary incontinence are life-changing problems. According to the National Institutes of Health, up to 5% of the general population and up to 39% of nursing home residents have fecal incontinence. People of all ages can be incontinent but the condition is more common in women and the elderly. Urinary incontinence can occur at all stages of life; it affects an estimated 38% of women and 17% of men 60 years of age and older.

  In this issue, Kathleen Francis, a student in LaSalle’s WOC Nursing education program, offers information on the management of fecal and urinary incontinence in spinal cord injury patients. She reviews the pathophysiology of these disorders and some basics about evaluation. Bladder and bowel emptying techniques – including voiding maneuvers, catheterization, nutrition, and bowel evacuation – are discussed. Surgical options for both disorders are outlined.

  Mikel Gray presents best nursing practices for incontinence-related skin damage. This article simply and clearly describes the condition and addresses prevalence, relationship to pressure ulcer formation, prevention, and treatment.

  Cathy Thomas Hess provides information on the new regulatory requirements for hospital-acquired conditions. Basically, hospitals will not be reimbursed for certain conditions such as catheter-associated urinary tract infections and pressure ulcers that develop while patients are in the hospital. This article is of particular interest to me – I am involved with an initiative to reduce Foley catheter use in my hospital. Decreasing the use of indwelling catheters is not easy but the impact of this regulation on a hospital’s bottom line could be significant. However, the most important benefit will be improving patient outcomes.

  The National Association For Continence weighs in with a special tribute to its 25 years of successful support, education, and advocacy for persons with incontinence. In lieu of this month’s “My Scope of Practice,” OWM salutes the NAFC’s Continence Champions Hall of Fame.

  This issue of OWM is particularly timely. Because fecal and urinary incontinence are underdiagnosed and underreported, identifying at-risk and affected populations is difficult. Also, the biological mechanisms that cause fecal and urinary incontinence are not well understood, hampering development of prevention and management strategies. To address these concerns, this month the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) and the Office of Medical Applications of Research (OMAR) of the National Institutes of Health (NIH) are convening a State-of-the-Science Conference, Prevention of Fecal and Urinary Incontinence in Adults. The Conference is being held December 10-12, 2007, at the National Institutes of Health in Bethesda, Md and webcast at https://www.videocast.nih.gov. The conference is sponsored by NIDDK and OMAR and co-sponsors include the National Cancer Institute (NCI), the National Institute on Aging (NIA), the National Institute of Child Health and Human Development (NICHD), the National Institute of Nursing Research (NINR), and the Office of Research on Women's Health (ORWH).

  As a member of the planning committee for this conference, my input was solicited in identifying six questions relevant to urinary and fecal incontinence.

    1. What are the prevalence, incidence, and natural history of fecal and urinary incontinence in the community and long-term care settings?
    2. What is the burden of illness and impact of fecal and urinary incontinence on the individual and society?
    3. What are the risk factors?
    4. What can be done to prevent fecal and urinary incontinence?
    5. What are the strategies to improve the identification of persons at risk and patients who have fecal and urinary incontinence?
    6. What are the research priorities in reducing the burden of illness in these conditions?

  The planned presentations address these questions relevant to both fecal and urinary incontinence and include information on their epidemiology and pathophysiology, as well as their economic impact on individuals and society; formal and informal caregiving; quality of life; the impact on incontinence of diabetes, disease, childbearing, hormones, psychiatric and iatrogenic disorders, medications, surgery, and exercise; and recommendations for evidence-based practice and prevention. A consensus statement will be prepared and available at the NIH website after December 12.

  The embarrassment of fecal and urinary incontinence is a barrier to their management. With increased knowledge and better understanding of their causes and characteristics will come improved treatment and prevention. I encourage clinicians to avail themselves of the many opportunities to learn more about the conditions that affect so many of their patients.

This article was not subject to the Ostomy Wound Management peer-review process.