Guest Editorial: Joining Forces to Make a Difference

   This is a particularly appropriate time for an issue highlighting advances in continence care because there is progress to report! For many years, pioneers in the field of incontinence fought an uphill battle to have incontinence recognized as a significant healthcare issue. Many healthcare providers considered it a minor "hygienic" problem unworthy of research dollars or medical attention (obviously, they were not dealing with the problem personally).

   The relentless efforts of our continence pioneers have been effective. Incontinence is now recognized as a significant healthcare problem, as evidenced by increased research into the etiology, pathology, and management of urinary incontinence as well as increased attention to its effects on quality of life. These advances are reflected in this issue. You will find new information on the demographics of urinary incontinence in African American women, a report of a study exploring a unique delivery system for a skin protectant, a CE article on the syndrome of urinary frequency and urgency now known as overactive bladder, and an article on current thinking regarding management of constipation. In this editorial, I want to briefly highlight some of the nonclinical advances - ie, efforts to increase public and professional awareness of continence-related issues.

   I also want to challenge each of us to become a continence advocate in our individual settings.

   A professional symposium was held in July 2002 entitled, "Urinary Incontinence: Research, Practice, and Policy Issues." This conference was co-sponsored by the American Journal of Nursing, the University of North Carolina Chapel Hill, and the University of Pennsylvania Health System Division of Urology, Center for Continence and Pelvic Health, and funded by a grant from the Agency for Healthcare Research and Quality (formerly AHCPR). Conference participants included nurse researchers, clinicians, educators, administrators, state and federal regulators for long-term care, and industry stakeholders. Participants were challenged to critically review the research base for management of urinary incontinence and to:
   * generate an agenda for nursing research
   * recommend future directions in nursing education and nursing practice
   * identify changes that need to be made now in nursing practice, professional and public education, and public and private payment policy in order to provide better care and outcomes for individuals with urinary incontinence.

   The specific recommendations and blueprint for action generated by this exciting conference will be widely disseminated, beginning with the March 2003 issue of the American Journal of Nursing; excerpts also will appear in a forthcoming issue of Ostomy/Wound Management.

   A consumer event - an educational forum for women held in Houston in the fall of 2002 - was hosted by the National Association For Continence. Actress Debbie Reynolds welcomed attendees and related her own experiences with bladder health issues. Other highlights included a panel presentation on urinary incontinence and pelvic disorders, a luncheon presentation focused on women's health issues, and a town meeting-type dialogue involving the attendees. The enthusiastic response to the forum reflected the women's interest in bladder health and continence care education.

   These two events are indicative of the increased awareness and focus on continence issues among professionals and the increasing interest and openness among consumers. Juxtaposed with the increased volume of research on the pathology and management of incontinence, the increasing number of bladder health and continence centers, and the widespread use of media to advertise medications for the treatment of overactive bladder, these events offer reason to believe that continence has finally arrived as a legitimate healthcare issue. This is good news for our patients and all of us as continence clinicians.

   I challenge each of you (any myself!) to contribute to the crusade for continence- whether you do something big (start or expand outpatient continence services), something simple (provide evidence-based skin care to patients with incontinence in the acute care setting), or just help debunk the myth that incontinence is inevitable and untreatable. Every contribution matters - and together, we can and are making a difference!