Urinary incontinence is defined by the International Continence Society (ICS) as “involuntary loss of urine”. Although incontinence is not a life-threatening condition, the psychological impact of incontinence on individuals is often under-estimated.
The World Health Organization (WHO) defines health as “a condition of total physical, emotional and social health and prosperity”, disproving the previous opinion of the absence, mostly, of disease or disability. The prevalence of urinary incontinence should, therefore, be considered a serious and life-altering condition. Adequate research with regards to its effect on the quality of life of patients has started only recently in the last fifteen years. This lack of research and discussion may possibly be due to the topic still being regarded as a taboo subject. As Dr Sarah McMullen states, “although almost half of all women experience urinary incontinence after childbirth, we know that many find it a difficult and embarrassing subject to raise.” Researchers conducting studies have recently designed, developed and suggested the use of various questionnaires which are completed by the patients of incontinence themselves.
In a study in 2003 which featured 5701 women aged from 50 to 69 years old, Nygaard et al. discovered that women with severe urinary incontinence had an 80% greater possibility of presenting deep depression. Women with incontinence of a mild to average degree had 40% greater possibility of presenting depression. In a different study conducted in 2008, Mellvile et al studied 218 patients with urinary incontinence and found that major depression and panic disorders often correspond to people with urinary incontinence.
Incontinence is conceived as a lack of health which generates feelings of strong anger and sadness, as well as embarrassment and depression. It is common for people to avoid social gatherings and lose self-confidence, which has a proportional impact on their social interactions, their sexual life and emotional health.
The main psychological effects of incontinence on individuals are the following:
> Sexual Dysfunction
> Loss of self-respect and self-confidence
The reason why incontinence has such a heavy psychological impact on adults in particular can be explained partially through the transition from independence to dependence. As children reach the age of 2, they recognize that they can control their sleeping pattern, when and what they eat and when they choose to urinate. Thus, they acquire a feeling of independence and control over their lives. This important initial stage of development prepares the child for the life ahead. However, when incontinence is exhibited later in life, this regression and loss of control may have serious consequences. An individual’s self-confidence can be rapidly reduced by the disability to control the bladder and the encounter of problems such as cleanliness. Often, this is accompanied by alienation from family and friends.
Living with Incontinence
A study conducted by Frida Olsson and Carina Bertero set out to identify the lived experiences of people living with incontinence and show how it effects daily life. The informants in the study said that their lives are limited in one way or another. The results outlined how every day life involves practical, time-consuming strategies to control the situation and avoid leakage. All of the individual’s lives were reportedly affected by going to the toilet frequently, going to the toilet after meals, avoiding certain kinds of foods and taking enemas in the morning. Odour is a common problem related to leakage, with individuals complaining of having to avoid going to the toilet when in public and constantly managing genital hygiene.
Living with incontinence can also often affect the relationship and closeness between partners. Some individuals with incontinence even avoid sex due to a fear of leakage during intercourse. One woman with incontinence explains how she wishes to stay single, stating “I was certain I could not go out and meet a partner. With incontinence, how could this be done? It was impossible.” Avoiding social interaction is a common solution that many people with incontinence turn to. Many of the participants in Olsson and Bertero’s study claimed that they could not work at all, due to the fear of leakage or not being able to reach the toilet. When away from home on trips or holidays, it is common for those with incontinence to worry about where the nearest toilet is. As a consequence, life can be limited by avoiding going on vacation, bathing or sunbathing in public places, foreign travel or long trips.
What is perhaps the most shocking aspect of the study is that all participants claimed they never felt safe and that incontinence was always on their mind. If you suffer from incontinence, you need to be aware that this doesn’t have to be the case. There are many things you can do to prevent incontinence from being scary and a huge burden. Starting by ensuring you have the right product that allows you to enjoy your day is a vital first step.