Our lives are a dynamic flurry of family and professional activities — our work, our families and friends, and duties on the home front. Some of us have additional challenges due to ill health, financial stress, elder care or marital breakdown. When small urine leaks begin to appear every now and then, they might feel like a nuisance amid the noise of everyday life. Research tells us that women wait about five to 10 years to seek assistance for urinary incontinence.
Our beliefs about the problem are important because they influence how and when we take action. The following are 10 common reactions that deter or delay sufferers, especially women, from seeking professional advice or assistance for the problem:
- It’s a private problem. When sufferers say “incontinence is private,” they reveal their feelings of vulnerability, embarrassment or shame about the condition. While these emotions are normal reactions to urinary problems, they also evoke the desire to draw inward in self-protection (Hagglund & Wadensten, 2007).
- Urinary problems are hereditary. Sufferers are discouraged from seeking assistance when urinary changes are viewed as an inherited problem. Why heredity beliefs discourage sufferers from seeking care is not well understood — in fact, many health problems that are inherited (consider diabetes and heart disease) benefit from medical care.
- Incontinence is a normal part of aging or childbirth. Some women believe urinary leakage to be “part and parcel of what it means to be a woman (Peake, Manderson & Potts, 1999).” The changes in urination are “normal” because they emerge around the time of pregnancy, labor and delivery.
- My health care provider should start the conversation. All of us avoid difficult topics by waiting for others to raise an issue for discussion, and our relationship with our doctors is no different. When it comes to urinary health issues, women expect their health care providers to start the conversation (Peake, Manderson & Potts, 1999).
- All women leak a little when they laugh. When women in their 40s and 50s get together in groups, at least one will make a joke about the leakage that ensues with all that laughter! This lightheartedness helps to defuse embarrassment, but it also suggests a kind of universality to these experiences. The belief that all women leak a little while laughing normalizes the problem, but it also perpetuates the view that professional care or advice is not necessary.
- Urine leaks are a minor problem that I cope with on my own. When urine leaks first appear, initial concerns are given to whether others see or smell it. Pads are quick, easy, and very familiar territory for menstruating women, and so they are a practical solution. Other lifestyle changes also follow (e.g., restricting water intake, avoiding certain sports). Mild to moderate leaks often are managed using lifestyle changes before seeking any professional advice (Dowd, 1991; Skoner & Haylor, 1993).
- I can’t deal with it. There’s no question that the appearance of urine leaks can be an emotional event that women just want to forget about (Skoner & Haylor, 1993). It’s hard to make sense of what happened, and these circumstances can threaten how sufferers see themselves and their future.
- My doctor will want me to have surgery. Many women express reluctance about seeking professional care because they are afraid that the doctor will recommend something they aren’t ready for — like surgery (Skoner & Haylor, 1993).
- My doctor told me to just get used to it. When doctors respond with cynicism, so do we. Such interactions can set us back on our path to health and wellness, but only if we let it. Family physicians have acknowledged their own struggles to provide optimal care due a lack of knowledge about the effectiveness and availability of treatment options (Teunissen, van den Bosch, van Weel, & Lagro-Janssen, 2006).
- Other health issues are a priority for me. Research tells us that when it comes to urine leaks, women prioritize other health issues as more important. Women can “lower” its priority by choosing to reveal the urine leakage after the doctor’s visit — like while walking out of her office — or by sharing a list of health concerns while inwardly hoping the doctor will pick “urine leakage” from the list (Teunissen, van den Bosch, van Weel & Lagro-Janssen, 2006).
While changes to a woman’s body may be inevitable during the cycle of life, beliefs that they cannot be changed reveal our low expectations about the body’s resiliency and capacity. Professional assistance in the early stages of urinary incontinence can be a useful way to learn more about the health of the bladder and pelvic floor, and how to optimize its function.
Options for treatment of urinary incontinence include acupuncture, urinary rehabilitation, behavior therapy (“bladder training”), pelvic floor physiotherapy and medication. Medical assessment is helpful to rule out any underlying health risks and provide clarity about the type of urinary leakage that sufferers experience.
Hägglund, D., & Wadensten, B. (2007). Fear of humiliation inhibits women’s care-seeking behaviour for long-term urinary incontinence. Scandinavian Journal of Caring Sciences, 21(3):305-12.
Peake, S., Manderson, L., & Potts, H. (1999). “Part and parcel of being a woman”: Female urinary incontinence and constructions of control. Medical Anthropology Quarterly, 13(3), 267-285.
Dowd, T. (1991). Discovering older women’s experience of urinary incontinence. Research in Nursing and Health, 14, 179-186.
Skoner M.M., Haylor, M.J. (1993). Managing incontinence: women’s normalizing strategies. Health Care for Women International, 14, 549-60.
Teunissen, D., van den Bosch, W., van Weel, C., Lagro-Janssen, T. (2006). Urinary incontinence in the elderly: attitudes and experiences of general practitioners. A focus group study. Scandinavian Journal of Primary Health Care. 24, 56-61.