Why is This Important?
You might be thinking, why is this relevant to me? I don't work with patients who have incontinence or other types of pelvic floor dysfunction. As a student or a new graduate, you would be seeing at least four patients each day when working clinically. It may come as a surprise that 1 in 4 Australians are incontinent [1]. If you have seen eight patients today on the wards, two of the people you treated statistically may have had incontinence or other type of pelvic floor dysfunction.
1 in 3 women and 1 in 10 men have urinary incontinence in Australia, and 1 in 20 adults experience faecal incontinence [1]. 70% of people in aged care have some form of incontinence [2].
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The economic burden of incontinence - $66.8 billion - is on par with projected expenditure for cardiovascular disease at $61.89 billion [2][3]. A major difference between these two is the publicised effort for prevention of cardiovascular disease and improvement of risk factors. There is not the same prevention nor improvement of risk strategy implemented in Australia for incontinence - everything you hear in the public space about incontinence is about management or containment of the problem, not ways to prevent dysfunction or improve function.
1 in 5 postnatal women report some form of incontinence [1]
Incontinence is more common in older women than breast cancer, diabetes or heart disease [4]
People who are obese or who have completed repeated manual labour are at higher risk of incontinence [1]
Incontinence impacts or exacerbates: [5]
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Social isolation
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Sleep disturbance
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Mental and physical exhaustion
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Comorbidities
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Unemployment
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Depression and other mental health conditions
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Financial and healthcare burdens
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Decreased appetite and/or fluid intake
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Strain on personal relationships
Incontinence is a major factor that places older adults at risk of admission to aged care or support living. Faecal incontinence is in the top three reasons that people are admitted to supported living or aged care facilities [1]. Any kind of intervention to improve continence was shown to reduce aged care admission [6]. Interventions to improve incontinence over a short-term treatment period significantly improved quality of life, self-efficacy and the incontinence severity in a wide population range [7].
Having some level of awareness of the impact pelvic floor dysfunction can have and how prevalent it is, is important regardless of the environment you are working in. As physiotherapists our role is to improve people's function and support their independence, yet this does not seem to be the message we associate with incontinence or pelvic floor dysfunction - we 'contain' it.
20% of adult men and 13% of women have faecal incontinence in Australia
Taking confidence to tackle complex issues such as pelvic floor dysfunction into the workplace as a new physiotherapist is a great starting point to address this gap in care for people with incontinence or other types of pelvic floor dysfunction.