Over 4.8 million Australians experience bladder or bowel control problems according to the Continence Foundation of Australia. Bowel or bladder incontinence is common across life stages and the sexes. It can affect people’s work, sex life, ability to exercise and maintain a healthy body weight, and participation in life. In the lead up to World Continence Week on 20th-26th June we ask Dr Lisa Fraser how to initiate patient communication on this personal subject. “The question reminds me that the relationship of the doctor and patient is unique. In what other relationship would you talk to someone you had not met before, or infrequently, about such a personal matter?,” says Dr Fraser, Registrar Liaison Officer for GP Training Queensland. “It is pretty normal for people to find it generally embarrassing to talk about incontinence,” The following are tips for doctors about how to start the conversation about incontinence: 1. Make incontinence discussions part of a general health check Incontinence can be an embarrassing issue for many patients and something they may not bring up themselves. For this reason Dr Fraser suggests doctors incorporate incontinence discussions during regular general health checks in both adults and children. “Key opportunities for discussing incontinence are during toilet training at the 4 year old healthy kid check, during the perinatal period in women, during an initial assessment prior to doing a pap smear and in older age as part of general and preventative health,” Dr Fraser says. 2. Ask for permission to enter a discussion around incontinence Asking permission acknowledges the private nature of the issue and allows the patient some control over the conversation. Doctors should keep in mind how personal this discussion is for many people. “I usually explain things by saying it is routine for me to have this discussion, that says to the person, I am not making any judgements about you based on how you look,” Dr Fraser says. “Here is an example phrase that I use: When I assess pregnant women/women after childbirth/women for a pap smear, it is routine for me to ask some personal questions about your sex, your bowel and bladder function, is that okay? They help me understand if you might be at risk of common problems. “If incontinence is identified I might say: Does it bother you? “If the answer is no, but it seems counter to what you would expect, in that the problem seems significantly disruptive, I would ask permission to explore why. Perhaps it is because they think they will automatically have to have surgery or maybe they are afraid of having an intimate examination.” 3. Normalise the subject of incontinence Having a formal set of questions can help normalise the discussion for patients. “I use a type of short checklist. Checklists normalise all sorts of things,” Dr Fraser says. “Then ask questions that further define the problem, such as: Do you leak urine when you jog, sneeze, laugh, in small spaces or as you get the key in the door at home? Is it just a small amount, or a lot? Do you have accidents with your bowels? Do you feel you have control? Imagine what else it is impacting. Do they take pads and changes of clothes to work?” 4. Allow the patient to tell their story Lastly doctors should explain the condition as much as possible and allow the patient to tell their story. “When talking about incontinence it is good to explain why we are talking about it. It is not just us being nosey but because we are very likely to be able to improve their situation, and in many cases with lifestyle or minimal medications,” Dr Fraser says. “Always allow somewhere for people to tell their story. We all have stories. They convey the special meaning for that person. For example, a lady’s relationship with her husband may be suffering because she is avoiding sex due to incontinence problems. “Regardless of the cause, a fluid diary always forms part of further assessment and initial management. Done over three days, the patient also develops insight into how their body works.” World Continence Week (WCW) is an annual initiative managed and run by the International Continence Society (ICS). It’s primary aim is to raise awareness of incontinence related issues. For further details visit http://www.ics.org/
