When my youngest son was enrolled in his first college sociology
class, he called to ask advice about an assignment he felt was baffling. "I need
to spend the day as some kind of 'social deviant' like in a wheelchair or blind
or....you know, different."
"Easy," I told him, "pour some water on the front of your
pants."
"Huh?"
"See how people treat you if they believe you peed your
pants."
It's possible that only a mother who has spent much of her life among
old people would realize that something as common as urinary incontinence has
huge social implications for the person experiencing it. And it is
common.
The U.S. Department of Human Services reported that approximately 13
million people in the United States were incontinent in 1998. Women are far more
likely to be incontinent than men. In fact, one out of four of us between the
ages of 30 and 59 will pee our pants often enough to be considered incontinent.
You can imagine what the addition of more years and a little extra weight can
do. At eighty, one out of every two of us will be incontinent. It's estimated
that 80% of the nursing home population is incontinent. In fact, it's a big
reason why people can no longer be cared for at home.
Back when I was in
graduate school, my primary adviser, who seemed ancient and not very cool to me
then, suggested and then demanded that I put at least half my intellectual and
clinical efforts into understanding and finding interventions for incontinence.
I didn't find it an appealing idea. I imagined being asked what I was studying
at a social gathering and finding myself in a conversation gone silent. Nobody
was talking about it and nobody wanted to. In those ancient times, the aisles of
Walgreen's were not prominently displaying products guaranteed to help those who
leak from anywhere at anytime of any solid or liquid, instant social
acceptability. Now there are even over-the-counter medications to deliver us
from humiliation if the need to go outruns the distance to the toilet.
As has
often happened over the years, my adviser turned out to be neither cruel nor
stupid. Had I adopted her direction whole-heartedly, I would likely be a
zillionaire and/or writing a blog for the National Institutes of Health. But I
learned enough, and have been grateful for her insistence since that first day
long ago that I landed my first acute rehabilitation job.
We spent $16.3
billion dollars on incontinence products in the U.S. in 2001. Judging by both
the amount of goods at the store and the amount of ads in magazines, we're
probably spending a lot more than that now. It seems incontinence has come out
of the closet. Or has it?
Here's the good news. Doctors routinely ask about
elimination issues now when you go in for your annual check up. Or at least the
the good primary care physicians do. There are many more medicines and/or common
surgical procedures available, so it isn't necessary to just "accept the way it
is" and drive yourself to the drug store. It's possible that even if the problem
can't be fixed, it can be managed better than resigning yourself to adult
diapers. But that's the problem, isn't it? Diapers.
We learned we weren't
babies anymore when we graduated to big girl panties (or big boy boxers or
whatever). That was likely the last time any of us was publicly congratulated
for announcing our progress in controlled defecation. If you are a certain age,
you were shamed by your mom or your whole neighborhood if you wet the bed at
night. Neither your mom or you was likely to discus the problem with your
pediatrician because it was thought to be more of a behavioral problem than a
medical one. Elimination in this culture has never been the subject for dinner
table conversation or public acknowledgement. We call the rooms in which these
things happen "rest" rooms or "wash" rooms--although in my experience neither of
those happen very often in there. You get the point.
The first time you wet
your pants as an adult you figure you might as well move to a deserted island
where you can pee when the need arises and nobody will judge you. You might, if
you are enlightened, get yourself to your family doctor if it keeps happening,
but you are not likely to talk about it with anyone else. It not only feels
physically uncomfortable, it feels like failure and it is shameful. When it
happens to you it doesn't matter how common, how many products and ads or how
educated you are about how things work. It's devastating.
Most nursing homes
aren't much help. Incontinence is so common in skilled facilities that we may
put you in products whether you might have been able to make it, if only you
could walk to the toilet by yourself, or not. We are professionally impersonal
about helping you into clean clothes so as not to acknowledge how humiliated you
feel, how demoralized. We don't ask about it, not when it started, not what
makes it better or worse or any of those fundamental assessment questions we ask
about your other physical problems. Some things haven't changed. Nobody is
talking and nobody wants to. Don't accept this.
Here's the thing. When I was
a kid in nursing school, they made us watch a movie titled, "Nobody ever dies of
old age." The same might be correlated to incontinence. Something can and
should be done to improve things if you are experiencing it. Failure to control
those sphincters does not mean personal failure. And if you aren't sure who to
talk to, ask a rehab nurse. It's our specialty. If you or your family are
needing our kind of service, ask the places you tour about restorative
continence programs. If the answer is "toileting q 2," find another place.
Skilled restorative nursing is much more than that. And whether you are in a
health care setting or not, talk about it. It's time for a change...and not just
of underwear.
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