A "Cinderella" issue

He Kitenga, 2005

Incontinence is rarely discussed openly, yet it affects the daily lives of many people.

Women are more often affected than men, and more people of both sexes are affected as they age. By age 50, about one in three women experiences incontinence, although about 10 per cent of women in their early twenties are also incontinent to some degree.

Incontinence researcher Dr Jean Hay-Smith says this “Cinderella” issue can impact greatly on lives, often restricting social participation and limiting activity. “People worry about leakage, smell, or that there won’t be a toilet nearby.”

Her work has included projects with Professor Don Wilson and Associate Professor Peter Herbison (Dunedin School of Medicine), and most recently Dr Sarah Dean at the Rehabilitation Teaching and Research Unit at the Wellington School of Medicine and Health Sciences.

In a University of Otago funded project a number of women experiencing uncomplicated incontinence, and their therapists, are being interviewed separately to determine how they each view incontinence and its conservative (non-surgical, non-drug) treatment.

“Women are often keen to avoid drugs and surgery, but conservative management can be more difficult than people anticipate because it requires behaviour change and this is not easy for women to implement or sustain. It seems difficulties can arise if the therapist and women don’t share similar views about the problem, or what they are trying to achieve. We know conservative treatments can work, but for some women the improvements are not maintained. Is this because conservative treatment ‘failed’, or it worked but could not be sustained?”

In ongoing research with colleagues at the Dunedin School of Medicine, Hay-Smith is also looking at new ways of enabling patients to express how much the outcome of treatment matters to them. “Incontinence research uses many outcome measures, but we really don’t know what is most important to patients.”

Using Point*Wizard, a revolutionary program designed by Dr Paul Hansen (Economics) and software developer Franz Ombler, patient preferences are used to rank treatment outcomes.