MENTAL HEALTH
MENTAL HEALTH ASPECTS OF INCONTINENCE IN ELDERLY WOMEN
Dr. Shaorin Tanira
MENTAL HEALTH ASPECTS OF INCONTINENCE IN ELDERLY WOMEN
Dr. Shaorin Tanira
Women present to hospital out-patient departments or specialists’ chamber with a wide variety of gynaecological conditions. Many of these gynecological conditions affect personal and intimate relationships, as well as social and professional roles, by the nature of the disorders themselves. Those result in a range of psychological issues, which, again cyclically influence the presentation and outcomes of coexisting physical conditions in women.1
Incontinence is a common gynaecological condition faced by the elderly women. Urinary incontinence (UI) is both common and distressing, with increasing prevalence as women get older, yet often remains hidden because of shame in seeking help for this condition. It is commonly classified into three subtypes: stress UI (involuntary leakage on effort, exertion, coughing or sneezing), urge UI (leakage associated with a sense of urgency to urinate) and mixed UI. Its prevalence is as high as 73% in older women.2 In ageing population, this condition is likely to be increasingly common, with an associated increase in its emotional and financial costs. Research shows that UI is a significant predictor of new symptoms of anxiety and depression, but anxiety is itself also a predictor of incident cases of urinary incontinence over a 1-year period.3 Onset of psychological distress in those women is very common, especially when their urinary incontinence is associated with functional impairment, such as avoidance of social occasions and physical activities in day-to-day life.1 Similarly, faecal incontinence is also significantly associated with symptoms of anxiety and depression having a prevalence of 8-15%; however, it has received far less attention than urinary incontinence because of its rarer occurrence.4
UI is both prevalent and associated with considerable social and psychological burden. UI and its treatment have focused on physical and behavioral treatments. Few studies have investigated whether improvements in bladder function are reflected in psychological symptom improvement. Usually psychological assessment is not considered a routine part of the assessment of incontinence in our country; however, some typical components of psychological treatments for anxiety and depression in elderly women with gynaecological problems showed promising results in western countries.1 Those are as follows:
1
Health education combined with mental health support:
Education and discussion intervention is useful covering the sociocultural, biomedical context and somatic aspects of menopause and other gynaecological disorders like incontinence, sexual difficulties, as well as body image changes, and relationship changes. Special sessions are arranged on management of stress and anxiety and reductions in insomnia and fatigue.
2
Adoption of healthy lifestyle:
Providing information on healthy lifestyle in older age, physical activities and exercise and diet and nutrition.
3
Cognitive Behaviour Therapy (CBT):
Group-based cognitive-behavioral intervention using the cognitive-behavioral model (gaining awareness of antecedents/triggering events and consequences in terms of thoughts and feelings); use of self-monitoring to improve the situation. Special attentions are given on keeping a bladder diary, learning techniques for responding adaptively to urge sensations and learning about the pelvic floor muscles.
References:
1.Bryant C, Kleinstäuber M, Judd F. Aspects of mental health care in the gynecological setting. Women’s Health 2014;10(3):237-54.
2.Dooley Y, Kenton K, Cao G, et al. Urinary incontinence prevalence: results from the National Health and Nutrition Examination Survey. J Urol 2008;179(2):656-61.
3.Margalith I, Gillon G, Gordon D. Urinary incontinence in women under 65: quality of life, stress related to incontinence and patterns of seeking health care. Qual Life Res 2004;13(8):1381-90.
4.Koloski NA, Jones M, Kalantar J, et al. Psychological impact and risk factors associated with new onset fecal incontinence. J Psychosom Res 2012;73(6):464-8.
Dr. Shaorin Tanira, MBBS, MSc (Aging and Health)
School of Rehabilitation Therapy
Faculty of Health Sciences, Queen’s University
Kingston, ON, Canada
& Geriatric Care Consultant, Phoenix Wellness Centre BD
Dhaka, Bangladesh
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