A desk-based review of how WASH actors can better address the hygiene needs of people living with urinary and/or faecal incontinence in developing countries was conducted with funding from WaterAid UK/SHARE in late 2015.
The report outlines what incontinence is and how people generally manage their incontinence, as well as relevant experiences and guidance from within the development and humanitarian spheres (related to incontinence as well as other areas such as menstrual hygiene managemant (MHM) and inclusive WASH). The report also provides recommendations on how to better support the hygiene and WASH needs of those people suffering from incontinence.
Globally, it is estimated that incontinence affects 1 in 4 women over the age of 35 years, and 1 in 10 adult men. A global study in 2003 reported the average (median) prevalence of female urinary incontinence to be 27.6%.
Incontinence can affect:
- Elderly or older people
- Men, women and children with physical disabilities and/or learning difficulties
- Women and adolescent girls who have recently given birth
- Women and adolescent girls with fistula from prolonged and/or obstructed childbirth
- People who have had certain types of illness (e.g. stroke) or operation (e.g. such as removal of prostate)
- Stress or urge incontinence (see below) can also affect both men and women of all ages across their lifetime due to malfunctioning bladder and urinary systems
Risk factors for incontinence included parity (number of times a woman has given birth), obesity, chronic cough, depression, poor health, lower urinary tract symptoms, previous hysterectomy, and stroke. It is important to note that there are large variations in the severity, type and impacts of incontinence.
Many people living with incontinence suffer embarrassment and fear of leakage or smell. They may be ostracised, isolated or teased (due to their condition or the related smell). As well as being anxious about finding a place (sometimes at very short notice) to urinate and/or defecate, people living with incontinence may be concerned with how to protect themselves from leaking urine and/or faeces, how to clean themselves discretely and how to dispose of any materials they may have used to soak up the urine and/or faeces. All of these factors can have severe negative impacts on day-to-day activities, everyday life and personal confidence and dignity.
In low or middle income countries, people suffering from incontinence may not have access to products (e.g. not stocked in markets or pharmacies) or the financial means to purchase sanitary protection materials/cloths/mattresses, or extra soap and water, in order to be able to manage their incontinence (or care for a family member who has incontinence). Severe incontinence may prevent people from being able to work.
In emergency contexts, incontinence (similarly to menstruation in some places), may restrict people’s ability to access food and water distributions, and others may be unwilling to assist them due to smell or stigmatism.
Key recommendations for WASH actors include:
- Incorporate incontinence related questions into inclusive and sensitive needs assessment tools and checklists.
- Utilize existing resources (particularly the Minimum Standards for Age and Disability Inclusion in Humanitarian Action, and Inclusion Checklist) in field-based responses and programmes providing support to those living with incontinence.
- Document experiences and case studies, particularly around the type and management (e.g. washing/drying/disposal) of hygiene and personal protection items that people with incontinence need, and share this information with humanitarian and development agencies.
- Encourage the continued inclusion of references about and guidance for incontinence-related activities and support into hygiene promotion and WASH resources (including hygiene and dignity kit case studies and resources).
- Sensitise WASH and health staff to the issue of urine and faecal incontinence, and build their confidence and capacity to address incontinence in activities and programmes.
- Further research into the impact of incontinence on daily life, and the availability and preferences for protection material and hygiene items of incontinence sufferers in low and middle income countries. (The report provides a draft generic key information interview guide.)
This text by the report’s author Chelsea Giles-Hansen was originally posted on hygienepromotionforum on 3 January 2016.
Read the full review: Giles-Hansen, C., 2015. Hygiene needs of incontinence sufferers. 18 p. : 7 fig. Download the full review