Breaking silence on unmentioned issues
Breaking silence on unmentioned issues
USF treats incontinence, affirms child-free living
You could help your patients with two problems they’ll probably never mention. Incontinence is one of them.
"It’s epidemic among older women, but we don’t talk about it readily," asserts Nancy Milliken, MD, director of the University of California – San Francisco’s National Center of Excellence in Women’s Health.
The other problem is the isolation of many women without children. They may be written off as selfish or regarded with pity.
"It’s difficult to find positive images of child-free women," notes Tracy Weitz, MPA, Center Manager for the Center of Excellence.
Treating incontinence and legitimizing child-free lifestyles are two areas in which the center is creating program prototypes you can adapt for your own clients. Last year, the university received a National Center of Excellence in Women’s Health award from Health and Human Services in Washington, DC. The award came with contract funds of $330,000, which the school will use to incorporate research findings into women’s services. The bridging of research and clinical practice will enable more women to benefit from the university’s wealth of expertise, Milliken predicts.
Replacing shame with hope
Incontinence plagues nearly one in three women as early as midlife, and it worsens with age.1 It’s also the last thing women want to talk about, even with health providers. In fact, fewer than half of incontinence sufferers mention it in a medical office.2
"It’s just heartbreaking what happens to women who have incontinence," Milliken points out, "A lot of them give up their jobs and become homebound because of the humiliation."
Most of that is needless, she says. To enlighten women about curing or managing incontinence, the center offers free public forums on campus. Staffed by university physicians and nurse practitioners, the forums offer immediately useful self-help tips. Women learn how to do Kegel contractions squeezing and releasing the urinary sphincter which is a fundamental preventive and cure for incontinence. Yet many women don’t know how to do it, Weitz says.
Participants receive incontinence diaries. Weitz explains that recording bladder leakage episodes in a diary reveals whether a woman has stress-incontinence associated with sneezing or coughing, for example. Learning what triggers urine loss points patients and health providers to the best treatment.
Treatment advances such as biofeedback help women isolate their pelvic floor muscles from the surrounding abdominal and rectal groups. With sensors placed near the pelvic area muscle groups and connected to a computer screen, women can train themselves to contract the right muscles. After one or two biofeedback sessions at the women’s center, most women can do the exercises on their own.
Forums are publicized through mailings to local senior citizen centers, retirement communities, and public agencies serving older women. The objective, Weitz says, is "to reach community-living women who have not sought incontinence care."
Because incontinence afflicts women of every nationality, the university has involved Russian, Spanish, Filipino, and Chinese women in creating multilingual incontinence diaries and education materials. The Russian versions are finished. Weitz expects completion of the Spanish and Chinese editions by the end of this summer. All the foreign language materials will be distributed through San Francisco Bay area senior citizen centers, retirement communities, and public agencies serving older women, as well as the university’s clinics and public education offerings. They’re available nationwide for the cost of duplication and mailing. (For more information, contact Weitz. See source box, below right.)
Giving child-free women a voice
Like incontinence sufferers, women without children may endure their own kind of loneliness.
"There’s a growing population of women choosing to be child-free, and they all feel exclusion and isolation," Weitz contends. "They’re left out of the dialogue of women’s workplace issues. Policies for family leave, day care, and flexible hours have emerged without consideration of how they may impact child-free women."
The term child-free symbolizes the center of excellence’s move to change the prevailing image of women who remain childless. Weitz says most live that way for the following reasons:
• They try infertility therapies, don’t conceive, and move on to accept a child-free lifestyle.
• They don’t find the right partner, lack economic stability, or run out of time.
• They never intend to bear children, preferring to pursue professional and personal interests; they shared parenting responsibilities for siblings and have no desire to parent more children; or they worry about global overpopulation.
Full houses at recent university-sponsored community programs on child-free living confirm Weitz’s hunch that child-free women want mutual support from kindred spirits. Since many women haven’t formulated answers to questions that arise in family, social, or work settings, they feel cornered and often turn defensive, she says.
"We teach them the skills to articulate their reasons for remaining child-free," she explains, "then they’re comfortable talking about it. They can have a dialogue instead of becoming defensive."
The sessions offer plenty of time to mingle, and the combination of presentations, discussions, and informal conversation encourages new friendships. Some women even form their own support groups.
Other women use the programs to think through the choice of whether to pursue motherhood. "It’s a safe environment where they can come out of isolation and talk to others who have been through similar experiences," Weitz says.
For presentations and discussion group leadership, Weitz engages local volunteers from two national organizations, RESOLVE in Somerville, MA, and the Childfree Network in Citrus Heights, CA. They usually don’t charge for their services.
The child-free programs are one-time events for 25 to 30 attendees. Weitz publicizes the programs through calendars in local newspapers and fliers posted at the center of excellence.
The programs are half- to full-day Saturday events involving admission fees of $10 and $25 respectively. Fees pay for lunches and handout materials. Other than the expenses mentioned, a program for child-free women can be virtually cost-free, Weitz explains.
Besides the community programs, Weitz is promoting research on the physical and mental health effects of child-free lifestyles. "We have never actually studied groups of child-free women over time," she says. "What we know about child-free women we’ve picked up mostly by grouping them with childbearing women."
(Editor’s note: Next month, we’ll bring you the latest on managing incontinence both from the University of California San Francisco’s researchers and other women’s health centers.)
References
1. Burgio KL, Matthews KA, Engel BT. Prevalence, incidence, and correlates of urinary incontinence in healthy middle-aged women. J Urology 1991; 146:1,255-1,259.
2. Burgio KL, Ives DG, Locher JL, et al. Treatment seeking for urinary incontinence in adults. J American Geriatric Soc 1994; 42:208-212. ß
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