Health chiefs target incontinence 'taboo'

A CAMPAIGN to break the 'last taboo' in medicine and bring help and cure to the thousands who suffer from incontinence was launched yesterday by John Bowis, Under- Secretary of State for Health.

Mr Bowis said incontinence was a problem affecting 3 million adults and 500,000 children. Yet fewer than one in six sought help. 'They suffer in silence. There is still a very deep reluctance in men and women to talk about problems which affect the bladder and the bowel,' the minister added.

Incontinence leads to acute embarrassment, shame and discomfort, he said, adding: 'It can place severe restrictions on people's lives. The tragedy is that in most cases it is curable and even when it is not, management of the right kind can make life manageable'.

The Department of Health is spending pounds 85,000 this year on raising awareness, focussing on National Continence Week this week. It has made continence a priority and required health service managers to take account of it in their budgets. Part of the money is boosting the Continence Foundation's confidential helpline.

It is estimated that one in 12 women suffers incontinence, often associated with childbirth. One survey among women found half left it for five years before seeking help.

One form of treatment is to construct new bladders from a piece of intestine with another portion of intestine, or the appendix, fashioned into a leak-proof outlet tube. For suitable patients it is an alternative to life constricted by nappies, catheters or a urostomy when urine is collected in a bag worn round the waist.

After surgery, all that can be seen on the outside, where the outlet tube emerges, is an extra navel or a 'tiny, little dimple' on the skin, usually placed below the bikini line in the pubic area. When patients want to empty their bladders, every four or five hours in the day, they push a plastic tube, painlessly, through the dimple and let the urine pass out, through it, into the lavatory.

'You can carry the tube around in your handbag,' said Christopher Woodhouse, consultant urologist at the Royal Marsden Hospital, London, who has developed and adapted the system from operation invented by Swedish and French surgeons.

'Incontinence can be exceptionally unpleasant to live with. It is utterly private, not a subject people want to talk and they get little sympathy. Bags can cause young people great probelms when they start to have girlfriends and boyfriends,' he said. 'Today those who have got a bag, want to get rid of it and those who had a bag and now have a new bladder say they would never go back. The operation is cosmetic but the difference it makes to people's lives is enormous.'

The drawbacks are that the operation can take up to five hours and recovery takes about three months. There is a complication rate of about 20 per cent. If performed privately the operation costs pounds 12,000 to pounds 15,000. The new bladders have a capacity of 150ml to start with expanding to 600ml to a litre after about six weeks. A normal adult bladder has a capacity of about 450ml.

Continence is achieved by anchoring the new bladder and its outlet tube to the stomach wall. In addition, the tube is inserted between the muscle and the lining of the pouch. This means that when it fills with urine the pressure squashes the tube flat preventing any leakage.

The Continence Foundation, 2 Doughty Street, London WC1N 2PH. The helpline, 091 213 0050, is available 9am-7pm weekdays.