Focusing on people in humanitarian and low- and middle-income contexts
Incontinence is the involuntary loss of urine and/or faeces
People of any gender, age or ability can experience incontinence: they cannot hold on to their urine and/or faeces (‘the involuntary loss of urine or faeces’), and need to manage their urine and/or faeces leaking out. Leakage can occur at any time, day or night (commonly referred to in children as ‘bedwetting’). Incontinence has a significant impact on the quality of life of those who experience it, and that of their family members and carers:
"The children (in Zaatari refugee camp, Jordon) are really suffering. The problem is that the mothers have been trying to cope for so long that basically they've given up. Night after night of urine and they can't keep them clean. It's soul-destroying (Venema, 2015)"
Members of an informal email group on incontinence in humanitarian and development settings* have identified a lack of acknowledgement and support for people with incontinence. In response the group has been developing tools and collating resources to enable development and humanitarian professionals to create a supportive environment for people in low- and middle-income countries to manage their incontinence hygienically, safely, in privacy and with dignity.
We have identified that anyone who experiences incontinence has increased water, sanitation and hygiene (WASH) needs compared to the rest of the population. WASH-related tools and resources have been collated on this webpage to help improve the knowledge and practices of the WASH sector. New resources will be added when available. This guidance can be summarised as:
For more information, please see:
- Guidance on supporting people with incontinence in humanitarian and low- and middle-income contexts (LMICs): an explanation of what incontinence is, who might experience the condition, and how incontinent people and their carers in LMICs (including humanitarian contexts) can be supported to manage the condition;
- Summary guidance: a four-page summary of the guidance document above;
- Case studies: a compilation of case studies related to incontinence in low- and middle-income countries (LMICs), including in humanitarian contexts; and
- References: websites, peer-reviewed literature and grey literature related to incontinence in low- and middle-income countries (LMICs).
*Please note that these documents will be regularly updated as more information becomes available.
In addition, the Sanitation Learning Hub has published a Frontiers of Sanitation issue on integrating incontinence into WASH programming, including a checklist on how to talk about this sensitive issue:
- Incontinence: We Need to Talk About Leaks
- A basic introduction to incontinence and the realities that people living with incontinence face;
- Practical suggestions for how to identify and engage with people living with incontinence to start ‘talking about leaks’; and
- Practical suggestions for the WASH sector (and others) to contribute to reducing inequalities associated with incontinence.
- How to Talk About Incontinence: A Checklist
Current projects investigating incontinence in humanitarian and LMIC contexts
Children and their caregivers' experiences with incontinence (Uganda and Bangladesh): a research and practice partnership to understand and dismantle the barriers to inclusion and well-being that children (aged five to 11), and others living with incontinence, face in humanitarian contexts.
Funder: The Humanitarian Innovation Fund (HIF), Elrha
Partners: University of Leeds, University of York, Plan International UK, Plan International Uganda, UNICEF Bangladesh and World Vision Bangladesh
Improving the lives of older people with incontinence (Ethiopia and Malawi): Oxfam and HelpAge International will develop a practical and sensitive methodology to understand the scope and scale of incontinence and how it affects older people living with it and their caregivers in humanitarian contexts.
Funder: The Humanitarian Innovation Fund (HIF), Elrha
Partners: Oxfam, HelpAge International, Dr Sarah House
Water, Women and Disability Study Vanuatu: a comprehensive population-based study of disability in Torba and Sanma Provinces, Vanuatu to quantify the prevalence and demographics of disability, and understand access to and experience of water, sanitation and hygiene, menstrual hygiene and incontinence management amongst persons with disabilities, alongside the situation of persons without disabilities.
Funder: The Department of Foreign Affairs and Trade’s Women for Water stream
Partners: London School of Hygiene and Tropical Medicine (LSHTM), World Vision, Vanuatu Society for People with Disability, Vanuatu Disability Promotion and Advocacy Association, Vanuatu National Statistics Office, Ministry of Justice and Community Services, Sally Baker (independent consultant)
Dr Amita Bhakta's work on the perimenopause: conducted at the Water Engineering and Development Centre (WEDC) in the School of Architecture, Building and Civil Engineering with Dr Julie Fisher and Brian Reed at Loughborough University
Other incontinence research being conducted at the University of Leeds
Talking to women about urinary incontinence on the BMJ Blog
Key contacts championing increasing learning on incontinence in humanitarian and LMICs
At the University of Leeds:
Dr Dani Barrington, Visiting Lecturer in Water, Sanitation and Health
Dr Pete Culmer, Associate Professor, School of Mechanical Engineering. Pete is also a member of the IMPRESS initiative of the National Institute for Health Research (NIHR) Surgical MedTech Cooperative which aims to encourage more engineers and scientists to work on researching new technologies for incontinence.
Professor Barbara Evans, Professor of Public Health Engineering
Claire Rosato-Scott PhD Candidate, Emergency sanitation for children aged 5 to 11 with urinary incontinence
External to the University of Leeds:
Chelsea Giles-Hansen (Public health and WASH Consultant)
Dr Sarah House (Freelance public health / water, sanitation and hygiene engineer)
Jane Wilbur, Research Fellow Disability, Water, Sanitation and Hygiene at the London School of Hygiene and Tropical Medicine
*If you have any questions or comments about anything on this page, incontinence in general, or if you would like to join the informal email group on incontinence in humanitarian and development settings, please contact firstname.lastname@example.org