"How did you get into this?" is a common question from friends, patients, and colleagues when they learn of the specialty I practice in physical therapy (PT) in home healthcare. I first learned about PT when I was 12 and observed my great grandmother recover from a severe stroke with the assistance of a physical therapist. That was when I knew I wanted to become a PT. Because of this, my entire high school course elective selection, extracurricular activities, and volunteering/employment were structured with that goal in mind. I wanted to specialize in geriatrics to help others, like my great grandmother. However, during my last year of PT school, my specialty changed.

It was during my last clinical rotation while at Johns Hopkins University that the world of pelvic floor dysfunction was presented. I will never forget my clinical instructor introducing herself and telling me that I would be practicing under her guidance to treat patients with bowel, bladder, and sexual dysfunction. An integral role of this therapy was performing internal vaginal and rectal neuromuscular examinations. As this specialty in PT had never been mentioned during PT school, I was horrified at this prospect and wondered what role PT could have in these diagnoses. Physical therapists, I quickly learned, play an important, critical role in treating conditions associated with pelvic floor dysfunctions. In fact, this role is so extensive, with so much evidence to support it, that it is beyond the scope of this editorial. (We hope to bring you an in-depth CE article on this topic in 2012!!)

In the home care environment, urinary incontinence (UI) is a prominent diagnosis healthcare providers encounter. In fact, research has shown that UI has greater annua l costs than ovarian, cervical, breast, and uterine cancers combined (Subak et al., 2007). So why, then, do we not have some kind of walk/run/bike ride to end incontinence? The most common response is that UI, unlike cancer, is a quality-of-life issue and not a medical emergency. Sadly, many healthcare providers do not even ask their patients whether they are experiencing issues with incontinence. Some healthcare providers, when asked why they do not ask about these symptoms, state either they are embarrassed to discuss them with their patients or they do not know how to treat incontinence and so do not want to bring up the topic. Of course, this needs to change.

Many patients believe UI is a "normal" part of aging and, as such, they do not bring up these issues to their providers. In addition, unlike a physical disability, which is common and easy to discuss, many with incontinence feel it is an embarrassing and shameful condition and so do not mention these symptoms/concerns to their healthcare providers. Even worse, some individuals actually deny that they have incontinence issues when asked. I have observed this numerous times within the home care environment when I see incontinence padding in the patient's bathroom, yet he or she denies experiencing symptoms. It is easy to talk to someone about paralysis from a stroke, or triple bypass surgery; however; the patient's perception is that discussions about UI are "off limits." Incontinence itself brings a large quality-of-life impact to the individual; however, I believe that for those patients who feel they cannot discuss these issues due to embarrassment, the impact from this on their quality of life can be even greater than from the UI itself.

Many individuals with incontinence need to stay close to a bathroom for fear of incontinence. At times this can result in men and women becoming/remaining homebound. If they do leave the house, they must be prepared by bringing extra padding, undergarments, and sometimes even a change of clothes. Some studies have shown that out-of-pocket expenses for incontinence can run upward of $900 per year for the individual (Subak et al., 2006). Talk about a quality-of-life issue!!

Often, UI can improve, or even be resolved, with simple measures including patient education, dietary changes, proper fluid intake, and exercise (e.g., bladder and pelvic floor muscles). These treatments are so simple, yet they are underutilized. Performing an internal vaginal or rectal pelvic floor muscle assessment is not always necessary, especially in the home care environment. Simply asking your patients about their symptoms and providing education and exercises can greatly improve their symptoms and therefore their quality of life. These exercises are not intense and patients can perform them while lying in bed or sitting in a chair.

The majority of people will experience UI at some point in their life. How would you feel if no one asked you about these issues and helped you resolve them? I challenge you today to learn simple measures about how you can help your patients with these conditions. Do not be afraid to ask your patients if they experience UI and help educate them to resolve these issues. Give your patients their lives back!!

There are many comorbidities for developing UI. In this issue, Martha L. Bruce and colleagues describe the management of depression for home care patients. As depression is a major risk factor for the development of UI, its management can help to decrease or eliminate incontinence symptoms. As discussed in the article by Jennifer B. Williams and colleagues, clinicians can play an active role in instructing patients and caregivers in proper nutrition and healthy bladder habits following renal transplants.

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