Many years ago, I had a patient who demonstrated that continence can be a quality-of-life indicator. He was withdrawn and depressed, and he wouldn't go out in public. Postprostatectomy incontinence had plagued him for nearly two years. He had suffered extreme weight loss because of a lack of appetite. He was being treated for major depression, but the medications didn't improve his condition. At that point, he was separated from his wife because of what she called "the mess and stink" of his urinary leakage. Before he was referred to me, he didn't know that his urinary incontinence (UI) could be treated.

For the past 17 years, I have been treating UI, primarily in men. When my patients learn that they can simply modify their behavior to correct their incontinence, they get angry: most of them have never been asked about UI, nor have they been offered help if they have. Fortunately, when their anger subsides, these patients are eager to begin the behavior modification techniques that can have such an effect on the course of UI-fluid regulation, timed voiding, and a regimen of contracting the muscles of the pelvic floor, or Kegel exercises. Taking control of UI helps make my patients feel socially confident. Still, many providers don't consider continence essential to a person's well-being, and UI often goes untreated.

The identification and treatment of UI could be improved if continence were assessed as a vital sign. Patients could be asked at the beginning of every visit to a provider whether incontinence affects their lives (greatly, moderately, slightly, or not at all), much as their blood pressure and pulse are taken at every visit. When patients are directly asked, "Do you have any uncontrolled urinary leakage?" they usually answer honestly. (A few patients say no because they are afraid of jeopardizing their living situation, although they may have arrived at their provider's office wearing adult diapers or smelling of urine. Convincing these patients that UI treatment may work for them is a challenge.)

Urinary incontinence can destroy a person's self-image, self-esteem, and sense of well-being. Assessing continence as a vital sign may avert some of these health crises and prevent more complicated urologic problems. When my patient learned that he could correct his UI, he embraced the behavioral techniques. Today he is "dry," off antidepressants, and reunited with his wife.

Continence assessment ought to be part of patient intake protocol, but it usually isn't. Even when a patient's UI is identified, treatment may not follow-sometimes because the patient has more acute clinical problems, sometimes because of the provider's ignorance.

Incontinence is not usually considered a significant condition until a patient must move into an assisted-living facility or the depression that often accompanies incontinence has made him suicidal. Why must patients get to that point before they are heard and helped when UI is so easily identified?

Nurses are usually the first providers to speak to patients. If they were to incorporate continence into the list of vital signs, they could ease the suffering of countless patients. Let's take the next step. Let's initiate a movement to make continence the sixth vital sign.