For one pregnant woman in Kansas City, when it came to accommodating for her need to use the bathroom, her workplace took a different approach: it terminated her. Like millions of other women, April Roller was delighted with her pregnancy, but had to endure unpleasant and uncomfortable symptoms like nausea, dizziness, and frequent urination. Roller’s manager at National Processing of America, a call centre, complained about her frequent departures from her desk, pregnancy-related shoes, and offered inappropriate solutions such as vomiting into a trashcan stored below her desk.
Roller is now suing National Processing of America for violations related to the Family Medical Leave Act, Pregnancy Discrimination Act, and Title VII. Her lawsuit alleges that her employer stated that it was not “fair to other employees” for Roller to be able to use the bathroom so frequently, and that she was demoted from her management position and asked to transfer because of her pregnant condition, which she refused. Roller also alleges that her family leave paperwork was delayed.
Urinary incontinence in neurological disease is not uncommon, a fact that NICE (National Institute of Health and Clinical Excellence) is now trying to stress in their guidelines. NICE sets the standards for the quality of care that individuals suffering from specific conditions should receive.
NICE Guideline 148 details the care and treatment that people with neurological conditions should receive, including those suffering from MS, head and spinal cord injuries, stroke, diabetes and other neurological conditions that may impact the urinary tract system or the nerves supplying this system.
The guidelines address the very real and distressing effects that urinary issues have on people living with neurological conditions, as well as the families who care for them. The guidelines recommend the following actions:
- assessment of bowel/sexual functioning
- review of current medications, as well as medications the patient may have tried in the past
- therapies that the patient is currently using and/or any that have been tried before
- cognitive function
- ability to use the hands
- lifestyle factors (fluid intake habits, use of alcohol, caffeine and other bladder irritants)
- social support
Assessment of these areas should be addressed at least every three years or more often if necessary. Often, lifestyle changes, changes in medications, trying different therapies and the use of assistive devices can dramatically improve or reduce episodes of incontinence, improving the quality of life of people with neurological conditions and their caregivers.
For people who have multiple sclerosis or have had a stroke, head injury, spinal cord injury, or suffered another neurological condition, a new 2012 clinical guidance encourages health care professionals in England and Wales to perform a thorough assessment of their urinary problems. These assessments include collecting data from such patients about their urinary tracts, neurological symptoms, reproductive health, and medications and other interventions.
This guidance came about from the efforts of the National Institute for Health and Clinical Excellence [NICE] in an effort to increase supports for people who have experienced a neurological condition. Its experts indicate that incontinence is common for such patients, causing problems exacerbated by limited mobility, eyesight, and hand function that result from stroke or other neurological conditions. By gathering information which specifically examines the role these factors play, health care professionals hope to better inform incontinence management strategies for patients and their caregivers.