Marie Carmela M. Lapitan MD
Continence Foundation of the Philippines
Research Co-Ordinator
Asia Pacific Continence Advisory Board

The past decade has witnessed the increased awareness of the problem of incontinence in Asia. Realizing the burden that incontinence places on its sufferer, on the medical profession and on the society, in general, has prompted the creation of organizations to address it.

In 1997, the Asia-Pacific Continence Advisory Board (APCAB) was established to develop continence promotion programs and develop strategies which will increase awareness and reduce the social burden of incontinence in the Asia-Pacific rim. Spearheaded by its visionary leader, Dr. Peter Lim of the Society for Continence (Singapore), the APCAB has been responsible in the advancement of already established continence organizations and the organization of new ones in the various member countries which include Singapore, Pakistan, Philippines, India, Indonesia, Malaysia, Taiwan, Hong Kong, China, Korea and Thailand. Having gained reputation insofar as continence work in the region is concerned, the APCAB sought to expand its status in the global community.

In order to further strengthen the networking of the Asian continence groups with the rest of the world, the APCAB participated in the ICS Continence Promotion Committee-organized workshop in the International Continence Society meeting in Seoul, Korea on September 18, 2001. The workshop served as a venue for the different Asian countries to present their goals, achievements and problems in continence promotion to rest of the world.

A total of 10 continence organizations of the APCAB member countries presented their work. These included the Indian Continence Foundation (Dr S SVasan), Continence Foundation of the Philippines (Dr. Marie Carmela Lapitan), Taiwanese Continence Foundation (Dr. Han Sun-Chiang) , Pakistan Continence Foundation (as prepared by Dr. Massood Shiek) , Malaysian Continence Society (Dr. R Malek), Society for Continence - Singapore (P.Lim), Hong Kong Continence Society (Dr. Edward Leung), Chinese Society of Urinary Incontinence (Dr Yang Yong), Continence Society of Indonesia (Dr. Rudi Yuwana) and Korean Continence Society, by Prof Jeung-Im Kim and Prof Soon-Hee Jung. Thailand was unable to present during the workshop.

The meeting was moderated by Dr. David Fonda, chair of the Continence Promotion Committee of the ICS and Prof. Peter Lim, president of the APCAB. There were 120 participants from several countries who attended the workshop.

All the continence organizations of the APCAB member countries were established in recent past decade. The Society for Continence, Singapore being the first to be founded in 1991 by Prof. Peter Lim. He still heads the Society at the present time. In 1994, the Hong Kong Continence Society , Taiwanese Continence Society and Malaysian Continence Society were established. This was followed in 1996 by the Korean Continence Society and the Indian Continence Foundation in 1998. The creation of the APCAB triggered the formation of continence organizations in several of its member countries, namely the Continence Foundation of the Philippines, the Pakistan Continence Work Group, and the Continence Society of Indonesia in 1999. The Chinese Society for Urinary Incontinence was founded in 2000.

In line with the APCAB’s mission to become the stalwart for continence promotion in Asia, the member countries, through their respective continence organizations, have worked towards its achievement as detailed in the following account.

Professional Education. Professional education is a major focus the Asian continence organizations. A significant effort has been given to increase the awareness and improve the delivery of continence care among health professionals. This is done through conducting postgraduate courses, scientific symposia, lecture series and workshops for physicians, specialists, nurses and midwives. Many of the organizations have held several of these training courses both on a regional and national basis. Some of these seminars have been graced by foreign experts such as Prof. Richard Millard (Australia) and Dr. Ananias Diokno (USA) in the Philippines, Prof. Paul Abrams (UK), Dr. James Malone-Lee (USA), Dr. Joseph Ouslander (USA) in Hong Kong, Dr Peter Dwyer (Australia) in Indonesia. In addition, Singapore, Malaysia, Hong Kong and Indonesia have hosted international scientific meetings in cooperation with the APCAB and the Asian Society for Female Urology (ASFU).

Public Awareness and Educational Programs. Another main thrust is enhancing public awareness on incontinence and promotion of educational programs. Notable achievements have been made through convening lay forums, assembling health camps and conducting free clinics. A wealth of educational materials have also been developed for the public, particularly in Singapore, Taiwan, Hong Kong, and Malaysia. The use of the tri-media has been instrumental in the promotion efforts of Singapore and Taiwan. Malaysia has been particularly successful in involving the government in their continence promotion activities involving the public.

Research. All presenting countries participated in the APCAB-initiated Asian prevalence study on urinary incontinence and overactive bladder. Surveys dealing with different issues on continence management have also been conducted such as survey on potential facilities, manpower and patients for incontinence service programs by Indonesia, knowledge and attitudes of the elderly on incontinence by the Philippines, and prevalence studies in the community from India, Malaysia and Pakistan. The continence organizations have also played key roles in the implementation of clinical trials for continence management in the Asian region, such as the tolteridine with pelvic floor exercise study (all countries) and the TVT clinical efficacy series (in Singapore and Taiwan). Members of the different continence organizations have also initiated several randomized controlled trials on the different treatment modalities for incontinence. The Continence Foundation of the Philippines is leading the efforts on doing an epidemiological study on vesicovaginal fistula among APCAB member countries. As an incentive to conduct more research work on incontinence in Asia, the Society for Continence-Singapore has made a research grant available annually for deserving projects.

ICS-related activities. Several continence organizations have contributed to the ICS endeavor to translate terminology on Pelvic Floor to different languages. These include Philippines, Korea and Indonesia. With effect from year 2001, Drs Marie Carmela Lapitan from Continence Foundation of the Philippines and Dr S S Vasan from Indian Continence Foundation have been incorporated as members in the Continence Promotion Committee of the ICS

Other academic activities. Aside from clinical research, the Asian continence organizations have acted on other academic pursuits. The Society for Continence, Singapore has published a comprehensive clinical handbook for continence management, now on its second edition. The Continence Foundation of the Philippines has produced a primer on incontinence for primary health caregivers. A textbook on urinary incontinence from the Indian Continence Foundation is currently in press. Hong Kong has successfully incorporated continence care in the medical and nursing school curricula.

The diversity in the socioeconomic, cultural and political backgrounds within which the continence organizations in Asia operate generates equally diverse and unique problems for continence promotion. For the predominantly Islamic countries like Malaysia, Pakistan and Indonesia, where urinary incontinence is equated with uncleanliness, there is the huge barrier of denial and concealment that must be overcome. In large or densely populated countries, particularly India and China, the burden of promoting continence may be too heavy for a newly established organization with limited resources. The financial load of continence promotion is the foremost obstacle for the developing countries like the Philippines, Indonesia and Pakistan. The insignificant role given to nurses by the medical society in China has been a challenge insofar as making nurses take up a more proactive role in continence promotion and care.

Despite the numerous problems besetting the Asian organizations, they have committed to persist on their efforts in continence promotion. Continued professionals and public education and awareness programs has been planned, as well as completion of ongoing research activities. In addition, plans have been laid out to further this objective. More active participation in collaborative projects within the APCAB, with the continence organizations of the Western world, and the International Continence Society is seen in the future. In the academic front, the Indian Continence Foundation is spearheading the creation of a journal that will serve as the primary source of relevant and up-to-date information on incontinence as applicable to the Asian context and as a venue to publish research work from the region.

The open discussion followed the presentations focused on the need to find effective strategies to facilitate the sharing of information and resources between the Asian continence organizations and the more established and experienced organizations of Europe, Australia and the America. There is a need to establish a close networking between all continence organizations.

The workshop highlighted the Asian continence organizations’ significant role in the global promotion of continence. While still in its early stages, important steps have been made in improving continence awareness and deliver of care in Asia through the efforts of the different continence organizations, with the support of the APCAB. The vision of attaining a level of continence promotion in Asia that equals that of the Western world appears to be feasible and real, albeit not without much work and perseverance. Aptly put by one of the presenter, for the Asian continence organizations to achieve this, "Think big, aim high. Little steps will get us by."