There is little information on the management of incontinence in low-income settings. This article provides some initial insights, of particular relevance to water, sanitation, and hygiene (WASH) and health practitioners, into the coping strategies used by sufferers and carers in Zambia. Incontinence is rarely reported to medical professionals in Zambia, possibly due to a reluctance to disclose as a result of the stigma associated with the condition. Management and treatment of incontinence is subsequently limited, and both coping strategies and treatment received are determined by affordability and accessibility. If the global community is to achieve the Sustainable Development Goals of universal sanitation (Goal 6) and well-being (Goal 3), future studies and programmes on incontinence in Zambia will need to involve collaborations between WASH and health practitioners that investigate how to reduce the stigma associated with the condition and increase awareness, and how to improve the availability and affordability of management and treatment, considering the potential preference for traditional medicine in rural communities.

Abrams, P., Cardozo, L., Khoury, S. and Wein, A. (eds) (2013) Incontinence, 5th edn, ICUD-EAU, Paris. Available from: <https://www.ics.org/Publications/ICI_5/INCONTINENCE.pdf> [accessed 6 April 2018].

Central Statistical Office (2015) Zambia Demographic and Health Survey 2013–14, Central Statistical Office, Lusaka. Available from: <http://dhsprogram.com/pubs/pdf/FR304/FR304.pdf> [accessed 6 April 2018].

Dumoulin, C., Hay-Smith, E.J.C. and Habée-Séguin, G.M. (2014) ‘Pelvic floor muscle training versus no treatment, or inactive control treatments, for urinary incontinence in women’, Cochrane Database of Systematic Reviews, issue 5 [online] <http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD005654.pub3/full> [accessed 6 April 2018].

Giles-Hansen, C. (2015) Hygiene Needs of Incontinence Sufferers: How Can Water, Sanitation and Hygiene Actors Better Address the Needs of Vulnerable People Suffering from Urine and/or Faecal Incontinence in Low and Middle Income Countries, WaterAid/SHARE Research Consortium. Available from: <http://www.communityledtotalsanitation.org/resource/hygiene-needs-incontinence-sufferers> [accessed 6 April 2018].

Gjerde, J.L., Rortveit, G., Muleta, M. and Blystad, A. (2013) ‘Silently waiting to heal. Experiences among women living with urinary incontinence in northwest Ethiopia’, International Urogynecology Journal 24: 953–8 <http://dx.doi.org/10.1007/s00192-012-1951-4>.

Hafskjold, B., Pop-Stefanija, B., Giles-Hansen, C., Weerts, E., Flynn, E., Wilbur, J., Brogan, K. et al. (2016) ‘Taking stock: incompetent at incontinence – why are we ignoring the needs of incontinence sufferers?’, Waterlines 35 (3): 219–27 <http://dx.doi.org/10.3362/1756-3488.2016.018>.

Haylen, B.T., de Ridder, D., Freeman, R.M., Swift, S.E., Berghmans, B., Lee, J., Monga, A. Petri E, Rizk DE, Sand PK, Schaer GN. (2012) ‘An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for female pelvic floor dysfunction’, Journal of the Association of Chartered Physiotherapists in Women’s Health 110: 33–57 <http://dx.doi.org/10.1007/s00192-009-0976-9>.

House, S., Mahon, T. and Cavill, S. (2012) Menstrual Hygiene Matters. A Resource for Improving Menstrual Hygiene around the World, WaterAid/SHARE Research Consortium. Available from: <http://linkinghub.elsevier.com/retrieve/pii/S0968808013417123> [accessed 6 April 2018].

Hu, T., Wagner, Y.H., Hawthorne, G., Moore, K., Subak, L.L. and Versi, E. (2005) ‘Economics of incontinence’, in P. Abrams, L. Cardozo, S. Khoury, and A. Wein (eds) Incontinence, 3rd edn, pp. 73–96, ICUD-EAU, Paris. Available from: <https://www.ics.org/Publications/ICI_3/v1.pdf/chap2.pdf> [accessed 6 April 2018].

International Continence Society (ICS) (2016) ‘Faecal incontinence’ [online], ICS <http://wiki.ics.org/Faecal+Incontinence> [accessed 6 April 2018].

Kapambwe, S., Parham, G., Mwanahamuntu, M., Chirwa, S., Mwanza, J. and Amuyunzu-Nyamongo, M. (2013) ‘Innovative approaches to promoting cervical health and raising cervical cancer awareness by use of existing cultural structures in resource-limited countries: experiences with traditional marriage counselling in Zambia’, Global Health Promotion 20 (4): 57–64 <http://dx.doi.org/10.1177/1757975913502689>.

Minassian, V.A., Drutz, H.P. and Al-Badr, A. (2003) ‘Urinary incontinence as a worldwide problem’, International Journal of Gynaecology and Obstetrics 82: 327–38 <http://dx.doi.org/10.1016/S0020-7292(03)00220-0>.

Minassian, V.A., Stewart, W.F. and Wood, G.C. (2008) ‘Urinary incontinence in women: variation in prevalence estimates and risk factors’, International Journal of Obstetrics and Gynaecology 111 (2): 324–31 <http://dx.doi.org/10.1097/01.AOG.0000267220.48987.17>.

Phiri, P. (2016) ‘Zambian women practice dry sex to avoid accusations of infidelity’, Global Press Journal [online] <https://globalpressjournal.com/africa/zambia/zambian-women-practice-dry-sex/> [accessed 6 April 2018].

Walker, G.J.A. and Gunasekera, P. (2011) ‘Pelvic organ prolapse and incontinence in developing countries: review of prevalence and risk factors’, International Urogynaecology Journal 22: 127–35 <http://dx.doi.org/10.1007/s00192-010-1215-0>.

World Health Organization (WHO) (2017) ‘Global Health Observatory (GHO) data’ [online] <http://www.who.int/gho/en/> [accessed 6 April 2018].

WHO/UNICEF Joint Monitoring Programme (JMP) (2017) ‘Estimates on the use of water, sanitation and hygiene in Zambia’ [online] <https://washdata.org/data#!/zmb> [accessed 6 April 2018].

Wood, L.N. and Anger, J.T. (2014) ‘Urinary incontinence in women’, British Medical Journal 349 <https://doi.org/10.1136/bmj.g4531> [accessed 17 June 2018].

World Bank (2017) ‘Zambia’ [online] <http://data.worldbank.org/country/zambia> [accessed 6 April 2018].

Abrams, P., Cardozo, L., Khoury, S. and Wein, A. (eds) (2013) Incontinence, 5th edn, ICUD-EAU, Paris. Available from: <https://www.ics.org/Publications/ICI_5/INCONTINENCE.pdf> [accessed 6 April 2018].

Central Statistical Office (2015) Zambia Demographic and Health Survey 2013–14, Central Statistical Office, Lusaka. Available from: <http://dhsprogram.com/pubs/pdf/FR304/FR304.pdf> [accessed 6 April 2018].

Dumoulin, C., Hay-Smith, E.J.C. and Habée-Séguin, G.M. (2014) ‘Pelvic floor muscle training versus no treatment, or inactive control treatments, for urinary incontinence in women’, Cochrane Database of Systematic Reviews, issue 5 [online] <http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD005654.pub3/full> [accessed 6 April 2018].

Giles-Hansen, C. (2015) Hygiene Needs of Incontinence Sufferers: How Can Water, Sanitation and Hygiene Actors Better Address the Needs of Vulnerable People Suffering from Urine and/or Faecal Incontinence in Low and Middle Income Countries, WaterAid/SHARE Research Consortium. Available from: <http://www.communityledtotalsanitation.org/resource/hygiene-needs-incontinence-sufferers> [accessed 6 April 2018].

Gjerde, J.L., Rortveit, G., Muleta, M. and Blystad, A. (2013) ‘Silently waiting to heal. Experiences among women living with urinary incontinence in northwest Ethiopia’, International Urogynecology Journal 24: 953–8 <http://dx.doi.org/10.1007/s00192-012-1951-4>.

Hafskjold, B., Pop-Stefanija, B., Giles-Hansen, C., Weerts, E., Flynn, E., Wilbur, J., Brogan, K. et al. (2016) ‘Taking stock: incompetent at incontinence – why are we ignoring the needs of incontinence sufferers?’, Waterlines 35 (3): 219–27 <http://dx.doi.org/10.3362/1756-3488.2016.018>.

Haylen, B.T., de Ridder, D., Freeman, R.M., Swift, S.E., Berghmans, B., Lee, J., Monga, A. Petri E, Rizk DE, Sand PK, Schaer GN. (2012) ‘An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for female pelvic floor dysfunction’, Journal of the Association of Chartered Physiotherapists in Women’s Health 110: 33–57 <http://dx.doi.org/10.1007/s00192-009-0976-9>.

House, S., Mahon, T. and Cavill, S. (2012) Menstrual Hygiene Matters. A Resource for Improving Menstrual Hygiene around the World, WaterAid/SHARE Research Consortium. Available from: <http://linkinghub.elsevier.com/retrieve/pii/S0968808013417123> [accessed 6 April 2018].

Hu, T., Wagner, Y.H., Hawthorne, G., Moore, K., Subak, L.L. and Versi, E. (2005) ‘Economics of incontinence’, in P. Abrams, L. Cardozo, S. Khoury, and A. Wein (eds) Incontinence, 3rd edn, pp. 73–96, ICUD-EAU, Paris. Available from: <https://www.ics.org/Publications/ICI_3/v1.pdf/chap2.pdf> [accessed 6 April 2018].

International Continence Society (ICS) (2016) ‘Faecal incontinence’ [online], ICS <http://wiki.ics.org/Faecal+Incontinence> [accessed 6 April 2018].

Kapambwe, S., Parham, G., Mwanahamuntu, M., Chirwa, S., Mwanza, J. and Amuyunzu-Nyamongo, M. (2013) ‘Innovative approaches to promoting cervical health and raising cervical cancer awareness by use of existing cultural structures in resource-limited countries: experiences with traditional marriage counselling in Zambia’, Global Health Promotion 20 (4): 57–64 <http://dx.doi.org/10.1177/1757975913502689>.

Minassian, V.A., Drutz, H.P. and Al-Badr, A. (2003) ‘Urinary incontinence as a worldwide problem’, International Journal of Gynaecology and Obstetrics 82: 327–38 <http://dx.doi.org/10.1016/S0020-7292(03)00220-0>.

Minassian, V.A., Stewart, W.F. and Wood, G.C. (2008) ‘Urinary incontinence in women: variation in prevalence estimates and risk factors’, International Journal of Obstetrics and Gynaecology 111 (2): 324–31 <http://dx.doi.org/10.1097/01.AOG.0000267220.48987.17>.

Phiri, P. (2016) ‘Zambian women practice dry sex to avoid accusations of infidelity’, Global Press Journal [online] <https://globalpressjournal.com/africa/zambia/zambian-women-practice-dry-sex/> [accessed 6 April 2018].

Walker, G.J.A. and Gunasekera, P. (2011) ‘Pelvic organ prolapse and incontinence in developing countries: review of prevalence and risk factors’, International Urogynaecology Journal 22: 127–35 <http://dx.doi.org/10.1007/s00192-010-1215-0>.

World Health Organization (WHO) (2017) ‘Global Health Observatory (GHO) data’ [online] <http://www.who.int/gho/en/> [accessed 6 April 2018].

WHO/UNICEF Joint Monitoring Programme (JMP) (2017) ‘Estimates on the use of water, sanitation and hygiene in Zambia’ [online] <https://washdata.org/data#!/zmb> [accessed 6 April 2018].

Wood, L.N. and Anger, J.T. (2014) ‘Urinary incontinence in women’, British Medical Journal 349 <https://doi.org/10.1136/bmj.g4531> [accessed 17 June 2018].

World Bank (2017) ‘Zambia’ [online] <http://data.worldbank.org/country/zambia> [accessed 6 April 2018].

Abrams, P., Cardozo, L., Khoury, S. and Wein, A. (eds) (2013) Incontinence, 5th edn, ICUD-EAU, Paris. Available from: <https://www.ics.org/Publications/ICI_5/INCONTINENCE.pdf> [accessed 6 April 2018].

Central Statistical Office (2015) Zambia Demographic and Health Survey 2013–14, Central Statistical Office, Lusaka. Available from: <http://dhsprogram.com/pubs/pdf/FR304/FR304.pdf> [accessed 6 April 2018].

Dumoulin, C., Hay-Smith, E.J.C. and Habée-Séguin, G.M. (2014) ‘Pelvic floor muscle training versus no treatment, or inactive control treatments, for urinary incontinence in women’, Cochrane Database of Systematic Reviews, issue 5 [online] <http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD005654.pub3/full> [accessed 6 April 2018].

Giles-Hansen, C. (2015) Hygiene Needs of Incontinence Sufferers: How Can Water, Sanitation and Hygiene Actors Better Address the Needs of Vulnerable People Suffering from Urine and/or Faecal Incontinence in Low and Middle Income Countries, WaterAid/SHARE Research Consortium. Available from: <http://www.communityledtotalsanitation.org/resource/hygiene-needs-incontinence-sufferers> [accessed 6 April 2018].

Gjerde, J.L., Rortveit, G., Muleta, M. and Blystad, A. (2013) ‘Silently waiting to heal. Experiences among women living with urinary incontinence in northwest Ethiopia’, International Urogynecology Journal 24: 953–8 <http://dx.doi.org/10.1007/s00192-012-1951-4>.

Hafskjold, B., Pop-Stefanija, B., Giles-Hansen, C., Weerts, E., Flynn, E., Wilbur, J., Brogan, K. et al. (2016) ‘Taking stock: incompetent at incontinence – why are we ignoring the needs of incontinence sufferers?’, Waterlines 35 (3): 219–27 <http://dx.doi.org/10.3362/1756-3488.2016.018>.

Haylen, B.T., de Ridder, D., Freeman, R.M., Swift, S.E., Berghmans, B., Lee, J., Monga, A. Petri E, Rizk DE, Sand PK, Schaer GN. (2012) ‘An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for female pelvic floor dysfunction’, Journal of the Association of Chartered Physiotherapists in Women’s Health 110: 33–57 <http://dx.doi.org/10.1007/s00192-009-0976-9>.

House, S., Mahon, T. and Cavill, S. (2012) Menstrual Hygiene Matters. A Resource for Improving Menstrual Hygiene around the World, WaterAid/SHARE Research Consortium. Available from: <http://linkinghub.elsevier.com/retrieve/pii/S0968808013417123> [accessed 6 April 2018].

Hu, T., Wagner, Y.H., Hawthorne, G., Moore, K., Subak, L.L. and Versi, E. (2005) ‘Economics of incontinence’, in P. Abrams, L. Cardozo, S. Khoury, and A. Wein (eds) Incontinence, 3rd edn, pp. 73–96, ICUD-EAU, Paris. Available from: <https://www.ics.org/Publications/ICI_3/v1.pdf/chap2.pdf> [accessed 6 April 2018].

International Continence Society (ICS) (2016) ‘Faecal incontinence’ [online], ICS <http://wiki.ics.org/Faecal+Incontinence> [accessed 6 April 2018].

Kapambwe, S., Parham, G., Mwanahamuntu, M., Chirwa, S., Mwanza, J. and Amuyunzu-Nyamongo, M. (2013) ‘Innovative approaches to promoting cervical health and raising cervical cancer awareness by use of existing cultural structures in resource-limited countries: experiences with traditional marriage counselling in Zambia’, Global Health Promotion 20 (4): 57–64 <http://dx.doi.org/10.1177/1757975913502689>.

Minassian, V.A., Drutz, H.P. and Al-Badr, A. (2003) ‘Urinary incontinence as a worldwide problem’, International Journal of Gynaecology and Obstetrics 82: 327–38 <http://dx.doi.org/10.1016/S0020-7292(03)00220-0>.

Minassian, V.A., Stewart, W.F. and Wood, G.C. (2008) ‘Urinary incontinence in women: variation in prevalence estimates and risk factors’, International Journal of Obstetrics and Gynaecology 111 (2): 324–31 <http://dx.doi.org/10.1097/01.AOG.0000267220.48987.17>.

Phiri, P. (2016) ‘Zambian women practice dry sex to avoid accusations of infidelity’, Global Press Journal [online] <https://globalpressjournal.com/africa/zambia/zambian-women-practice-dry-sex/> [accessed 6 April 2018].

Walker, G.J.A. and Gunasekera, P. (2011) ‘Pelvic organ prolapse and incontinence in developing countries: review of prevalence and risk factors’, International Urogynaecology Journal 22: 127–35 <http://dx.doi.org/10.1007/s00192-010-1215-0>.

World Health Organization (WHO) (2017) ‘Global Health Observatory (GHO) data’ [online] <http://www.who.int/gho/en/> [accessed 6 April 2018].

WHO/UNICEF Joint Monitoring Programme (JMP) (2017) ‘Estimates on the use of water, sanitation and hygiene in Zambia’ [online] <https://washdata.org/data#!/zmb> [accessed 6 April 2018].

Wood, L.N. and Anger, J.T. (2014) ‘Urinary incontinence in women’, British Medical Journal 349 <https://doi.org/10.1136/bmj.g4531> [accessed 17 June 2018].

World Bank (2017) ‘Zambia’ [online] <http://data.worldbank.org/country/zambia> [accessed 6 April 2018].

Abrams, P., Cardozo, L., Khoury, S. and Wein, A. (eds) (2013) Incontinence, 5th edn, ICUD-EAU, Paris. Available from: <https://www.ics.org/Publications/ICI_5/INCONTINENCE.pdf> [accessed 6 April 2018].

Central Statistical Office (2015) Zambia Demographic and Health Survey 2013–14, Central Statistical Office, Lusaka. Available from: <http://dhsprogram.com/pubs/pdf/FR304/FR304.pdf> [accessed 6 April 2018].

Dumoulin, C., Hay-Smith, E.J.C. and Habée-Séguin, G.M. (2014) ‘Pelvic floor muscle training versus no treatment, or inactive control treatments, for urinary incontinence in women’, Cochrane Database of Systematic Reviews, issue 5 [online] <http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD005654.pub3/full> [accessed 6 April 2018].

Giles-Hansen, C. (2015) Hygiene Needs of Incontinence Sufferers: How Can Water, Sanitation and Hygiene Actors Better Address the Needs of Vulnerable People Suffering from Urine and/or Faecal Incontinence in Low and Middle Income Countries, WaterAid/SHARE Research Consortium. Available from: <http://www.communityledtotalsanitation.org/resource/hygiene-needs-incontinence-sufferers> [accessed 6 April 2018].

Gjerde, J.L., Rortveit, G., Muleta, M. and Blystad, A. (2013) ‘Silently waiting to heal. Experiences among women living with urinary incontinence in northwest Ethiopia’, International Urogynecology Journal 24: 953–8 <http://dx.doi.org/10.1007/s00192-012-1951-4>.

Hafskjold, B., Pop-Stefanija, B., Giles-Hansen, C., Weerts, E., Flynn, E., Wilbur, J., Brogan, K. et al. (2016) ‘Taking stock: incompetent at incontinence – why are we ignoring the needs of incontinence sufferers?’, Waterlines 35 (3): 219–27 <http://dx.doi.org/10.3362/1756-3488.2016.018>.

Haylen, B.T., de Ridder, D., Freeman, R.M., Swift, S.E., Berghmans, B., Lee, J., Monga, A. Petri E, Rizk DE, Sand PK, Schaer GN. (2012) ‘An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for female pelvic floor dysfunction’, Journal of the Association of Chartered Physiotherapists in Women’s Health 110: 33–57 <http://dx.doi.org/10.1007/s00192-009-0976-9>.

House, S., Mahon, T. and Cavill, S. (2012) Menstrual Hygiene Matters. A Resource for Improving Menstrual Hygiene around the World, WaterAid/SHARE Research Consortium. Available from: <http://linkinghub.elsevier.com/retrieve/pii/S0968808013417123> [accessed 6 April 2018].

Hu, T., Wagner, Y.H., Hawthorne, G., Moore, K., Subak, L.L. and Versi, E. (2005) ‘Economics of incontinence’, in P. Abrams, L. Cardozo, S. Khoury, and A. Wein (eds) Incontinence, 3rd edn, pp. 73–96, ICUD-EAU, Paris. Available from: <https://www.ics.org/Publications/ICI_3/v1.pdf/chap2.pdf> [accessed 6 April 2018].

International Continence Society (ICS) (2016) ‘Faecal incontinence’ [online], ICS <http://wiki.ics.org/Faecal+Incontinence> [accessed 6 April 2018].

Kapambwe, S., Parham, G., Mwanahamuntu, M., Chirwa, S., Mwanza, J. and Amuyunzu-Nyamongo, M. (2013) ‘Innovative approaches to promoting cervical health and raising cervical cancer awareness by use of existing cultural structures in resource-limited countries: experiences with traditional marriage counselling in Zambia’, Global Health Promotion 20 (4): 57–64 <http://dx.doi.org/10.1177/1757975913502689>.

Minassian, V.A., Drutz, H.P. and Al-Badr, A. (2003) ‘Urinary incontinence as a worldwide problem’, International Journal of Gynaecology and Obstetrics 82: 327–38 <http://dx.doi.org/10.1016/S0020-7292(03)00220-0>.

Minassian, V.A., Stewart, W.F. and Wood, G.C. (2008) ‘Urinary incontinence in women: variation in prevalence estimates and risk factors’, International Journal of Obstetrics and Gynaecology 111 (2): 324–31 <http://dx.doi.org/10.1097/01.AOG.0000267220.48987.17>.

Phiri, P. (2016) ‘Zambian women practice dry sex to avoid accusations of infidelity’, Global Press Journal [online] <https://globalpressjournal.com/africa/zambia/zambian-women-practice-dry-sex/> [accessed 6 April 2018].

Walker, G.J.A. and Gunasekera, P. (2011) ‘Pelvic organ prolapse and incontinence in developing countries: review of prevalence and risk factors’, International Urogynaecology Journal 22: 127–35 <http://dx.doi.org/10.1007/s00192-010-1215-0>.

World Health Organization (WHO) (2017) ‘Global Health Observatory (GHO) data’ [online] <http://www.who.int/gho/en/> [accessed 6 April 2018].

WHO/UNICEF Joint Monitoring Programme (JMP) (2017) ‘Estimates on the use of water, sanitation and hygiene in Zambia’ [online] <https://washdata.org/data#!/zmb> [accessed 6 April 2018].

Wood, L.N. and Anger, J.T. (2014) ‘Urinary incontinence in women’, British Medical Journal 349 <https://doi.org/10.1136/bmj.g4531> [accessed 17 June 2018].

World Bank (2017) ‘Zambia’ [online] <http://data.worldbank.org/country/zambia> [accessed 6 April 2018].