Military Women's Urinary Complications in Deployment Settings
Military Women's Urinary Complications in Deployment Settings
It is well known that frequent and complete voiding is associated with a reduction in the incidence of urinary tract infections (UTIs) (Brusch, Bavaro, Cunha, & Tessier, 2012). Unfortunately, many deployment settings are not conducive to frequent and/or complete urination. Further more, many austere conditions cannot be changed, such as climate, terrain, and security issues, so the best resolution is adaptation by military women. Un fortunately, minimal effort has been put forth to assist military women to adapt urination practices to the austere deployment environment.
The lack of adaptive measures has forced military women to revert to deleterious strategies (Scannell-Desch & Doherty, 2012; Trego, 2012; Wilson & Nelson, 2012). Interestingly, the urination practices that military women use to overcome female urination problems in the deployment setting are common across all three military services (Army, Air Force, and Navy). The majority revert to one or more of the following four deleterious practices to cope with the difficulties of urination in the field setting.
Urination Practice #1. The first practice is to intentionally restrict fluid intake to avoid the need to void. This is quite effective in limiting urination, but consequently, can lead to heat injury, dehydration, and the risk for hypovolemic shock. The associated complication of dehydration can result in decreased physical performance and/or mental alertness, as well as increased risk for UTIs (Albright, Gehrich, Buller, & Davis 2005; Czerwinski et al., 2001; Lowe & Ryan-Wenger, 2003, Trego, 2012).
Urination Practice #2. The second practice is to voluntarily hold urine for prolonged periods. Infrequent and/or incomplete emptying of the bladder impedes the regularity, force, and flow of voiding that expels bacteria from the urinary tract. Therefore, this practice is associated with an increased incidence of UTIs (Howes, 2009; Mehnert-Kay, 2005; Sheffield & Cunningham, 2005). In one report, 56.5% (476/841) of the military women surveyed in a female health study reported holding urine to avoid using toilet facilities in the deployment environment (Lowe & Ryan-Wenger, 2003).
Urination Practice #3. The third practice involves military women either squatting over or holding bottles, plastic bags, or cans to their perineum to urinate. One female Army specialist described her convoy experience as follows:
Military women traveling in military convoys don't have much opportunity to urinate. We can sit for hours with minimal stopping due to security reasons. I rode many times with the Marines as their convoy mechanic, and I would have to sit side by side, very close to other soldiers, for hours and hours. They were all men. They would just pee in a can while I suffered. So, I just learned to pee using a jeep funnel that I carried with me when I traveled in convoys. I hooked it up to a large bottle. I would just sit and pull my pants down, and cover up with my top as much as possible, stick the funnel under me, pee in a large jar. The guys just laugh and laugh. I hated it, but when you got to go, you got to go! (Anonymous, personal communication, September 25, 2010)
These practices can expose the urethra to bacteria and other microorganisms, and increase the likelihood of their migration to the bladder, resulting in a UTI (National Kidney and Urologic Diseases Information Clearing-house [NKUDIC], 2012).
Urination Practice #4. The final practice is wearing several layers of perineal pads or disposable incontinence briefs. Aside from the discomfort, inconvenience, and cost of these items, they can increase heat and moisture to the perineum (Omli et al., 2010; Trego, 2007). They also can add bulk to uniform pants that may already be tight-fitting and constricting. Tight, poor-fitting, and/or constricting uniform pants were reported to significantly contribute to UTIs in military women (Lowe & Ryan-Wenger, 2003, Wardell & Czerwinski, 2001; Wilson & Nelson, 2012). Furthermore, increasing the amount of heat and moisture to the perineum can promote the colonization of microbes that can contribute to UTIs and other conditions, such as vaginitis (Rao, Bhatt, Houghton, & Macfarlane, 2004). These items also can act as a culture medium for fecal bacteria, which may then be rubbed against the urethral opening, thereby promoting migration of bacteria into the bladder (Brusch et al., 2012).
The majority of deployed military women continue to maintain these four practices and others to avoid or minimize urination difficulties in austere environments. Subsequently, these precarious behaviors predispose them to increased risk of dehydration, urinary symptoms, and UTIs, as well as other related health conditions (Hawley-Boland, 1995; Nielson et al., 2009; Ryan-Wenger et al., 2010; Trego, 2012; Wilson & Nelson, 2012). The deleterious practices used by military women to cope with the difficulties of urination in the field setting may also increase their risk of combat-related injury or death. More over, the discomfort and distress of GU symptoms and complications can have an effect on the physical and psycho-social well-being of deployed military women, thereby decreasing the military readiness of the units in which military women serve (Lowe & Ryan-Wenger, 2003).
Urination Practices and Complications
It is well known that frequent and complete voiding is associated with a reduction in the incidence of urinary tract infections (UTIs) (Brusch, Bavaro, Cunha, & Tessier, 2012). Unfortunately, many deployment settings are not conducive to frequent and/or complete urination. Further more, many austere conditions cannot be changed, such as climate, terrain, and security issues, so the best resolution is adaptation by military women. Un fortunately, minimal effort has been put forth to assist military women to adapt urination practices to the austere deployment environment.
Varying Urination Strategies
The lack of adaptive measures has forced military women to revert to deleterious strategies (Scannell-Desch & Doherty, 2012; Trego, 2012; Wilson & Nelson, 2012). Interestingly, the urination practices that military women use to overcome female urination problems in the deployment setting are common across all three military services (Army, Air Force, and Navy). The majority revert to one or more of the following four deleterious practices to cope with the difficulties of urination in the field setting.
Urination Practice #1. The first practice is to intentionally restrict fluid intake to avoid the need to void. This is quite effective in limiting urination, but consequently, can lead to heat injury, dehydration, and the risk for hypovolemic shock. The associated complication of dehydration can result in decreased physical performance and/or mental alertness, as well as increased risk for UTIs (Albright, Gehrich, Buller, & Davis 2005; Czerwinski et al., 2001; Lowe & Ryan-Wenger, 2003, Trego, 2012).
Urination Practice #2. The second practice is to voluntarily hold urine for prolonged periods. Infrequent and/or incomplete emptying of the bladder impedes the regularity, force, and flow of voiding that expels bacteria from the urinary tract. Therefore, this practice is associated with an increased incidence of UTIs (Howes, 2009; Mehnert-Kay, 2005; Sheffield & Cunningham, 2005). In one report, 56.5% (476/841) of the military women surveyed in a female health study reported holding urine to avoid using toilet facilities in the deployment environment (Lowe & Ryan-Wenger, 2003).
Urination Practice #3. The third practice involves military women either squatting over or holding bottles, plastic bags, or cans to their perineum to urinate. One female Army specialist described her convoy experience as follows:
Military women traveling in military convoys don't have much opportunity to urinate. We can sit for hours with minimal stopping due to security reasons. I rode many times with the Marines as their convoy mechanic, and I would have to sit side by side, very close to other soldiers, for hours and hours. They were all men. They would just pee in a can while I suffered. So, I just learned to pee using a jeep funnel that I carried with me when I traveled in convoys. I hooked it up to a large bottle. I would just sit and pull my pants down, and cover up with my top as much as possible, stick the funnel under me, pee in a large jar. The guys just laugh and laugh. I hated it, but when you got to go, you got to go! (Anonymous, personal communication, September 25, 2010)
These practices can expose the urethra to bacteria and other microorganisms, and increase the likelihood of their migration to the bladder, resulting in a UTI (National Kidney and Urologic Diseases Information Clearing-house [NKUDIC], 2012).
Urination Practice #4. The final practice is wearing several layers of perineal pads or disposable incontinence briefs. Aside from the discomfort, inconvenience, and cost of these items, they can increase heat and moisture to the perineum (Omli et al., 2010; Trego, 2007). They also can add bulk to uniform pants that may already be tight-fitting and constricting. Tight, poor-fitting, and/or constricting uniform pants were reported to significantly contribute to UTIs in military women (Lowe & Ryan-Wenger, 2003, Wardell & Czerwinski, 2001; Wilson & Nelson, 2012). Furthermore, increasing the amount of heat and moisture to the perineum can promote the colonization of microbes that can contribute to UTIs and other conditions, such as vaginitis (Rao, Bhatt, Houghton, & Macfarlane, 2004). These items also can act as a culture medium for fecal bacteria, which may then be rubbed against the urethral opening, thereby promoting migration of bacteria into the bladder (Brusch et al., 2012).
The majority of deployed military women continue to maintain these four practices and others to avoid or minimize urination difficulties in austere environments. Subsequently, these precarious behaviors predispose them to increased risk of dehydration, urinary symptoms, and UTIs, as well as other related health conditions (Hawley-Boland, 1995; Nielson et al., 2009; Ryan-Wenger et al., 2010; Trego, 2012; Wilson & Nelson, 2012). The deleterious practices used by military women to cope with the difficulties of urination in the field setting may also increase their risk of combat-related injury or death. More over, the discomfort and distress of GU symptoms and complications can have an effect on the physical and psycho-social well-being of deployed military women, thereby decreasing the military readiness of the units in which military women serve (Lowe & Ryan-Wenger, 2003).
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