Military Women's Urinary Complications in Deployment Settings
Military Women's Urinary Complications in Deployment Settings
Since the Persian Gulf War, health experts have recognized the need to target gender-specific self-care measures to prevent risk factors that predispose military women to UTIs in the deployment environment; however, the problem persists (Christopher & Miller, 2007; Czerwinski et al., 2001; Davis & Woods, 1999; Hanna, 1992; Institute of Medicine [IOM], 1996; Murphy, Browne, Mather, Scheele, & Hyams, 1997; Nielsen et al., 2009; Pierce, Antonakos, & Deroba, 1999). Currently, all deploying military personnel must process through mandatory Pre-Deployment Readiness Processing (PRP). This is achieved at specialized sites, called PRP centers. The actual set up at each center may vary from unit to unit, but the outcome remains the same, which is to have deploying service members move through a series of stations designed to ensure their medical, financial, and personal affairs are current. Briefings are provided at each station, but few PRP centers provide guidance about female health, or more specifically, selfcare measures that could mitigate risk factors for urinary symptoms or UTIs. Although health experts have recommended that specialized educational sessions about female GU issues be added to pre-existing PRP programs, most programs still do not address female health issues (Friedl, 2005; Nielson et al., 2009; Thomson & Nielsen, 2006; Trego, 2012). Because female health issues are not a mandatory part of most PRPs, the responsibility for female health readiness continues to ultimately remain with military women themselves.
Some PRP centers provide military women with an Internet address to access a pre-deployment re source developed by the U.S. Army Public Health Command (USAPHC, 2010b) entitled, "Guide to Female Soldier Readiness" (GFSR) (available at http://www.25idl.army.mil/PT/Guide%20to%20Female%20Soldier%20Readinesss%20TG281.pdf). The GFSR is an extensive readiness guide for military women that provides pertinent information about gender-specific health care situations and considerations during deployment. The guide provides strategies for effectively ensuring female readiness with the least amount of impact on the day-to-day mission of the unit. Among other topics, the guide provides an overview of field needs and preventive health measures for military women in the deployment environment. In Section III of the GFSR, recommendations regarding female urination during deployment are addressed as follows:
It is essential that a Soldier drink plenty of water when in the field to maintain adequate urine flow even though bathroom facilities may not be optimal. During convoys or other operations that restrict the places and time allowed for urination, many female Soldiers limit their consumption of liquids. In this effort to decrease their need to urinate, Soldiers dehydrate themselves, sometimes to a dangerous degree. Females should be allowed enough time to urinate on a regular basis, especially since they have to remove much of their gear and require more time than men. There are several commercially developed female urinary devices (FUD), which are available for bladder relief in difficult situations. These devices allow females to urinate through the fly of the uniform while still standing. As of the date of this document, one brand is available in theater in South-west Asia (SWA) and can also be obtained from the U.S. Army Medical Material Command (USAMMC) Europe (USAPHC, 2010b, p. 3).
The military's GFSR recognizes and addresses many complications of female urination in a deployment environment, but findings from current literature suggest these problems continue to persist in military women deployed to OIF and OEF (Lowe & Ryan-Wenger, 2003; Nielsen et al., 2009; Ryan-Wenger et al., 2010, Trego, 2012, Wilson & Nelson, 2012). Although a female urinary diversion device (FUDD) is recommended as a self-care measure for urination in difficult situations in the deployed environment, they are not routinely provided to deploying military women as part of the PRP. In fact, very few military women reported being aware of FUDDs, and even less reported having used the devices (Nielsen et al., 2009).
One reason for the lack of awareness and lack of use may be the dearth of scientifically based support for its utility, especially in the deployment environment. Skepticism about its utility may deter military leaders from ordering them for deploying military women. Military women who may have knowledge about FUDDs often remain reluctant to purchase them in a civilian store for fear that it may not work in a military environment. For some military women, the cost of the FUDDs may deter them from purchasing them because they do not want to waste money on something that may or may not work. There are several brands of FUDDs available online and in stores that carry outdoor or camping equipment. The price range of FUDDs varies from $14 (with shorter tubing) to $28 for those with longer tubing. An urgent need remains to determine the utility, health, and quality of life effects of the FUDD to determine if its implementation as a self-care measure can alleviate the discomforts and difficulties of urination and mitigate associated predisposing risk factors for urinary symptoms and UTIs in deployed military women.
Female Readiness Issues
Since the Persian Gulf War, health experts have recognized the need to target gender-specific self-care measures to prevent risk factors that predispose military women to UTIs in the deployment environment; however, the problem persists (Christopher & Miller, 2007; Czerwinski et al., 2001; Davis & Woods, 1999; Hanna, 1992; Institute of Medicine [IOM], 1996; Murphy, Browne, Mather, Scheele, & Hyams, 1997; Nielsen et al., 2009; Pierce, Antonakos, & Deroba, 1999). Currently, all deploying military personnel must process through mandatory Pre-Deployment Readiness Processing (PRP). This is achieved at specialized sites, called PRP centers. The actual set up at each center may vary from unit to unit, but the outcome remains the same, which is to have deploying service members move through a series of stations designed to ensure their medical, financial, and personal affairs are current. Briefings are provided at each station, but few PRP centers provide guidance about female health, or more specifically, selfcare measures that could mitigate risk factors for urinary symptoms or UTIs. Although health experts have recommended that specialized educational sessions about female GU issues be added to pre-existing PRP programs, most programs still do not address female health issues (Friedl, 2005; Nielson et al., 2009; Thomson & Nielsen, 2006; Trego, 2012). Because female health issues are not a mandatory part of most PRPs, the responsibility for female health readiness continues to ultimately remain with military women themselves.
Some PRP centers provide military women with an Internet address to access a pre-deployment re source developed by the U.S. Army Public Health Command (USAPHC, 2010b) entitled, "Guide to Female Soldier Readiness" (GFSR) (available at http://www.25idl.army.mil/PT/Guide%20to%20Female%20Soldier%20Readinesss%20TG281.pdf). The GFSR is an extensive readiness guide for military women that provides pertinent information about gender-specific health care situations and considerations during deployment. The guide provides strategies for effectively ensuring female readiness with the least amount of impact on the day-to-day mission of the unit. Among other topics, the guide provides an overview of field needs and preventive health measures for military women in the deployment environment. In Section III of the GFSR, recommendations regarding female urination during deployment are addressed as follows:
It is essential that a Soldier drink plenty of water when in the field to maintain adequate urine flow even though bathroom facilities may not be optimal. During convoys or other operations that restrict the places and time allowed for urination, many female Soldiers limit their consumption of liquids. In this effort to decrease their need to urinate, Soldiers dehydrate themselves, sometimes to a dangerous degree. Females should be allowed enough time to urinate on a regular basis, especially since they have to remove much of their gear and require more time than men. There are several commercially developed female urinary devices (FUD), which are available for bladder relief in difficult situations. These devices allow females to urinate through the fly of the uniform while still standing. As of the date of this document, one brand is available in theater in South-west Asia (SWA) and can also be obtained from the U.S. Army Medical Material Command (USAMMC) Europe (USAPHC, 2010b, p. 3).
The military's GFSR recognizes and addresses many complications of female urination in a deployment environment, but findings from current literature suggest these problems continue to persist in military women deployed to OIF and OEF (Lowe & Ryan-Wenger, 2003; Nielsen et al., 2009; Ryan-Wenger et al., 2010, Trego, 2012, Wilson & Nelson, 2012). Although a female urinary diversion device (FUDD) is recommended as a self-care measure for urination in difficult situations in the deployed environment, they are not routinely provided to deploying military women as part of the PRP. In fact, very few military women reported being aware of FUDDs, and even less reported having used the devices (Nielsen et al., 2009).
One reason for the lack of awareness and lack of use may be the dearth of scientifically based support for its utility, especially in the deployment environment. Skepticism about its utility may deter military leaders from ordering them for deploying military women. Military women who may have knowledge about FUDDs often remain reluctant to purchase them in a civilian store for fear that it may not work in a military environment. For some military women, the cost of the FUDDs may deter them from purchasing them because they do not want to waste money on something that may or may not work. There are several brands of FUDDs available online and in stores that carry outdoor or camping equipment. The price range of FUDDs varies from $14 (with shorter tubing) to $28 for those with longer tubing. An urgent need remains to determine the utility, health, and quality of life effects of the FUDD to determine if its implementation as a self-care measure can alleviate the discomforts and difficulties of urination and mitigate associated predisposing risk factors for urinary symptoms and UTIs in deployed military women.
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