The first national audit of continence care for older people in the UK shows a widespread failure to diagnose and manage problems.
Incontinence can affect elderly people
The Royal College of Physicians looked at the care of nearly 10,000 people in England, Wales and Northern Ireland.
It found specialist NHS staff had good continence knowledge, but patients were often not examined thoroughly or given routine assessments.
Even when they were, there was no guarantee of a full diagnosis.
For most patients only the symptoms were managed, when in some cases there could be a cure.
Urinary incontinence affects 24% of older people and 30-60% of people in institutional care
Faecal incontinence occurs in approximately 1-4% of adults and up to 25% of people in institutional care
The RCP audit, carried out for the Healthcare Commission, also found a widespread rationing of continence pads, an over-reliance on the use of catheters and limited staff training.
The National Service Framework for Older People set the requirement that service providers should establish integrated continence services by April 2004.
However, the audit found provision of services remains extremely variable.
Only 59% of primary and 32% of secondary care sites had a written policy covering continence care for older people.
Similarly, only 64% of primary and 44% of secondary sites had a protocol for providing basic assessment to patients.
The report said placing the emphasis on containment of continence problems, rather than seeking a cure, was expensive.
Dr Adrian Wagg, chairman of the Continence Working Party, said: "It shows that care for people with continence problems is patchy at best, that a cure is seldom attempted and that the single mandatory target for continence in the NSF has not been met."
Clive Evers, of the Alzheimer's' Society, said: "It is shocking that incontinence care throughout the country is so appalling.
"Incontinence can be distressing and humiliating for the person concerned, and their family, and it is vital that everything possible is done to reduce this distress."
Dr Lorna Layward, of the charity Help the Aged, said incontinence was still treated as a taboo subject, and had not been given due priority.
"We urgently need to look at ways of treating the underlying causes of incontinence rather than just treating the symptoms."