People with incontinence face a "life sentence" of suffering due to poorly organised NHS care, a report has said.
Bladder and bowel incontinence affects one in five people and causes poor health, depression and social isolation, while costing the NHS millions of pounds. But the study found services are failing patients, in particular the elderly, who may not get treatments or a clear diagnosis.
An audit of services for more than 18,000 people in health trusts and care homes found "diagnosis and treatment of incontinence is often poor or non-existent".
Only half of patients in mental health trusts and care homes had a treatment plan for urinary incontinence, according to the National Audit of Continence Care. Many patients had no bowel history taken despite being incontinent in that area, while many also suffered due to lack of diagnosis.
The report, commissioned by the Healthcare Quality Improvement Partnership and carried out by the Royal College of Physicians' clinical effectiveness and evaluation unit, said continence services are poorly integrated across hospitals, care homes and services in the community, even though most claim to be integrated.
Dr Adrian Wagg, clinical director of the audit, said: "Although these are treatable conditions, people of all ages, and vulnerable groups in particular (frail older people and younger people with a learning disability) continue to suffer unnecessarily and often in silence, with a life sentence of bladder and/or bowel incontinence."
Patients Association chief executive, Katherine Murphy, added: "Continence problems are a silent epidemic with symptoms that can be very distressing and drastically reduce the quality of life of a sufferer.
"Many millions of people are affected and this report shows yet again that too many of them are suffering unnecessarily and not getting the help they need."
A Department of Health spokesman said: "This audit shows a distressing lack of response to patients' views and needs, a lack of expertise in commissioning continence care, and a lack of integrated care.
"The Government's White Paper puts patients at the heart of the service, and will strengthen clinically-led commissioning. This audit will be a powerful spur, to enable patients and clinicians to deliver the quality of care patients have a right to expect."