Patients with bladder and bowel incontinence are being failed by the NHS, according to a report.
The National Audit of Continence Care said that patients with these illnesses are being given a "life sentence" of inadequate treatment.
Incontinence affects 20% of the population, but an audit of more than 18,000 people found that the NHS needs to create clearer guidance in this field.
The report said: "Diagnosis and treatment of incontinence is often poor or non-existent."
In mental health trusts and care homes only 50% of patients had a treatment plan for urinary incontinence, while many bowel patients had not been identified due to insufficient histories being taken.
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."