The International Continence Society (ICS) defines incontinence as the involuntary loss of bladder or bowel control.

Urinary Incontinence (UI) is a stigmatized, underreported, under-diagnosed, under-treated condition that is erroneously thought to be a normal part of aging.1 One-third of men and women ages 30-70 believe that incontinence is a part of aging to accept.2

Information on healthy bladder function can help promote the understanding that incontinence is not a normal part of aging but a symptom of another problem.3

The social costs of UI are high and even mild symptoms affect social, sexual, interpersonal, and professional function.4


General Prevalence

UI affects 200 million people worldwide.5

Based on expert opinion, 25 million adult Americans experience transient or chronic UI.6 NAFC estimates that 75-80% of those sufferers are women, 9-13 million of whom have bothersome, severe, symptoms.

Consumer research reveals that one in four women over the age of 18 experience episodes of leaking urine involuntarily.2

One-third of men and women ages 30-70 have experienced loss of bladder control at some point in their adult lives and may be still living with the symptoms.2

Of men and women ages 30-70 who awaken during the night to use the bathroom, more than one-third get up twice or more per night to urinate, fitting the clinical diagnosis of nocturia. Of these adults, one in eight say they sometimes lose urine on the way to the bathroom.2

Two-thirds of men and women age 30-70 have never discussed bladder health with their doctor.2

One in eight Americans who have experienced loss of bladder control have been diagnosed. Men are less likely to be diagnosed than women. Men are also less likely to talk about it with friends and family, and are more likely to be uninformed.2

On average, women wait 6.5 years from the first time they experience symptoms until they obtain a diagnosis for their bladder control problem(s).2

Two-thirds of individuals who experience loss of bladder control symptoms do not use any treatment or product to manage their incontinence.2


Nursing Homes/ Elderly

53% of the homebound older persons are incontinent, and UI is one of the 10 leading diagnoses among homebound persons.7 

More than half of all residents in nursing homes are incontinent and it is the second leading cause of institutionalization.3

The elderly’s need for frequent toileting and/or the urgency to void increases the risk of falls by as much as 26% and bone fracture by as much as 34%.8

22% of continent female residents admitted to a long-term care facility became incontinent within one year of admission.3


Stress Incontinence

Stress urinary incontinence, the most prevalent form of incontinence among women, affects an estimated 15 million adult women in the U.S.9,10,11

29% of individuals ages 60-70 experience leakage when coughing, sneezing, or laughing compared to 17% of men and women ages 30-39. A portion of these individuals also experience urge incontinence.2

One-fourth of women older than 17 reportedly experienced stress incontinence during the immediately preceding 30 days from being questioned. 24% of women ages 25-44 experienced symptoms compared to 33% of women ages 45-64.2

Studies have indicated that as many as 50% of men report leakage due to SUI in the first few weeks following prostate surgery after removal of the catheter.12 In approximately 20% of men, some degree of SUI will continue to be a significant problem one year post-surgery.13


Urge Incontinence / Overactive Blader (OAB)

About 17% of women and 16% men over 18 years old have overactive bladder (OAB) and an estimated 12.2 million adults have urge incontinence. 14

One in five adults over age 40 are affected by OAB or recurrent symptoms of urgency and frequency, a portion of whom don’t reach the toilet before losing urine.2

OAB and UI occur about twice as frequently in women as in men and become more prevalent with advanced aging.15

Women with OAB are significantly more likely to suffer from other health disorders, such as hypertension, obesity and arthritis, than women without OAB. Also, OAB sufferers are two to three times more likely to regularly experience disturbed sleep, overeating, and poor self-esteem, compared with non-OAB sufferers.2

An estimated 17 million community-dwelling adults in the United States have daily UI and a further 33 million suffer from the overlapping condition, OAB.1


Economic Costs

The 1995 societal cost of incontinence for individuals 65 years of age and older was $26.3 billion, or $3565 per individual with urinary incontinence. Most of the total cost is associated with direct treatment, such as the cost of diagnostic testing and medication. 16

The cost of OAB is 12.6 billion in year 2000 dollars. $9.1 and $3.5 billion, respectively, was incurred by community and institutional residents.17

Nearly half of the costs of UI are for medical services paid by Medicare.18

The cost of caring for UI and OAB in nursing facility patients is an estimated $5.3 billion.16

Key statistics related to adult incontinence & underpads such as demographics, volume per unit, supply/demand, major national brands & private label, market share national brands & private label, market trends & estimates can be found in a report authored by Ian Butler and available for purchase by contacting the Association of the Nonwoven Fabrics Industry (INDA) at:

           

INDA

PO BOX 1288

Cary, NC 27512-1288

Ph: (919) 233-1210

Fax: (919) 233-1282

www.inda.org


Fecal Incontinence

Fecal incontinence is the inability to control the passage or the loss of gas, liquid and/or solid stool.

It has been estimated that more than 6.5 million Americans have fecal incontinence.19

One out of ten women in the general population has fecal incontinence, with one in fifteen of these women suffering from moderate to severe symptoms. 20

It is suggested that 2.2 % of all women that have delivered one or more children experience fecal incontinence. 21

Seven percent of healthy people 65 years & older experience fecal incontinence, and 23% of stroke patients experience it. 20

33% of elderly people at home or in a hospital experience bowel control problems.2

Vaginal delivery with the assistance of forceps has been shown to be a cause of clinically significant pelvic floor dysfunction, which can lead to fecal incontinence.22


Pelvic Organ Prolapse

Pelvic organ prolapse (POP) may be considered a type of “hernia” in which the pelvic organs descend or shift within the pelvis, and in some cases, protrude outside the vagina. 

As many as 50% of women who have given birth one or more times have some degree of genital prolapse, but only 10 to 20% experience symptoms.23

At whole, the lifetime risk for women undergoing surgery for repair of POP is 11%. 27% percent of women have repeat surgery. 24

Approximately half of all women over age 50 complain of symptoms associated with prolapse.23

It is very rare for someone who has not had a child to experience POP. Changes in connective tissue during pregnancy, pressure and weight of the uterus on the pelvic floor, weight gain of the mother, trauma to the pelvic floor and connective tissue during vaginal delivery, abdominal straining during labor, and ensuing nerve damage all promote POP. 25,26


Enlarged Prostate/ Benign Prostatic Hyperplasia (BPH)

BPH is characterized by urinary frequency, urgency, nocturia, weakened stream, and incomplete bladder emptying.

As many as 50% of men experience symptoms of an enlarged prostate by age 60, and 90% of men will report symptoms by age 85. 27

In most men the prostate gland will undergo two stages of growth. The first stage occurs early in life and is usually complete by the end of puberty. The prostate usually remains the same size for many years but may begin growing again, and cause problems by age 40. 28


Bedwetting (Nocturnal Enuresis)

It is estimated that more than 5 million children in the US experience nocturnal enuresis (bedwetting). 29

2-3% of men and women older than eighteen have never gained nighttime dryness. 30


Sources

1 Levy R, Muller N. Urinary incontinence: economic burden and new choices in pharmaceutical treatment. 

2 Muller N. What Americans Understand How they Affected by Bladder Control Problems: Highlights of Recent Nationwide Consumer Research. Urologic Nursing. 2005:25(2): 109-115.

3 Bell M, DeMarinis M. The psychological cost of incontinence. ECPN. 2006;109:13-14.

4 Lenderking WR, Nackley JF, Anderson RB, Testa MA. A review of the quality-of-life aspects of urinary urge incontinence; importance of patients’ perspective and explanatory lifestyle. J Am Geriatr Soc. 1998;46(6)683-692. 

5 Vulker, R. International Group Seeks to Dispel Incontinence “Taboo”, JAMA, 1998, No.11: 951-53.

6Resnick, NM, Improving treatment of urinary incontinence (commentary letter). JAMA. 1998;280 (23):2034-2035.

7 Martin CM. Urinary incontinence in the elderly. Consultant Pharmacist. 1997;12(8).

8 Saffel D. Medication in the treatment of urinary incontinence. ECPN. 2006;109:27-31.

9 Hampel C, Weinhold D, Benken N, Eggersmann C, Thuroff JW. Definition of overactive bladder and epidemiology of urinary incontinence. Urology. 1997;50 (suppl 6A):4-14.

10 Abrams P, Cardozo L, Fall M, et al. The standardisation of terminology of lower urinary tract function: Report from the Standardisation Sub-committee of the International Continence Society. Neurolgy Urodynamics. 2002;21(2)167-178.

11 Derived from Diokno, 2004 and Hampel and based on United States Census, 2000.

12 Catalona WJ, Ramos CG, Carvalhal GF, Contemporary Results of Anatomic Radical Prostatectomy, Ca Cancer Clinic 1999, 49: 282-296.

13 Burgio K, Goode P, Urban D, Umlauf M, Locher J, Bueshen A, Redden D. Preoperoative Bio-feedback-Assisted Behavioral Training to Reduce Post-Prostatectomy Incontinence. Birmingham VA Medical Center, Neurourology and Urodynamics 2005, 24: 477-478.

14 Stewart WR et al. Prevalence and impact of OAB in the US: results from the NOBLE program. Neurological Urodynamics. 2001; 20:406-408.

15 Stewart WF, Van Rooyen JB, Cundiff GW, et al. Prevalence and the burden of overactive bladder in the United States. World J Urol. 2003;20(6):327-336. 

16 Wagner TH, Hu TW. Economic costs of urinary incontinence in 1995. Urology. 1998;51(3):355-361. 

17 Hu TW, Wagner TH, Bentkover JD, Leblanc K, Zhou SZ, Hunt T. Costs of urinary incontinence and overactive bladder in the United States: a comparative study. Urology. 2004;63(3):461-465.

18 Wound Ostomy and Continence Nurses S. Position statement on coverage for pelvic floor biofeedback therapy. http://www.wocn.org/publications/posstate/biofeedback.html Accessed 2005/01/06

19 US. National Institutes of Health. Department of Health and Human Services. “Fecal Incontinence.” Bethesda, MD: NIDDK, 2001.

20 Bharucha AE, Zinsmeister AR, Locke GR, Seide BM, McKeon K, Schleck CD, 11Melton LJ.  Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, Rochester, MN.  Gastroenterology.  2005; 129(1):42-9.  

21 Palmeri Md, Beniamino, Giorgia Benuzzi, Bsc, and Nicola Bellini, Bsc, Phd. The anal bag; a modern approach to fecal incontinence management. Ostomy Wound Management. 2005; 51(12): 44-52.   

22 Farrell, Scott A. “Cesarean Section Versus Forceps-Assisted Vaginal Birth: It’s Time to Include Pelvic Injury in the Risk-Benefit Equation.” Canadian Medical Association Journal (2002): 166-169. 26 May 2006.

23 Beck RP, Nordstrom L: A 25 year experience with 519 anterior colporrhaphy procedures. Obstetr.Gynecol 78:1011-1018, 1991.

24 Olsen AL, Smith, Bergstrom, et al: Epidemiology of surgically managed pelvic organ prolapse and urinary incontinence. Obstetrics and Gynecology 89:501-506, 1997.

25 Aanestad O, Flink R: Urinary stress incontinence. A urodynamic and quantitative electromyographic study of the perineal muscles. Acta Obstetricia et Gynecologica Scandinavica 78:245-253, 1999.

26 Hale DS, Benson JT, Brubaker L, et al: Histologic analysis of needle biopsy of urethral sphincter from women with normal and stress incontinence with comparison of electromyographic findings. American Journal of Obstetrics & Gynecology 180:342-348, 1999.

27 Berry SJ, Coffey DS, Walsh PC, et al: The Development of human benign prostatic hyperplasia with age. J Urol 1984; 132:474.

28 Berry SJ, Coffey DS, Walsh PC, et al: The Development of human benign prostatic hyperplasia with age. J Urol 1984; 132:474.

29 Dunlop, Amy. “Meeting the Needs of Parents and Pediatric Patients: Results of a Survey on Primary Nocturnal Enuresis.” Clinical Pediatrics 44 (2005): 297-303.

30 Sakamoto, Kyoko, and Jerry G. Blaivas. “Adult Onset Nocturnal Enuresis.” Journal of Urology 165 (2001): 1914-1917.