Urinary Incontinence: An Under-Reported Problem

With news headlines for 2020 being dominated by the COVID-19 pandemic, it would be easy to miss World Continence Week, which is scheduled for 17 to 23 June 2020. Incontinence, both urinary and faecal, is a condition which lends itself to being an under-reported problem. Most of us know someone who has been diagnosed or succumbed to cancer. Sadly, many of us already have friends, family or colleagues who have suffered or passed away from COVID-19. In contrast, how many of us know of a friend or family member with incontinence?  Not many, I would guess. This does not mean it is an uncommon condition. It is estimated that 46 million adults in Europe over the age of 40 suffer from an overactive bladder. As many as 27 million adults in Europe suffer from faecal incontinence. So why is there such a lack of awareness around this common and bothersome condition?

Well, approximately half of adults with an overactive bladder do not seek medical help, and 85% of adults have not even told their doctor that they struggle with faecal incontinence. Many patients are embarrassed by their condition, some are in denial, and hope that things will resolve spontaneously, and others do not believe effective therapies exist. Contrary to popular belief, there are many effective therapies available. These vary from oral medications and injectable therapies, to advanced therapies such as Sacral Nerve Stimulation. For a variety of reasons, many patients are only ever offered oral medications. While these can be effective, they are not universally so. In addition, they are characterised by a high discontinuation rate due to a variety of side effects which are poorly tolerated, progressive symptoms, and cost. Sadly, most medical funders do not treat urinary incontinence as a chronic condition, and medications are paid from a day to day or medical savings benefit, which is rapidly exhausted. Many patients do not return for a repeat consult. A common refrain I hear is, “I saw the doctor, who prescribed some medication. It never worked, so I never went back.”

For patients who do return, they are usually offered an alternative oral medication. They are often never made aware of the availability of alternative therapies with proven success in the form of injectable therapies such as urethral bulking agents and intravesical botulinum toxin, and medical devices. Their quality of life is significantly impaired, and many patients are hesitant to even leave their home, for fear of an embarrassing incontinence episode. To see someone who has lost all hope, and successfully treat them, is tremendously rewarding. They often become different people and are filled with new confidence and a zest for life. This is one condition where quality of life can be dramatically improved with effective treatment. World Continence Week is a highly effective way of drawing attention to this very common condition. Making our patients aware that effective therapies exist – that can potentially change their lives – is very important. 

By Dr. Prenevin Govender, Urologist at Life Kingsbury Hospital