THE BIG ISSUE

Incontinence is a 'Big Issue'!!!

Urinary incontinence is one of the most important health problems confronting modern society.

The statistics are quite astounding without taking into consideration those people with lower urinary tract symptoms (LUTS), who with advice and treatment at this stage, may be able to prevent incontinence from developing.

Some astounding statistics

  • In the UK, there are over 14 million people who have bladder control problems and 6.5 million with bowel control problems - this is approximately the number of people in the UK aged 60 and over!
  • Approximately 10% of all adult women suffer from urinary incontinence[1].
  • 0.4%–16% men are thought to have moderate to severe urinary incontinence. The number of affected men increases with age, and men aged 75 plus are most likely to experience bladder problems[2].
  • Urinary incontinence affects 11% men and 20% women over age 60[3].

    That is 1 in every 5 older women and 1 in every 10 older men.

Did you know? More older women experience incontinence than breast cancer, heart disease or diabetes.

You probably were not aware of this because incontinence is taboo!

Lower urinary tract symptons (LUTS)

It is not just about incontinence or actual leakage. We also need to think about the ‘almost’ leaks and the people who get to the toilet ‘just in time’, because providing advice and treatment at this stage may prevent incontinence from developing.

Did you know? More people experience lower urinary tract symptoms, or LUTS, than urinary incontinence but most do not seek treatment because they believe their symptoms are a normal part of ageing or because they are too embarrassed.

LUTS are usually grouped as:

  • Symptoms which affect storage of urine in the bladder, or
  • Symptoms which affect the voiding of urine, or
  • Symptoms that occur post-micturition, after the voiding has finished

Specific LUTS are associated with particular conditions.

What’s forecast for the future?

  • In 2011 an increase of approximately 20% across the globe was predicted by 2018 for:
    • Lower Urinary Tract Symptoms (LUTS) - 2.3 billion report these
    • Urinary Incontinence (UI) - 423 million report this
    • Overactive Bladder (OAB) - 546 million report this
  • By 2030 the greatest increase in demand for UI care will be in older women aged 60-89 with OAB. Urinary incontinence care demands will increase by 80%[4]
  • Overall the ageing of the global population is the biggest influence on prevalence of UI.
  • Europe has the greatest prevalence of UI of all, globally.

  • The oldest old, those over 80, are the fastest growing group In Europe. The oldest old have the most severe continence issues because they are also the most frail, with large numbers of risk factors and co-morbidities.

  • The highest concentration of people living with bladder and bowel incontinence are those in care homes.

  • A survey of 12,120 UK care home residents by BUPA in 2012 found

    • 13% had UI only

    • 2% had faecal incontinence (FI) only

    • 56% had dual UI/FI (equivalent to 6,788 people)

Incontinence is associated with different diseases and medical conditions

Incontinence is associated with lots of different diseases and medical conditions. One example is stroke:

  • UI affects 40-60% of people after a stroke. This is 60,000 – 90,000 people in the UK each year
  • 44% stroke survivors report UI at 3 months, 38% at 12 months[5]
  • The most common type of UI experienced following stroke is urge UI[6]

Your task

  1. Find information and definitions for the LUTS which make up the overactive bladder syndrome (OAB) and identify which one must always be present in OAB

  2. Describe the four LUTS most commonly found in men with ‘benign prostatic hyperplasia’ (BPH) and note their definitions.

  3. Which is the most common LUTS experienced by adults across the world?

Don’t forget to add these definitions into your glossary.


References

1. Milsom I. The prevalence of urinary incontinence. Acta Obstet Gynecol Scand. 2000;79(12):1056-9. [Cited 26 July 2018]. Available from: https://www.ncbi.nlm.nih.gov/pubmed/11130087

2. Markland AD, Goode, PS, Redden DT, Lori G, Burgio KL. Prevalence of urinary incontinence in men: results from the national health and nutrition examination survey. J Urol. 2010;184(3):1022–7. [Cited 26 July 2018]. Available from: http://dx.doi.org/10.1016/j.juro.2010.05.025

3. Irwin DE, Milson I, Hunskaar, S, Reilly K, Kopp Z, Herschorn S, et al. Population-based survey of urinary incontinence, overactive bladder, and other lower urinary tract symptoms in five countries: results of the EPIC study. Eur Urol. 2006;50:1306–14 [Cited 26 July 2018]. Available from: http://dx.doi.org/10.1016/j.eururo.2006.09.019

4. Irwin DE, Kopp, ZS, Agatep, B, Milsom I, Abrams P. Worldwide prevalence estimates of lower urinary tract symptoms, overactive bladder, urinary incontinence and bladder outlet obstruction. BJU Int. 2011;108,1132-1139 [Cited 26 July 2018]. Available from: https://doi.org/10.1111/j.1464-410X.2010.09993.x

5. Williams MP, Srikanth V, Bird M, Thrift AG. Urinary symptoms and natural history of urinary continence after first-ever stroke – a longitudinal population-based study. Age and Ageing. 2012;41;371-376 [Cited 26 July 2018]. Available from: https://academic.oup.com/ageing/article/41/3/371/31896

6. Pettersen R, Stien R, Wyller TB. Post-stroke urinary incontinence with impaired awareness of the need to void: clinical and urodynamic features. BJU Int. 2007;99(5):1073-7 [Cited 26 July 2018]. Available from: http://dx.doi.org/10.1111/j.1464-410X.2007.06754.x

Milsom, I et al. Global Prevalence and Economic Burden of Urgency Urinary Incontinence: A Systematic Review. European Urology. 2014 January;65(1)79-95. [Cited 26 July 2018]. Available from: http://dx.doi.org/10.1016/j.eururo.2013.08.031

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Understanding Continence Promotion: Effective Management of Bladder and Bowel Dysfunction in Adults

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