A look at how incontinence Affects physical, mental and financial well-being.
Maria, a 52-year old mother of 3, first began experiencing Bladder Leaks in her mid-forties. It was an occasional problem, only occurring once or twice a month, and something she didn’t really think much about. “I just thought it was a part of growing older,” she said. However, as she began to edge closer to 50, the episodes began happening more frequently. “I’d be out walking the dog and have a sudden urge to use the restroom – and I found I couldn’t hold it in”, she said. As the leaks continued to increase, she began limiting her activities. “I tried to stay close to home just in case the urge came to go. When I’d go out, I located the nearest bathroom right away in case I needed to make a run for it.” She didn’t reach out to her doctor, or even tell her family about her problem for a long time. “I was just so embarrassed. I’m a grown woman – I didn’t want people to know I peed my pants.”
Maria’s not alone. One in 4 women over the age of 35 is affected by incontinence. (1) It can happen in men, but it occurs twice as much in women, due to things like pregnancy, childbirth and menopause.(2) Unfortunately, many of these people do not seek help for their condition– most people wait an average of 6 years before even talking with a doctor. (3) This is due, in large part, to embarrassment about having bladder leaks, and the misconception that incontinence is just a part of getting older.
But incontinence is not just a part of getting older. Yes, it’s common, but it shouldn’t be thought of as normal, especially considering the many options in management. In fact, ignoring incontinence can be detrimental to your physical, mental and financial well being. Let’s take a look at how incontinence affects these three areas of life.
The Physical Impact Of Incontinence
While many people see incontinence as embarrassing, until you’ve experienced it yourself you may not realize the true physical impact that it can have on your life. Of course there’s the obvious problem of having to change clothes or bedding often, or running to the bathroom, but incontinence can impact your physical health in other ways too. Many people with regular incontinence suffer from skin infections, due to over-exposure to moisture. Incontinence dermatitis (also known as diaper rash) can occur frequently and bacterial or fungal infections can also develop easily when skin comes into contact with bacteria from waste products repeatedly.
Additionally, many people report reducing their physical activity when they have Incontinence. For those who were once active, activities such as running or other high impact exercises are often avoided or stopped completely once the practice may lead to unexpected and involuntary leakage of urine. In fact, over 20% of women have quit their physical activities due to urinary incontinence. (4) In a large Australian study, it was found that more than33.3% of women between the ages of 45 and 50 reported that they avoid athletic activities fearing an incontinence episode during exercise. This can be dangerous, as it can lead to a more sedentary lifestyle, which may contribute to other diseases, such as osteoporosis, hypertension, and coronary heart disease. (5)
Finally, incontinence presents a much greater risk for falls and fractures, especially in older adults. One study showed that weekly or more frequent urge incontinence independently increased the risk of falls by 26% and the risk of fractures by 34% in older adult women. (6) It is hypothesized that this occurs because older adults have a reduced capacity to divide their attention. Thus, an elderly person who is focused on needing to get to the restroom quickly may become unaware of the potential hazards that lie in their path to get to the bathroom, or may become inattentive to controlling their posture or body movements, which increases the risk of falling. Given that the CDC has reported that falls are the leading cause of fatal injury and the most common cause of nonfatal trauma-related hospital admissions among older adults, it is important to take measures to reduce anything that may contribute to them, including incontinence. (7)
The Mental Impact of Incontinence
While the physical impact of incontinence is substantial, the effect of incontinence on a person’s mental health can be truly devastating. Many people with incontinence carry an emotional burden of shame and embarrassment in addition to the physical disruption on their lives. They learn to hide their problem from close friends and family, and even significant others for years. Most wait at least 6 years before even discussing the problem with a doctor. (3). They shy away from social activities for fear they will have an accident in public, and stop doing things they once took joy in. Slowly, their isolation and shame may lead to depression and anxiety. Even after accounting for other medical conditions and demographic differences, incontinence negatively impacts a person’s quality of life. (8-13). In fact, research has found an association between incontinence and declining mental health and an increased risk of the onset of psychological distress and depressive symptoms. (14) In one study, women with severe urinary incontinence had an 80% greater possibility of presenting deep depression while women with mild incontinence had a 40% greater possibility of presenting depression. (15) Another study showed when urinary incontinence is severe enough, the incidence of a stress disorder increased by 4 times. (16).
And the impact doesn’t stop there – sexual functioning also takes a hit. One study reported that 43% of participants with urinary incontinence felt that their urinary disorder had adversely affected sexual relations. (17) Premenopausal women with urinary incontinence have reported lower scores of desire, stimulation, lubrication of the vagina, orgasm and satisfaction. (18) Add to that the anxiety that many women feel that they may have an incontinent episode during sex, and it’s easy to see why many women with incontinence may avoid the act all together.
Unfortunately, the mental impact of incontinence doesn’t just affect the patient. The physical and psychological toll of those caring for an incontinent loved one is also significant. Many caregivers have reported problems with role change, sleeping, finances, intimacy and social isolation (19). It’s been shown that incontinence adds to the psychological and physical burden of caregivers and can be a risk factor for nursing home placement, hospitalization and death. (14) In fact, urinary incontinence has been reported to be one of the leading causes of nursing home admissions. (20) Given the extreme guilt that often accompanies this decision, it’s no surprise that incontinence negatively affects caregivers as well as patients.
The Financial Impact of Incontinence.
As if the cost to a person’s mental and physical health weren’t enough, the economic impact that incontinence has also weighs heavily on patients and caregivers. Incontinence presents a significant financial burden to the individual and to society. In the US, the cost of bladder incontinence among adults was estimated at $19.5 billion in 2000. (14) And on an individual level, women with severe urinary incontinence pay $900 annually for incontinence care. (21) The expenses include costs for things like absorbent products, medications, doctor visits, and dry cleaning or laundry. Unfortunately, incontinence gets worse with time if left untreated and costs only go up as we age. Women over 65 tend to spend more than twice as much on incontinence (7.6 billion annually) than younger women (3.6 billion annually). (22)
And it’s not just the direct costs that contribute to the financial stress of incontinence. Up to 23% of women take time off work due to incontinence. (23) The combination of lost work, plus the funds needed to actually treat the condition can really add up to a financial drain on the pocketbook.
What Can Be Done.
While incontinence may not be a life-threatening condition, it’s clear that the physical, mental and financial burdens that are placed on a person with the condition severely affect overall quality of life. But, the good news is that there is a wealth of treatment options available to patients, which can ease many of these burdens. However, in order to get the treatment that so many need, we must first start by thinking about this condition differently. Doctors need to have a forthcoming discussion with their patients about incontinence, and patients need to be willing to speak up about the condition with their doctors. And, as a community, we all need to be more open about incontinence to erase the stigma that has held so closely to it for so many years. If you live with this condition, or know someone who does, we urge you to speak up, educate yourself, and get treatment. Because living with a condition that so severely impacts you physically, mentally and financially is no way to live.
As for Maria, she finally took action against her problem. After seeking help from her doctor – a full 7 years after she started experiencing leaks – she was put on a plan that included medication and physical therapy to address her bladder leakage. “I feel like I have a new lease on life. I wasted so many years hiding and feeling ashamed for something that I now see was so easily treatable. I just wish I had sought help sooner.”
Check us out at: www.ActivKare.com
1. Stavros Charalambous . The impact of Urinary Incontinence On Quality Of Life. Review Article, June, 2009.– Argyrios Trantafylidis, Department of Urology, Ippokratio General Hospital, Thessaloniki, Greece
2. NIH Website: https://www.niddk.nih.gov/health-information/urologic-diseases/bladder-control-problems-women
3. National Association For Continence. (2002). National stress urinary incontinence survey. Unpublished study. Charleston, SC: Author.
4. Nygaard I, Delancey JO, Arnsdorf L. Exercise and incontinence. Obstet Gynecol. 1990;75:848-51.
5. Brown WJ et al. Too wet to exercise? Leaking urine as a barrier to physical activity in women. J Sci Med Sport 2001; 4: 373-378
6. Brown JS, Vittinghoff E, Wyman JF, et al for the Study of Osteoporotic Fractures Research Group.Urinary incontinence: does it increase risk for falls and fractures?J Am Geriatr Soc2000 Jul;48:721–5PubMedWeb of Science
7. Center For Disease Control. https://www.cdc.gov/features/older-adult-falls/index.html
8. EH, Coyne T, Hawes SK, Merikhi L, Naples SP, Kanagarajan N, et al. Fecal incontinence: Prevalence, severity, and quality of life data from an outpatient gastroenterology practice. Gastroenterol Res Pract 2012:947694. 2012.
9. Khatutsky G, Walsh EG, Brown DW. Urinary incontinence, functional status, and health-related quality of life among Medicare beneficiaries enrolled in the program for all-inclusive care for the elderly and dual eligible demonstration special needs plans. J Ambul Care Manage 36(1):35–49. 2013.
10. Minassian VA, Devore E, Hagan K, Grodstein F. Severity of urinary incontinence and effect on quality of life in women by incontinence type. Obstet Gynecol 121(5):1083–90. 2013.
11. Kwong PW, Cumming RG, Chan L, Seibel MJ, Naganathan V, Creasey H, et al. Urinary incontinence and quality of life among older community dwelling Australian men: The CHAMP study. Age Ageing 39(3):349–54. 2010.
12. Bartlett L, Nowak M, Ho YH. Impact of fecal incontinence on quality of life. World J Gastroenterol 15(26):3276–82. 2009.
13. . Ko Y, Lin SJ, Salmon JW, Bron MS. The impact of urinary incontinence on quality of life of the elderly. Am J Manag Care 11(4 Suppl):S103–11. 2005.
14. Prevalence of Incontinence Among Older Americans. Vital & Health Statistics, Series 3, Number 36, US Department of Health And Human Services. June, 2014 : https://www.cdc.gov/nchs/data/series/sr_03/sr03_036.pdf
15. Nygaard I et al. Urinary incontinence and depression in middle-aged United States women. Obstet Gynecol 2003; 101: 149-156
16. Bogner HR et al. Anxiety disorders and disability secondary to urinary incontinence among adults over age 50. Int J Psychiatry Med 2002; 32: 141-154.
17. Sutherst J, Brown M: Sexual dysfunction associated with urinary incontinence. Urol Int 35: 414, 1980
18. Aslan G et al. Sexual function in women with urinary incontinence. Int J Impot Res 2005; 17: 248-251.
19. Cassells, C., & Watt, E. (2003). The impact of incontinence on older spousal caregivers.
20. Martin CM. Urinary incontinence in the elderly. Consult Pharm. 1997;8:12.
21. Leslee L. Subak, MD, Jeanette S. Brown, MD, Stephen R. Kraus, MD, Linda Brubaker, MD,MS, Feng Lin, MS, Holly E. Richter, PhD, MD, Catherine S. Bradley, MD, MSCE, Deborah Grady, MD, MPH, and Diagnostic Aspects of Incontinence Study (DAISy) Group The “Costs” of Urinary Incontinence for Women . Obstet Gynecol 2006 Apr; 107(4): 908-916.
22. Wilson L1, Brown JS, Shin GP, Luc KO, Subak LL. Annual direct cost of urinary incontinence. . Obstet Gynecol. 2001 Sep;98(3):398-406.
23. Amy J Sinclair, Ian N Ramsay. The psychosocial impact of urinary incontinence in women. The Obstetrician & Gynaecologist 10.1576/toag.22.214.171.124665