A wooden figure posed with its hands over its bladder-area, as if it needs to use the bathroom urgently..
The condition brings both financial & social costs
by Aleece Fosnight

Incontinence and diapers are often associated with babies and young children. They are considered parts of a natural learning curve and growing up. However, incontinence does not discriminate—it impacts people of all ages and walks of life and, for some, continues or returns in adulthood. In fact, 50% to 84% of older people in long-term care facilities struggle with incontinence and more than 25 million adult Americans experience temporary or chronic urinary incontinence.

Adults living with incontinence and requiring incontinence care supplies often go unnoticed in the health care world and are subject to the stigmas many feel around the subject. These stigmas, including the idea that incontinence is embarrassing, shameful or dirty, prevent people from seeking treatment and may even keep them from talking to health care providers about their conditions. This connection between incontinence and mental health can create much larger effects if not addressed properly.

For adults living with incontinence, anxiety, stress, shame and depression are all too common. Home medical equipment (HME) providers and home health agencies must understand this dynamic relationship between incontinence and mental health in order to improve patient outcomes and their bottom line. The following article will look at the most important issues impacting this topic, underlining what HME providers and agencies need to know.

The Increase in & Causes of Adult Incontinence

Incontinence is the loss of bladder control (urinary incontinence) or bowel control (bowel incontinence), and there are many different versions of the condition, including:

  • Overactive bladder (OAB)
  • Stress incontinence
  • Overflow incontinence
  • Functional incontinence
  • Mixed incontinence

OAB refers to a number of urinary symptoms, the most common of which is an extremely frequent and urgent need to void urine. Stress incontinence stems from physical pressure on the bladder, such as laughing, sneezing or coughing, while overflow incontinence is when the bladder cannot be completely emptied, leading to regular leaks and dripping. Functional incontinence is incontinence that’s a result of a physical or mental limitation, such as Parkinson’s disease or living with a wheelchair. Mixed incontinence is any combination of the different types of
urinary incontinence.

While anyone can suffer from the incontinence conditions described above, it is most common among women over 50, as it is a symptom for those entering menopause. It is a popular misconception that incontinence begins in menopause, as it actually begins in the perimenopause stage, or menopause transition, due to hormonal changes at that time. The urethral and vaginal tissues thin and pelvic floor muscles relax as levels of estrogen and testosterone start to decrease during this period. Perimenopausal and menopausal women thus see an increase in incontinence symptoms during this time, such as frequent leaks and urges to urinate.

Incontinence can come with age, menopause and changing bodies. Sometimes, incontinence is also caused by physical injuries, such as spinal cord injuries, or can be associated with other illnesses. When left untreated, it can also lead to secondary effects or illnesses, including urinary tract infections and anxiety or depression.

Mental Health Symptoms Exacerbate Physical Symptoms

In addition to the physical symptoms that people experience with incontinence, many of those with the condition also find themselves seeing an increase in anxiety and social anxiety due to the fear of having an accident in public or around friends and family. A recent survey found that 53% of adults reported skipping social events because of incontinence. Going to fewer social events can lead to isolation and depression, which can result in further mental health issues if continued.

However, anxiety and stress may not only be side effects for those with incontinence, but risk factors for developing incontinence as well. This creates a vicious cycle in which incontinence can lead to stress and the stress can lead to incontinence and so on. Notably, stress increases the body’s amount of adrenaline, and increased adrenaline can create the urge to urinate. Hence, managing stress, anxiety and mental health is a necessary aspect of overall health care for adults who are living with this condition or are experiencing changes in their health where incontinence could develop.

Costs of Managing Incontinence & Related Symptoms

Those suffering from incontinence will first go to their primary care physician. There is a co-pay associated with this visit if the patient has health insurance, or an out-of-pocket visit cost for those without insurance. Then, if the patient is referred to a specialist such as a urologist, there will be a specialist co-pay for that visit as well, and likely an even higher out-of-pocket visit cost for those without insurance. Next, the physicians may order various lab tests, which come with additional fees.

In addition to office visits, incontinence care supplies come with a huge cost as well. Incontinence care supplies are disposable by nature and are required to be repurchased on a regular basis for that reason. “Staple” incontinence care products include adult briefs, adult protective underwear, bladder control pads, pediatric diapers and pediatric pull-ups. Then come the “supplemental” incontinence care supplies, such as under pads, booster pads, gloves, wipes and
barrier creams.

If incontinence is not properly managed, it can lead to infections such as urinary tract infections and skin infections from sores. There would be a list of costs associated
with any sort of incontinence-related infection. Some may say that therapy or counseling is a secondary cost of incontinence, as it is mental health care focused on the psychological side effects of living with this condition.

Incontinence among adults is a much more widespread issue than meets the eye. This extremely common medical condition, which impacts tens of millions of adults every year, has countless secondary medical conditions related to it, as well as costs. Namely, the mental health impact of adult incontinence often goes unnoticed. In order for patients to receive the care they need, health care providers must take initiative in understanding this condition and all of its various impacts on patients’ lives. For health care providers looking to relieve the suffering associated with adult incontinence, the first step is to understand all the moving pieces needed for treating this condition beyond simply supplying diapers.

Aleece Fosnight, MSPAS, PA-C, CSC-S, CSE, NCMP, IF, HAES, is a board-certified physician assistant specializing in urology, and a medical advisor for Aeroflow Urology. Visit aeroflowurology.com.