Understanding Comorbidity Helps Customers and Cashflow
Compassion and subtlety are key with new customers
by Ken Edmunds

When a person suffers from two illnesses or disorders either simultaneously or with one the result of the other, it is generally referred to as comorbidity.

Understanding some of the more common comorbidities that are associated with items routinely carried in the HME arena can lead to a more thorough consultative level of service and increased sales. In this article dedicated to matters regarding incontinence, we will explore just a few examples of understanding comorbidities that allow you to jump start cash sales and not leave these profitable “crumbs” to chain stores and online retailers.


We’ll start by looking a little more closely at some of the illnesses and disorders that result in a diuretic prescription. Here are a few of the more common ones:

  • High blood pressure
  • Congestive heart failure (CHF)
  • Liver failure (cirrhosis)
  • Tissue swelling (edema)
  • Certain kidney disorders (ex. kidney stones)

The use of diuretics to treat these types of conditions will increase the frequency of urination leading to different levels of urinary incontinence, most commonly urge incontinence.

Some of these conditions can cause an increased risk of urinary incontinence, even before any corresponding medications are considered.


However, some studies point to a 70 percent likelihood of urge incontinence amongst older adults taking a diuretic. How many of your customers does this represent?



Another example of incontinence as a comorbid result is obesity. Extra weight around a person’s mid-section puts stress and pressure on their pelvic floor. This leads to sagging muscles in the pelvic floor that often causes an accidental leakage of urine.


In fact, for most people carrying around extra weight, even an increase of 5 points on the BMI scale (body mass index) can lead to a 60 to 100 percent greater risk of incontinence. This connection between obesity and incontinence usually presents as stress and mixed incontinence, but sometimes as urge incontinence and overactive bladder syndrome as well.

Additionally, customers that are obese or even significantly overweight are at much greater risk for Type 2 diabetes. This type of diabetes causes damage to the nerves that control the bladder resulting in even more severe forms of urinary incontinence.

Identifying customers that may be living with obesity, while often readily apparent, is no guarantee that they are in need of incontinence products, but is often a signal that the conversation may be productive. Can you think of customers this represents?


The evidence linking issues of mobility and various forms of incontinence is very clear. This generally presents more in an urge incontinence form versus stress incontinence, but also increases the likelihood and/or frequency of fecal incontinence.


This holds true with customers showing difficulty ambulating and tends to be worse for those that are completely dependent on a mobility aid.

Roughly 38 percent of American adults over the age of 65 have a disability. The latest reports are that two-thirds of this group experience problems with mobility. How can you assist customers in this category?

It is important to keep in mind that starting the conversation when it comes to sensitive topics such as incontinence usually requires a gentle and patient approach. Very few of us would choose to talk openly about such a personal issue or even admit it in any social situation. I often choose softer conversational routes to help ease into these discreet conversations:

Situation 1—Good rapport with mobility customer: “Are you having any trouble getting to the bathroom in time?”

Situation 2—New compression hosiery customer: “We are trying to get some feedback on a new protective product we are trying out. Would you know anyone you could pass this sample along to?”

Placing small signs offering incontinence samples in different areas where customers are visiting in your store is usually effective.

Choose your product lines carefully to preserve and enhance your reputation and enjoy these additional sales for many years to come.

In the case of incontinence products, the vast majority of people visiting your store fall into one of these categories:

  • They are (secretly) incontinent and just not buying those products from you.
  • They have a loved one at home or nearby who is living with incontinence.
  • They have a family member living in a long-term-care community that is incontinent.

Incontinence is just one area where comormid conditions can help increase sales. If you take the time, you can learn how the products you offer can and should lead to ancillary sales.

This article is the fourth in a seven-part series. Each article will focus on a particular concern of the retail incontinence marketplace. Read the full series here.