Bladder weakness

Clinical

Bladder weakness

Most people find incontinence difficult to come to terms with and it can affect all aspects of everyday life, as well as physical activities and relationships with other people...

Learning objectives

After reading this feature you should be able to:

  • Identify the symptoms and causes of urinary incontinence
  • Understand the debilitating impact bladder weakness has on sufferers
  • Provide discreet advice to help improve the quality of life of sufferers.

 

Around 14 million people in the UK suffer from some form of bladder problem – as many as one in four women and one in 10 men are affected at some point in their lives – yet there is still a strong stigma associated with bladder weakness and incontinence. As a result, many people suffer in silence or use inappropriate products to manage the condition.

According to the British Association of Urological Surgeons, 60-80 per cent of people suffering from urinary incontinence have never sought medical advice for their condition, with 35 per cent viewing it simply as part of the ageing process.

Add to this the fact that prevalence of the commonest forms of incontinence is increasing as the population ages and levels of obesity rise, and incontinence and bladder weakness is clearly an area where pharmacy teams can make a real difference by giving appropriate advice and reassurance.

Pharmacy staff have a real opportunity to help people, says Boots pharmacist Angela Chalmers. “Whether it is the person suffering or a family member or carer asking for advice, pharmacy teams can listen to concerns and try to identify what may be causing the condition. They can reassure the person that incontinence or bladder weakness is a common ailment and there are steps they can take that will help.”

Signs, symptoms and risk factors

There are several types of urinary incontinence, but around nine in every 10 people will have either stress incontinence or urge incontinence. It is also possible to have a mixture of both.

Stress incontinence

Stress incontinence is the involuntary leakage of urine at times when the bladder is under pressure from, for example, heavy lifting, exercise, coughing or laughing. The causes and risk factors are:

  • Pregnancy and vaginal birth, which stretches and weakens the pelvic floor muscles
  • The menopause, which depletes the hormones that help to keep the vagina and bladder healthy
  • Ageing
  • A prostate operation, which can lead to men developing stress incontinence
  • Obesity: people with a body mass index of 30 or more are at greater risk
  • Long-term constipation, which puts additional stress on the pelvic floor muscles
  • Family history of incontinence.

Urge incontinence

Urge incontinence is the involuntary leakage of urine caused by an overactive bladder. The main symptom is an urgent need to pass urine, but not being able to reach the toilet in time. Sufferers may also need to pass urine more often than usual and may be woken several times in the night.

About three in 10 cases of incontinence are due to urge incontinence, which can occur at any age but commonly starts in early adult life. Women are more commonly affected than men.

In most people the cause of an overactive bladder is unknown. Sometimes it happens following a stroke or other disease of the nervous system, when the brain is no longer able to tell the bladder to ‘hold on’. Symptoms may get worse at times of stress and may also be made worse by caffeine in tea, coffee or cola, or by alcohol.

Some women develop urge incontinence after the menopause. This is thought to be due to the lining of the vagina shrinking because of a drop in oestrogen levels.

Key facts

  • Bladder weakness affects up to one in four women and one in 10 men
  • Sufferers are likely to feel embarrassed and be reluctant to seek help
  • The commonest forms of incontinence are increasing in prevalence as the population ages and levels of obesity rise.

How can you help?

The pharmacy team can provide both lifestyle advice on how to reduce symptoms and information on specialist incontinence products that will enable customers to feel more confident about carrying on with their everyday activities. Staff can also signpost customers to trusted sources of information or refer them to the GP or incontinence nurse if their symptoms require further investigation.

Lifestyle advice should include quitting smoking, losing weight, cutting down on caffeine and alcohol, and drinking plenty of water. Daily pelvic floor exercises will help to strengthen the group of muscles that wrap around the underside of the bladder and rectum. Some customers may benefit from bladder retraining where, guided by a specialist, they learn ways to help them wait longer between needing to urinate and passing urine. Many customers will need advice on incontinence products. Consider referring to a GP if:

  • Blood is present in the urine
  • The customer complains of pain in the lower abdomen and/or back
  • You suspect they have an infection
  • You suspect there is an underlying cause
  • The condition is getting worse
  • The customer is struggling to cope.

The adult incontinence market

The bladder weakness category was worth over £155m in the 12 months to July 2016, according to IRI, the retail and market intelligence company.

“This category is one of the few that has enjoyed double digit growth in value sales – up 13.9 per cent in the past year,” says Silvia Navarro, IRI Insight manager. “Over the past 10 years, value sales have increased by 186 per cent.” Men’s products currently represent only 5.6 per cent of the category, says Navarro, but this area has seen a 40 per cent increase in sales in the past 12 months.

Donna Wilson, TENA training and brand manager, agrees male urine leakage is an emerging market trend and says that, with one in four men over the age of 40 years experiencing the condition, it has the biggest growth potential. Many men still assume that bladder weakness products are only available for women, so will often ignore the issue or improvise, she says.

“Stocking a range of products that have been specifically manufactured for this demographic, in a variety of absorbencies, is the perfect way to introduce men to the category.

“To help grow this section in-store, and if space allows, pharmacists could trial dual siting products so that men who are looking to purchase urine leakage products can look in the male fixture before the intimate hygiene fixture.” This would help capture men and also women purchasing products on behalf of their partners – driving potential sales in this emerging growth area, she adds.

What lines to stock?

Products for bladder weakness that should be stocked include:

  • Pads of differing absorbencies, including slim pads (many people with bladder weakness don’t always require thick incontinence pads) 
  • Disposable absorbent pants with the pad built in as these are important for bed-bound sufferers 
  • Bed pads; barrier creams to relieve sore skin
  • Fragranced nappy bags, which can be useful for disposing of used products.  

Time lag 

“Research shows it may take people up to six-and-a-half years to discuss their problem with a GP or pharmacist,” says Lourdes Fuentes, P&G Northern Europe feminine care brand manager, “because most people are too embarrassed to ask for help.” Pharmacy staff can play a crucial role in helping consumers find the right product by asking a few discreet questions to understand the level of incontinence being experienced, she says. 

If a shopper is frequently browsing the feminine care section, this may be a sign that, potentially, they are suffering from bladder weakness. In such cases, find discreet ways of starting a conversation about incontinence and have leaflets ready to hand out. Alternatively, start a conversation about feminine hygiene products and then go on to incontinence products and explain the difference. 

If it appears the customer is keen to talk about the condition, offer to take them to a consulting room so that they can have a discreet one-to-one conversation. During this conversation you can assure them that this condition is very common and that they should not be ashamed of it.

Making a recommendation

When recommending a bladder weakness product, pharmacy staff should think about the different features and which ones are best suited for a particular problem.

For example:

  • When is the customer experiencing bladder weakness? (At night, when coughing/sneezing, when laughing, when exercising?)
  • When the customer is experiencing bladder weakness, how much urine do they lose? (Is the bladder weakness light, moderate or heavy?)
  • Are they taking any medication, have they recently given birth or experienced the menopause? For men with urine leakage, have they experienced any prostate problems?

Once pharmacy staff have this information, they are in a good position to pick out a few products and point out some of the features that will help benefit that particular customer.

Growing importance

As bladder weakness has become increasingly normalised and customers have become more accepting of purpose-made products, the category’s importance to pharmacy has continued to grow, says Donna Wilson.

“Pharmacists and pharmacy staff can aid growth and benefit from this upward trend by providing much-needed help, support and advice to encourage trade-up to more absorbent products and recruit more men into the category,” she points out.

To make the most of the incontinence category, pharmacies should:

  • Stock a comprehensive range of incontinence pads, pants and bed pads to cater for various levels of need
  • Barrier creams can also be stocked, as incontinence sufferers often develop contact dermatitis, and secondary bacterial and fungal infections
  • Fragranced nappy bags can be useful for disposing used products
  • Display bigger packs at the bottom of the fixture with smaller packs on the middle and top shelves to make it easier for customers to browse and find what they need 
  • Display discreet posters and shelf-edge signage that encourage customers to chat with the pharmacy team in confidence
  • Locate incontinence products in a quiet area that is visible from the pharmacy, so people can be approached to see if they need help 
  • Train staff so they know what causes incontinence and the different types of incontinence that affect both men and women. Staff should also know how to approach someone browsing the fixture who may find the range of products available daunting, how to help people select the right type of absorbency and when to refer to the pharmacist.

Useful sources of information for customers

Up to 80 per cent of people suffering from urinary incontinence have never sought medical advice for their condition

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