Incontinence is a prevalent health condition that is rarely discussed as people living with the condition are often embarrassed to discuss it with their healthcare providers; for many it is a medical taboo, not to be spoken aloud. Incontinence includes the more common, urinary incontinence (UI) and the less common, fecal incontinence (FI); over-active bladder (OAB) refers to that frequent need for voiding without leakage. Many incontinent people will have both urinary incontinence and fecal incontinence, with or without urinary leakage.
The continence care community generally agrees that the prevalence of incontinence in Canada is about the same as in the United States—about 10% of the population. That means that approximately 3.5 million Canadians experience some form of incontinence. Individual research estimates for the prevalence of incontinence in Canada range from 2% to 50% of the population, depending upon the study, the research method, and the questions posed. For example, asking the question “are you incontinent” will garner a dramatically lower rate of positive responses that the question “do you suffer from occasional leakage of urine?” There tends to be a greater prevalence of incontinence amongst women than men; it is believed that this difference is related to female childbearing and other consequences specific to women.
The number of individuals living with incontinence is likely to increase as the population ages, since the prevalence of the condition tends to increase with age. One study indicated that incontinence occurs in more than half of the community-dwelling women 45 years old and older; almost one of five women in the community reported UI affecting normal activities.
The most common form of incontinence, urinary incontinence (UI), affects individuals’ ability to function in daily life. Canadians with urinary incontinence have more frequent visits to their physicians and spend more time in hospitals and nursing homes than those Canadians without UI.
Even though incontinence is not life-threatening or overly disabling per se, it has a major impact upon the quality-of-life for those affected—physical, social, mental, and emotional. The care of incontinence in the community is often funded out-of-pocket which can be a burden on seniors, in particular, on low, fixed incomes. With elders, family care giving is often strained resulting in institutionalization and the accompanying loss of independence.
Direct costs associated with urinary incontinence are significant. Each year, a senior with UI living at home will spend an average of $1,400 to $2,100 on incontinence supplies. Further, the cost of a senior with incontinent living in a long-term facility can total an average of $4,000-$14,000 per year for supplies and nursing care. Factoring in laundry, clothing and linen changes as well as supply costs and nursing time, the total direct costs of UI in Canada is over $1 billion per year.
Indirect costs such as loss productivity, absenteeism, presentism, and individual, familial, and societal impacts are more difficult to measure, but it is estimated that the combined costs of incontinence total $2.6 billion per year.
This does not include the costs associated with fecal incontinence. With both direct and indirect costs being about the same for both UI and FI, but fecal incontinence affecting only about 40% of as many people as UI does, then the total costs to Canada of both UI and FI would be about $4 billion annually.
Considering that continence does not yet have a high profile in Canada, it is important that Canadians are given accurate information on the true burden of the condition, the treatment options available, as well as health policy and funding issues.
Incontinence: The Canadian Perspective