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Incontinence in Canada: a well kept secret
November 14, 2007
The Canadian Continence Foundation released a report today which sheds light on a well kept secret – that as many as 3.3 million Canadians experience some form of incontinence, including one in four women who are middle-aged or older.
While the impacts of this on society are hard to measure, the financial costs associated with urinary incontinence (UI) total an estimated $2.6 billion per year. November is Incontinence Awareness Month, and the foundation hopes to use this occasion to reveal the true burden this condition presents to Canadians.
‘The World Health Organization calls incontinence one of the last medical taboos,’ said Jacqueline Cahill, executive director of The Canadian Continence Foundation.
‘It is the mission of the foundation to raise public awareness and bring the topic of incontinence out of the closet so individuals experiencing incontinence can comfortably seek help from a healthcare professional and not suffer in silence.’
Urinary incontinence (UI) affects individuals’ independence and 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.
‘Considering that this condition does not have a high profile in Canada, it is important that Canadians are given accurate information on the true burden of the disease, the treatment options available, as well as health policy issues related to UI,’ said Hilda Dube, Continence Foundation spokesperson, registered nurse and former UI sufferer.
What is Urinary Incontinence?
The bladder is the urine storage reservoir, and there are supportive structures and muscles surrounding it that are responsible for preventing leakage. Incontinence has been defined by the International Continence Society as the ‘complaint of any involuntary leakage of urine.’
The following are the main types of incontinence: - Stress Urinary Incontinence (SUI), which is the leaking of urine with coughing, sneezing, straining, exercise or any other type of exertion. About 50 percent of individuals with incontinence have SUI.
Urge Incontinence (UI) is leaking of urine associated with the sudden uncontrollable urge to empty the bladder. The urge to empty the bladder cannot be delayed and leakage occurs. UI is a key symptom of the overactive bladder syndrome.- Overflow incontinence (OI) is constant leaking or dribbling from a full bladder. OI implies that normal urination is impossible.
- Mixed incontinence (MI) is a combination of stress and urge incontinence.
Other types of incontinence include:- Functional incontinence denotes incontinence related to causes outside of the urinary system. A person may have trouble controlling urine, but this problem is exacerbated by functional factors, such as physical barriers to the toilet, a lack of mobility, a degree of unwillingness to comply, medication issues, etc. This type of incontinence may be managed by addressing the functional factor, such as improving the patient's mobility, motivating the patient, improving access to the toilet, modifying meds, etc.
- Nocturnal enuresis is used to describe bedwetting in children who are old enough to be ‘potty trained’ and adults who have loss of control at night.
What triggers incontinence?
Urinary incontinence can be caused by a weakening of the pelvic muscles and urethra muscles (the tube that connects the bladder with the outside) or because of damaged ligaments.
When weakened, the pelvic muscles and urethra cannot contract enough to hold urine in when stress is placed on them, such as during a strong cough or sneeze.
Urinary incontinence also occurs when a person cannot control the bladder muscle. In these circumstances, the bladder will empty when it has reached a certain degree of filling (such as it does in children before toilet training) or when something happens to make the individual feel the need to urinate.
Other Factors
The following factors are associated with incontinence:- Occasionally incontinence can be caused by neurological injury or disease;
- Increasing age
- Menopause can bring on or worsen all forms of incontinence because estrogen loss contributes to the weakness of muscles and tissues in the pelvic floor area, which supports the bladder and urinary tract;
- Weakened pelvic muscles;
- Previous pregnancies;
- Certain medicines (e.g. diuretics);
- Build-up of stool in the bowels;
- Urinary tract (bladder) infection;
- Medical problems such as diabetes and stroke;
- Smoking;
- Physical conditions affecting mobility and dexterity (e.g. MS, arthritis);
- Obesity;
- Caffeine and fluid intake;
- High impact physical activities; and
- Occupations which involve heavy lifting and straining.
Earlier this year, The Canadian Continence Foundation commissioned a report to assess the prevalence and burden of urinary incontinence in Canada.
Some of the key findings include: - The direct costs of UI in Canada total $1 billion per year
- Indirect costs, such as loss of productivity and absenteeism, are estimated to total $1.6 billion per year.
- 3.3 million Canadians – nearly 10 percent of the population – experience some form of UI.
Each year, a senior with UI living at home will spend an average of $1,000 to $1,500 on incontinence supplies. A senior living with incontinence in a long-term care facility can have costs averaging $3,000-$10,000 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 $1 billion per year. Indirect costs such as loss of productivity, absenteeism and individual, familial, and societal impacts are difficult to measure, but it is estimated that the combined direct and indirect costs of incontinence in Canada measure up to $2.6 billion per year.
Despite the prevalence and cost of this condition, it is a topic rarely discussed as people living with incontinence are often embarrassed to ask their healthcare providers for help.
In 2007, The Canadian Continence Foundation commenced a grassroots advocacy campaign aimed at raising awareness of the social and economic burden of urinary incontinence generally, and stress urinary incontinence more specifically, on both patients and the health care system. The campaign is also focused on ways that these burdens can be addressed and alleviated.
Currently, the foundation is conducting a major advocacy campaign in Ontario to help sufferers gain access to new treatment options that can restore their quality of life.
Source: The Canadian Continence Foundation
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