How big is the problem?
Incontinence in numbers
Ian Milsom
Gothenburg Continence Research Center (GCRC)
Sahlgrenska Academy, Gothenburg University
Gothenburg, Sweden
If UI where a
country, it would
2
be the third largest
in the world!
Sweden United Brazil Indonesia United States UI1 India China
Kingdom of America
1. Irwin et al. Worldwide prevalence estimates of lower urinary tract symptoms, overactive bladder, urinary incontinence and bladder outlet obstruction. BJU Int. 2011 Oct;108(7):1132-8.
GFI #GFIForum2018
Forum 2018 2. Demographics: Economist Intelligence Unit, http://www.eiu.com/
Make the population with
incontinence more transparent/
understandable based on
10
questions
about
incontinence
GFI Forum 2018
HOW MANY PEOPLE
01 ARE AFFECTED?
People 20+
12,4% of all 8,7% 5% of all
women worldwide (> 423 million) men worldwide
303 million 121 million
GFI Forum 2018 Irwin et al. BJU Int. 2011 Oct;108(7):1132-8
AFFECT ON
02 THE AFFLICTED INDIVIDUAL?
Age 40-70
UI IS MORE COMMAN
AMONGST WOMEN
SENSE OF
Daily UI
5-15%
• loss of control
Age 70+
• shame
in institution
Women • isolation
Age 40+ • depression >15%
Men 30-60%
50% Urge UI
3-11% Do NOT 40-80%
seek help
Stress UI
10%
1. Milsom et al. Epidemiology of Urinary Incontinence (UI) and other Lower Urinary Tract Symptoms (LUTS),
GFI Forum 2018 Pelvic Organ Prolapse (POP) and Anal (AI) Incontinence. In: Incontinence, Editors Abrams, Cardozo, Wagg and Wein, 2017.
TYPES
03 OF INCONTINENCE?
MALE1 FEMALE1
STRESS
11% 21%
STRESS UI 10–39 % 51%
URINE 55% 23%
OTHER
URGE UI 1–7 % URGE
8,7% OTHER
17%
MIXED
STRESS
MIXED UI 7–15 % 11%
11%
MIXED
URGE
Faecal Incontinence2 occurs Combined Faecal and Urinary Incontinence2 affects around
in up to 6% of those under 40 10% of women and 6–10% of men living in the community,
and 15% of older people. increasing to almost 50% in nursing home residents.
GFI Forum 2018 1. Irwin et al. BJU Int. 2011 Oct;108(7):1132-8; 2. Riemsma et al. BMC Med. 2017 Mar 24;15(1):63
INCONTINENT POPULATION
04 AGE AND SEX
45 100%
40 90%
35 80%
70%
30
60%
25
50%
20
40%
15
30%
10 20%
5 10%
0 0%
20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80-
3 TIMES MORE WOMEN Women
Men
4,9
1,6
6,6
5,5
7,9
1
10,2 12,7 14,2 13,9 14,5 18,7
2,1 4 5,8 5,4 6 7
16
8,6
22,3 17,4 21,9
10,4 13,9 17,8
NOTE: Difference reduces with age. Distribution 75% 55% 89% 83% 76% 71% 72% 71% 73% 65% 68% 56% 55%
GFI Forum 2018 Irwin et al. BJU Int. 2011 Oct;108(7):1132-8
PATHOLOGICAL REASONS
05 FOR INCONTINENCE?
1 Bladder and bowel dysfunction
2 Neurological disorders
3 Functional incontinence
GFI Forum 2018 Incontinence. Editors Abrams, Cardozo, Wagg and Wein 2017
RISKFACTORS1
06 FOR INCONTINENCE?
Age Prevalence and severity of UI stratified for age and BMI2
Obesity
Parity, pregnancy
and mode of delivery
Hysterectomy
Ethnicity and race
Mobility
Diabetes
Dementia
Menopausal
replacement therapy
LUTS and infections
UI stratified by age Leakage once a
Comorbidities
week or more often
1. Milsom et al. Epidemiology of Urinary Incontinence (UI) and other Lower Urinary Tract Symptoms (LUTS), Pelvic Organ Prolapse (POP) and Anal (AI) Incontinence. In:
GFI Forum 2018 Incontinence, Editors Abrams, Cardozo, Wagg and Wein, 2017. 2. Al-Mukhtar Othman et al. Am J Obstet Gynecol. 2017 Feb;216(2):149.e1-149.e11.
SEVERITY
07 UI?
Q1. How often do you
SEVERITY INDEX1 experience urinary leakage?
1. Less than once a month
2. A few times a month
3 3 6 8 12
3. A few times a week
2 2 4 6 8 Based on multiplikation 4. Every day and/or night
Q2 of Q1 and Q2
1 1 2 3 4
Q2. How much urine do
FOUR LEVEL INDEX
1 2 3 4
1–2 = slight
you lose each time?
3–6 = moderate 1. Drops
Q1 8–9 = severe 2. Small splashes
12 = very severe
3. More
GFI Forum 2018 Sandvik et al. Neurourol Urodyn. 2000;19(2):137-45.
HOW MANY
08 MANAGE UI DAILY?
Over 50% NOT being treated
NOT seeking help because of:
• misinterpretation of symptoms
3 out of 4 • misbelieves
manage UI daily • unawareness
• shame
Many of those who received
treatment are NOT cured
1. Milsom et al. Epidemiology of Urinary Incontinence (UI) and other Lower Urinary Tract Symptoms (LUTS),
GFI Forum 2018 Pelvic Organ Prolapse (POP) and Anal (AI) Incontinence. In: Incontinence, Editors Abrams, Cardozo, Wagg and Wein, 2017.
WHERE DO PEOPLE > 65 WITH DAILY UI
09 LIVE AND HOW DO THEY MANAGE?
50,4% independent 41,5% dependent on 8,1% dependent on care
at home care of others at home of others in institution
Source: Institutions from OECD data : long term care recipients in institutions, Dependent at home: calculated by using population with severe limitations ( from Eurostat) -/- long term
care recipients in institutions (OECD), independent: calculated by : total population ( from EIU country fact sheet ) -/- dependent at home -/- institution.
GFI Forum 2018
10 GEOGRAPHY AND UI?
EUROPE
Population: 576 M
NORTH AMERICA
Prevalence: 57 M
Population: 410 M
Prevalence: 37 M 9.9%
9% ASIA
Population: 3 062 M
Prevalence: 256 M
SOUTH AMERICA
8.4%
Population: 293 M AFRICA
Prevalence: 24 M Population: 600 M
8.2% Prevalence: 43 M
7.2%
GFI Forum 2018 Irwin et al. BJU Int. 2011 Oct;108(7):1132-8
Driving outcomes in continence
INCONTINENCE care, creating a win-win for
IS A HUGE patients, carers and health
HEALTH CARE systems is very important given
the size of the population afflicted
PROBLEM! and the diversity of the group.
GFI Forum 2018
