The British Medical Journal (BMJ) published recently a research that systematically studied the clinical, biological and psycho-social attributes of the average 85 year old and then cross referenced with subsequent health trajectories as the cohort ages.
One of the first findings was that the average life-expectance in this country is increasing and that means there could be a third more 85 year olds alive by 2020. This information is of high interest to our health authorities who should start preparing the health system and budget for when the time comes.
The study also discovered that 12% had moderate or severe mental decline and 21% suffered from incontinence. More widespread were hearing problems (60%) and high blood pressure (58%).
The online version of the report published on the BMJ, said:
“For planners of services, on the basis of present demographic trends, we can say that in the UK by 2020, the 85-year-old population will increase by 33%, 10% of whom currently require institutional care, 32% of whom have had an outpatient attendance, and 7% an attendance at an accident and emergency department in the past three months.”
In the field of urinary incontinence, stress incontinence (where sudden pressure on the pelvic floor muscles results in leakage) and urge incontinence (where miss-messaging between the brain and the bladder wall muscles leads to untimely contractions) are the most prevalent types. However, there is another form of incontinence – known as overflow incontinence – which is very real and also distinctly from stress and urge incontinence in terms of symptoms, cause and treatment. Another factor which separates it from the other, perhaps more common forms of urinary incontinence, is the fact it’s more common amongst men than women.
What is Overflow Incontinence?
Overflow Incontinence is a condition whereby the bladder is unable to completely empty when urinating; the cycle of excess urine that’s not emptied leads to irritation of the bladder wall resulting in unpredictable contractive actions. In other words, the bladder wall, urethra and pelvic floor muscles aren’t in synergy. The types of symptoms that indicate overflow incontinence are feeling unable to urinate even when you feel the urge and an unnatural amount of leakage (particularly just after urinating).
The underlying medical reasons can be broadly separated into root causes. The first is when the prostate gland – located underneath the bladder, in front of the rectum and wraps around the urethra – has become enlarged and thus obstructs the passage of urine. The second is when damage or complications to sacral nerves, causing a lack or sensory urge – when this happens, a person simply cannot feel how full their bladder is and it eventually ‘overflows’ – this is know as a neurogenic bladder.
Both result in a stretching of the bladder wall, which in turn, weakens it. Therefore the condition can exasperate over time.
Why does this develop?
The first root cause can happen as the result of several things, most commonly; a benign prosthetic hypertrophy (BPH), urinary stones and tumours. The second root cause often results from complications of medical surgery, birth defects that materialise with age and injury inflicted on the spinal chord. Diseases such diabetes and polio have been linked to instances of a neurogenic bladder.
What are the treatments?
In the instance where BPH, urinary stones or tumours enlarge the prostate gland, the incontinence cannot be cured until these underlying medical conditions have been addressed and remedied themselves.
With a neurogenic bladder, the only proven way of curbing overflow incontinence is using catheterization techniques to consistently empty the bladder – as only by consistently emptying the bladder completely will the overflow urinary incontinence be eliminated in the risk of infection decreased.
According to a market report from Marketstrat, the Urinary Incontinence devices market is expected to grow over 4% between 2008 and 2016 reaching the $2 billion mark by the end of 2016.
Despite the fact that the Urinary Incontinence market is one of the most under-penetrated medical markets, the technological developments are nonetheless very well developed and the report forecast and even greater development over the following years with the implementation of less invasive incontinence devices that include: artificial sphincters, urethral bulking agents, male slings, female slings, neuromodulators and urine drainage products (catheters and drainage bags).
Marketstrat’s report also does a detailed analysis of the global market share and market size forecast in US Dollar and segmented geographically – namely the US, Europe, Japan and the ROW.
About Markestrat, Inc.
Marketstrat specialises in medical market researches assisting companies with market, technology and best practice strategies and intelligence, through a unique combination of published reports, solutions and services.
After having surgery to remove his prostate gland, Bob Rau developed urinary incontinence as a side effect. Bob, an Engineer from Sunnyvale California, knew that incontinence was a risk, but nonetheless opted for the surgery over other treatments.
In the years following his operation, Bob’s incontinence worsened and became, in his own words; ‘intolerable’. First, he required a tube to drain urine from his kidneys to a bag. Then came several procedures that involved unblocking scar-tissue, after which, he lost all control.
Over time, Bob’s emotional wellbeing fluctuated between long periods of depression and short highs from the medication (to tackle the depression) which made him very ‘hyper’.
Like so many who suffer with incontinence, Rau became increasingly fearful of public events (and even family gatherings) and consequently more reclusive. While incontinence is a relatively un-discussed medical problem, there are nonetheless an estimated 17 million people in the US that have urinary incontinence and roughly 40% of those are adult men.
The problem with incontinence is that the root cause can vary from person to person and therefore difficult to treat. However, doctors are continually learning more about the condition and have developed treatments – some universal, others more specific to individual patients – that allow sufferers to get this area of their life handled for good.
Solutions include nonsurgical techniques, such as exercises and medications, and new surgical options that have been developed in the past two years, but many have to actively seek them out as they’re not commonplace practices.
Which is exactly what Rau did, who’s now completely cured and off depression medication having sought the help of Dr. Edward Karpman, a surgeon with El Camino Urology Medical Group Inc.
Another specialist in the field of treating urinary incontinence is Dr. Christopher Threatt of the Peninsula Urology Center in Atherton whose assertion of incontinence in men and women is that “Once the problem is controlled, they have a new lease on life.”
According to Carers UK, one in six carers have had to give up or cut work to ensure their loved ones have the appropriate kind of care needed. With a significant number of carers not aware of governments benefits, this has led many to a financial crisis that could be avoid had they known about available initiatives such as the Carers Allowance.
A survey conducted by Ipsos MORI revealed that 9% of carers had to give up work and 7% have reduced their work hours to care. Nearly one third of carers interviewed are caring for over 50 hours a week and the average number of years they had cared for is 6.5 years.
On another survey, this time conducted by Carers UK, numbers were even more alarming. Over two thirds (77%) of carers surveyed cared for 50 or more hours a week, 35% of carers had missed out on State benefits because they didn’t realise they could claim them and 49% said not getting these benefits had directly affected their health, while 20% said they were struggling financially and 20% claimed they were in debt.
Last Friday – December 4th 2009 – was Carers Rights Day and over 1,500 events took place across the UK providing carers with advice and information on their finances including benefits checks and pensions forecasts.
Coinciding with the events, two new advice guides were published by Carers UK. Caring About Your Pension and Looking After Someone: A Carer’s Guide to Rights and Entitlements. Both of which can be ordered from:
* from 0808 808 7777
* by emailing email@example.com.
* or by going into any Lloydspharmacy store. To find local stores visit: www.lloydspharmacy.com
Are you currently caring for a partner, family member or even a close friend? Did you know you were entitled to these benefits? Share your experience with others and lets help spread out the word about this serious matter.
Comedian Jo Brand has recently come under fire after making several quips made about incontinence on the BBC show QI, which received an influx of complaints, including one from a particularly incited viewer who claimed the jokes were sexist and ageist.
Brand has been cleared by the BBC Trust over the gags, after a formal complaint to the Trust was originally rejected earlier this year and now an appeal to the Trust’s Editorial Standards Committee has also been turned down. The committee concluded the joke about incontinence were “editorially justified”, did not amount to prejudice and did not breach programme guidelines.
Whenever Sue Jacobs, a 56-year-old hairdresser from Chiswick, met with friends for coffee or a meal, it would always be punctuated by her constant need to rush to the toilet. This she describes as ‘something I simply put up with for many years’, explaining that:
“after I had a drink, I’d need to go three or four times within an hour. I’m not the sort of person who gets embarrassed easily and I wasn’t going to stop going out and doing the things I enjoyed. But it does have an impact on your life.”
For a long time, Sue didn’t recognise that she was dealing with an incontinence problem, instead believing that she simply needed to go far more often than other people. Dr Shirin Irani, consultant gynecologist at Heartlands Hospital in Birmingham believes this is a common attitude among women living with incontinence – an attitude largely born out of an unwillingness to acknowledge and accept they may have incontinence issues, explaining that:
“There is an embarrassment which can stop women seeking help and also a sense it’s part of a woman’s lot.”
In her late 40s, the problem became more pressing and was only once she’d turned 50 that she finally saw her GP, who prescribed drugs to block the signals which tell bladder muscles to contract. She recalls:
“These didn’t help and I wasn’t offered any other treatment. You feel it’s something you have to live with.”
Usually bladder retraining exercises, combined with medication – that block the nerve impulses telling the bladder to contract – is enough to alleviate cases of incontinence for the majority of female sufferers. But some, like Sue, need further intervention. When she returned to her GP, she was referred to consultant urologist Jeremy Ockrim at University College Hospital, who is a practitioner of a new treatment called Sacral Neuromodulation and Botox injections for incontinence.
The Botox treatment involves the chemical being injected into the sides of the bladder to relax muscles, thus stopping contractions. ‘It has been helpful for many patients, but it isn’t perfect,’ says Mr Ockrim, who explains that:
“Patients need repeat injections every six to nine months and symptoms may return gradually. There is also a 20 per cent risk of paralysing the bladder muscles, which means the patient will need a catheter to pass urine.”
With the Sacral Neuromodulation treatment, a thin wire with a small needle on is implanted in the sacral nerves. An electrical current is then delivered through it, which enables the brain to inhibit unwanted signals from the bladder. This technique effectively suppresses the sudden contractions and the need to rush to the toilet. Patients trial a modulator for three weeks and can choose to have a permanent implant if it works – which is exactly what Sue decided, having noticed dramatic changes soon after the procedure:
“The effect was immediate… two hours after it was switched on, I hadn’t gone to the toilet once.”
She returned to hospital to have a permanent modulator – the size of a £2 coin – implanted under the tissue and skin of her lower back. While Sacral Neuromodulation has been approved by NICE since 2004, only 100 or so women have benefitted from the treatment in the UK – a major factor most likely being the cost.
The stimulator itself costs £8,500 and overall treatment is £12,000. Mr Ockrim, who has treated nearly 60 patients with sacral neuromodulation believes:
“It’s a large initial expense, but comparable with a lifetime of Botox injections…We should consider the social and personal cost for women with incontinence. They go out less, take time off work or even stop working.”