Urinary incontinence: common problem, not commonly reported
SummaryDespite not being a widely acknowledged affliction, urinary incontinence (UI) is a relatively common condition, with up to 23% of the female population suffering from one form alone. Yet despite the significant impact UI can have on the quality of life of the sufferers, according to a new report, approximately half of sufferers neither seek treatment nor report the problem to a physician.
UI is defined as "the complaint of any involuntary leakage of urine" and can be divided into three main subtypes: urge urinary incontinence (UUI), stress urinary incontinence (SUI) and mixed (urge and stress) urinary incontinence (MUI).
UI is a common condition, with physicians interviewed by Datamonitor estimating that 18.1%, 21.2% and 22.9% of the female population suffer from UUI, MUI and SUI, respectively. UI can affect all age groups; however, differences in the underlying causes and risk factors for each subtype of UI mean a slightly different age distribution is observed in each patient cohort. Whereas SUI is often observed in younger women, UUI and MUI are observed more frequently with increasing age.
However, despite the widespread nature of the condition, many sufferers do not present to a physician. UI can have a profound impact on quality of life and symptoms such as unpredictable urges, frequency, and urine leakage can be extremely distressing for sufferers. Many sufferers worry about the symptoms and this frequently results in them modifying their lifestyle and restricting their activities.
This reluctance to seek help means that many individuals suffer in silence and try to cope by using behavioral modifications such as limiting trips, fluids and routine activities; and/or by using widely available absorbent products. Although these products may help sufferers live with the problem, such strategies neither treat nor cure UI.
Knowledge is power
Datamonitor has found that the key reasons patients do not seek help is because they think that their condition is a normal part of aging/childbirth, they are too embarrassed to discuss their condition, and don't think that their condition is treatable or have not heard that it can be treated.
Such findings are worrying since there is little need for patients to suffer, because UI can normally be treated with simple interventions. However, the bigger issue here is the need for improved patient education, which is required to improve presentation rates.
This situation presents a great opportunity for pharmaceutical companies to become involved in awareness programs - promoting awareness of symptoms and treatment options.
Healthcare professionals report that one of the most effective methods that would influence a patient to decide to visit a healthcare professional is exposure to public information campaigns/advertisements in the media (magazines, newspaper, internet, television) which talk about symptoms and treatment options. Such a campaign has managed to bring the issue of male erectile dysfunction out of the bedroom and into the public consciousness in recent years.
However, there is little point educating patients unless this is combined with educational programs targeted at key healthcare professionals. At present, diagnosis rates for UI are poor. The reasons for this are multi-factorial. Firstly, many primary care physicians (PCPs) - the physician group that the majority of patients initially present to - are simply not knowledgeable enough about the different types of UI. This frequently leads to misdiagnosis and the prescribing of inappropriate treatment.
Secondly, PCPs sometimes feel that they do not have the time to establish a correct diagnosis when they are not faced with a life-and-death situation, and therefore may initially dismiss the patient or carry out an incomplete assessment. Such factors frequently result in the misdiagnosis of the patient, underestimation of the severity of the patient's condition and the prescribing of an inappropriate treatment.
Datamonitor believes the most effective way of reaching out to and gaining the attention of healthcare professionals such as PCPs is to include UI educational programs as part of a more comprehensive program that touches on wider issues affecting women or elderly patients.
Getting the right treatment
Treatment for each UI subtype requires a different approach and, although the results from Datamonitor's study showed differences in treatment strategies for each of the subtypes of UI, the research also showed inappropriate use of available drugs, particularly in the case of SUI.
Experts interviewed by Datamonitor suggest that this is due to both a poor understanding of the different types of UI and the limited number of pharmacological agents for SUI. Up until recently, there were no globally-developed or widely-approved drugs for the treatment of SUI.
This has led to treatment that typically involves the use of non-pharmacological methods, notably conservative therapies (behavioral therapies, lifestyle modifications, pelvic floor exercises) or surgical interventions. Although many of the conservative therapies can be helpful for patients, many have low success rates, particularly in the more elderly or severely afflicted. Furthermore, not all female patients are suitable for surgery and certainly not all desire such invasive therapies.
In September 2004, Eli Lilly and Boehringer Ingelheim received marketing approval in the EU for their serotonin and norepinephrine reuptake inhibitor (SNRI), duloxetine, for moderate to severe SUI, which was subsequently launched in several EU markets.
Nevertheless, despite its first-to-market position, results from this study clearly showed that, even where duloxetine is currently available, uptake has been poor. Based on physician interviews, the uptake of duloxetine has been affected by varying opinions of the drug's efficacy (especially when compared to surgical interventions) and concerns over its side effects will have also been impacted by poor understanding of the disorder itself.
New entrants into this market must, therefore, fully consider the importance of physician education and highlight the risk-benefit profile versus currently used therapies in order to gain a foothold.
§ Mixed Urinary Incontinence - An Opportunity for Novel Drug Therapies priced $11,400
§ Stress Urinary Incontinence - Opinion Divided on Drug Therapy priced $15,200