More than half the people aged 65 or more who live outside institutions report episodes of bladder or bowel incontinence, with women plagued considerably more than men, according to a large government report released Wednesday that highlights the surprising prevalence of the debilitating condition.
Twelve percent of women who suffer from urinary incontinence had severe or very severe forms of the condition, while the rest of the women and virtually all the men surveyed reported slight or moderate incontinence on a scale used in the National Health and Nutrition Examination Survey, taken from 2007 to 2010.
The study, released by the National Center for Health Statistics, part of the Centers for Disease Control and Prevention, is the first to pull together data on incontinence among people living in their homes, in nursing homes, in residential care facilities and in hospices, as well as people who receive health assistance in their homes. Because different definitions of incontinence were used for the various populations, the researchers could not compare the results against each other.
"The purpose was to show...the prevalence and the magnitude of the issue," said Yelena Gorina, of the agency's Office of Analysis and Epidemiology. "Because it's a very serious issue, a very debilitating issue."
Benjamin Brucker, an assistant professor of urology at the NYU Langone Medical Center in Manhattan, said he hopes a major study that shows how common incontinence is will encourage people to overcome the shame and embarrassment of the condition. "A lot of people that...have incontinence are afraid or fearful or not willing to bring it up to their doctor, and not willing to bring it up to their family members," Brucker said.
The report said that the cost of incontinence to individuals was estimated at $19.5 billion in 2000, half to three quarters of it for purchases related to routine care, such as "absorbent pads, protection and laundry."
Results varied considerably for people in institutions, from the 39 percent in residential care facilities who reported an episode of bladder or bowel incontinence during the seven days before they were interviewed to the 75.8 percent of long-term nursing home residents who could not completely control bladder or bowel function in the 14 days prior to their survey.
Brucker said incontinence has become more prevalent as the U.S. population has aged. Causes include loss of muscular control after childbirth and declining estrogen levels after menopause in women, as well as medications and other disorders, such as diabetes, that can contribute to incontinence in both men and women.
The good news, Brucker said, is the increasing number of treatments for various forms of incontinence. They include muscle exercises; changes to diet and fluid consumption; medications and surgery.
"Certainly when we talk about cost-effectiveness, it may be as simple as a pill a day or a simple behavioral change that can reduce the number of pads people are using," he said.