More than a ‘wee’ problem


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Five million Australians are affected by incontinence, but many don’t seek help or don’t know the most appropriate product… This presents a huge opportunity for pharmacy

Sue Blinman, manager of the National Continence Helpline and continence nurse practitioner, explains, “The main barrier for people with incontinence not seeking help is usually around the embarrassment and shame associated with losing bladder or bowel control. About 70% of people affected by incontinence don’t discuss the issue with anyone, including their GP.

She says that when people don’t seek help they can end up feeling socially isolated. “Incontinence inhibits a person’s ability to participate in social activities, affects employment, relationships and intimacy.

“Pharmacists can play a key role in helping destigmatise and mitigate the burden of incontinence by taking a patient-centred approach. Don’t be embarrassed to ask customers about incontinence, particularly if they are commencing a new medication. Enquire about constipation, as this may be a precursor for urinary incontinence and long-term constipation, which may lead to faecal incontinence.

“Pharmacists can also play an important role in reassuring people with incontinence that they’re not alone—one in four adult Australians are affected by incontinence. They can also advise people that there is plenty of help, including financial support through the CAPS and various state funding schemes,” says Blinman. 

Incontinence insights

Hianyang Chan, senior research analyst at Euromonitor International, says the value sales of adult incontinence grew by 9% in 2016 to reach $149 million, with Australia’s ageing population likely to fuel continued growth.

“In 2016 we observed increasing shelf space and better positioning of adult incontinence products next to sanitary protection products, to avoid potential embarrassment for consumers. These improvements in retail distribution positively benefited the category,” says Chan.

Euromonitor International reports that women are more likely to suffer from incontinence compared to their male counterparts, accounting for approximately 80% of all cases of urinary incontinence.

“Traditionally, women who suffer from urinary incontinence have been too embarrassed to pick up incontinence products during their grocery runs and purchase sanitary towels or panty liners as alternatives. However, this habit is gradually declining as it is observed that people are more open to talking about their incontinence problems with health professionals who will then advise them to use the appropriate incontinence products based on their condition.”

He says the moderate to heavy incontinence category experienced the strongest value growth (9%) last year and this is expected to continue. As such, manufacturers are likely to focus their innovations on moderate to heavy incontinence products to cater to the growing demand.

“While light incontinence experienced 8% value growth, slightly below that of moderate to heavy incontinence, it’s worth noting that light incontinence accounted for 79% of overall adult incontinence volume sales in 2016.”

When it comes to product choice, Chan points out, “Australian consumers pay attention to brand image and quality reputations when purchasing their incontinence products. It is observed that Australians tend to remain loyal to major brands such as Tena, Poise and Depend. As a result, private label products only accounted for a value share of 2% in the category in 2016.

“Most consumers are willing to pay more for reputable renowned brands rather than risk potential discomfort by using private label products that could be inferior in terms of quality and performance.”

He says last year Depend saw strong performance growth due to the growing demand for disposable undergarment incontinence products, which are commonly used by moderate to heavy incontinence users.

Gabrielle Davidson, senior category development manager for Kimberly-Clark, says, “Depend® Real Fit underwear is specifically designed to fit and feel like real underwear and protect against heavy loss of bladder control. It is soft, discreet and breathable making it very comfortable to wear. The range launched in 2013 and has had a great response from consumers. It is now the number one brand within the underwear segment with 43.3% value share, and is growing at 4.3% in value (Source: IRI Measured Market + Pharmacy Scan, MAT to 7/5/17).

The incontinence category has also gained strength from new products entering the market, such as Tena’s revamped male incontinence range. Tena Men incontinence products now feature darker colours, instead of the previously light blue and green carton packs, to give men more confidence to purchase.

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“Tena Men has been very successful in pharmacy. Born from insights in male grooming, the new Tena Men packaging is designed to reduce the stigma of the category and make it more acceptable,” says Bronwyn Miller, manager – pharmacy at Asaleo Care.

Growing the category

“Pharmacies are generally the first place incontinence products are purchased, as consumers feel comfortable seeking guidance and information from this channel,” says Davidson.

She says given that one in five Australian adults have urine leakage and 43% of people with incontinence are not using any product to manage the condition, there is significant opportunity within the category.

Miller says, “When it comes to product recommendations, pharmacy is well positioned to provide a comprehensive discussion and feedback loop, building rapport and trust with consumers. The confidence of pharmacy staff comes from educating themselves about the condition and the products available, including the key features and benefits. 

“Consumer confidence is about having the right product, so a well-educated team is essential to providing that advice. Educate staff on the category, specifically what to look for, how to broach the subject, which products to recommend and on the support services available.

“Sampling is also essential in this category to help consumers find the right solutions. Sampling supports the pharmacist in driving customer engagement by offering a value-added service and an important point of difference.

“Pharmacy has a unique opportunity to service the wide variety of bladder weakness needs across the community. The section in-store should be discreet, without being hidden. It should also cover a breadth of product types and absorbencies with the flow of the layout to reflect the decision-making criteria to guide customers in product navigation,” says Miller.

According to Davidson, some of the ways in which pharmacy can assist customers include:

  • Using signage to help shoppers easily locate the category
  • Making it discreet to shop by placing the category next to Feminine Hygiene and out of main traffic areas
  • Blocking the category by brand to help existing shoppers locate their preferred product
  • Optimising layout based on brand and product format
  • Increasing variant differentiation to meet the different needs of incontinence shoppers

“Make navigation easy for both light end and heavy end shoppers. For light end shoppers, keep these products as close to Feminine Care and as far from the heavy end products as possible (but still within the section). This will help elevate some of the emotional barriers of entry.

“For heavy end shoppers, vertical blocking of products can assist with access for less mobile shoppers,” Davidson advises.

Miller says,Changes in government regulations are increasing choice for older Australians receiving care at home. The decision of how and what to spend the funds on has moved from the care provider to the patient. This is a major opportunity for pharmacies as they offer a wider range of heavy incontinence products than grocery. And there is further opportunity to tap into the carer market by introducing bariatric and skin health products.”

Prevention and treatment advice

“Light, stress-induced urinary incontinence cases can occur amongst women of all ages, triggering from childbirth, obesity, dehydration or other factors. Several studies have shown that obesity can be directly associated with urinary incontinence,” Chan says.

Catherine Willis, member of the Australian Physiotherapy Association (APA), says there is a range of lifestyle modifications that pharmacists can recommend to assist with incontinence issues. These include:

  • Limiting caffeine and aiming for 1.5 to 2 litres of fluid (mostly water) per day
  • Aiming for a healthy BMI – although even reducing weight by 5kg can help with some pelvic floor conditions
  • Quitting smoking
  • Changing toileting behaviour. For example, don’t hover over the loo and don’t strain
  • Avoiding “just in case” trips to the toilet when the bladder may not need to be emptied

Bilman advises, “It’s important that pharmacists know the value of pelvic floor exercises for men and for women. There is plenty of evidence that pelvic floor exercises are an effective, safe, non-invasive technique to reduce the symptoms of incontinence.

“Recent studies show that pelvic floor exercises before prostate surgery reduces the period for men to regain continence, when compared to doing them after surgery.

“Pharmacists can also discuss importance of pregnant and post-partum women maintaining a healthy pelvic floor, alerting them to resources such as the Pregnancy Pelvic Floor Plan phone app and the pelvicfloorfirst.org.au website. 

“Pharmacists should also know the location and contact details of the nearest continence service and women’s or men’s health physiotherapists.”

Willis, says, “There’s a growing acceptance of physiotherapy and pelvic floor exercises due to the evidence supporting their effectiveness in treatment of urinary incontinence. This is leading to more frequent referrals.

“Pharmacists can encourage patients to seek a referral from their GP to local hospital continence physiotherapists, or use the APA ‘Find A Physio’ service to recommend private practitioners with experience in managing incontinence.”

USEFUL RESOURCES

The Continence Foundation of Australia offers a range of information for consumers and healthcare professionals. Visit: continence.org.au

To support pharmacists, the Continence Foundation of Australia and the Guild Pharmacy Academy have developed a two-hour CPD-accredited online course, Continence care for pharmacists. Enrol at mycpd.org.au.

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