By Sowmya Rajagopalan, Research Analyst, Healthcare EIA

Incontinence can be described as condition where the patient lacks the ability to control the excretory functions. There can be both fecal incontinence and urinary incontinence.

Urinary Incontinence: It is the condition where there is involuntary leakage of urine. This can be attributed to overactive bladder, pelvic floor muscle weakness, detrusor muscle over activity etc. Based on the cause of incontinence, it can be further classified as Stress Incontinence and Urge Incontinence

Stress Incontinence: This is the condition where a patient loses a small amount of urine while coughing, laughing, sneezing etc. This is mainly due to stress on the weak pelvic floor muscles. It is prevalent in people across all ages. Physical changes in women after pregnancy, child birth and menopause, and in men post prostatectomy usually cause stress incontinence.

Urinary incontinence in pregnancy was reported by 79% with most of them experiencing stress incontinence. In general, the prevalence of stress incontinence in adult was estimated too be as high as 17-45 %. As incontinence is mainly caused due to pelvic floor muscle weakness, strengthening or supporting these muscles would be the ideal treatment method. The treatment modes can be classified into three broad categories:

• Exercises
• Drugs
• Surgeries

Exercises include pelvic floor exercises (Kegel exercises), that can result in better control of bladder during coughing, sneezing etc by strengthening the pelvic floor muscles. Kegel exercises reduce stress incontinence in 70% of women who do them.

Drugs can be also used to treat these conditions. At times a combination of drugs along with exercises has been highly effective in the initial stages or less complex stages of this condition. However, in the more advanced stages, surgery is the best option to treat this condition. In surgery there are different methods available like sling surgery, urethral bulking agent etc. The slings and urethral bulking agent market is a growing slowly. There are different types of slings like vaginal slings and male slings and more specialization within them.

Urge Incontinence: Urge incontinence is a condition where the patient suffers due to leakage of urine before getting to the toilet during urgency. It is usually due to an 'overactive bladder'. This is the second commonest cause of incontinence. It is believed that about 3 in 10 patients suffering from incontinence are due to urge incontinence. This can occur at any age, but more prevalent in the adults. Statistics also reveal that women are more commonly affected than men.

The real cause for this condition is unknown, but it usually occurs when the bladder muscle seems to become overactive and contract when not wanted.

In normal conditions the bladder muscle (detrusor) is relaxed and the bladder gradually fills up. But when the bladder stretches, there is an urge to urinate. This urge to urinate usually arises, when the bladder is half full, but normal individual have the capability to hold on the initial felling for a short period easily. But in patients whose bladder is overactive, the bladder contracts too early, thus resulting in leakage of urine before reaching the toilet.

The common treatments for this condition include lifestyle changes, bladder retraining medications, pelvic floor exercises and surgery. Lifestyle changes include reducing caffeine and alcohol intake. This is because; caffeine may directly stimulate the balder to worsen the urgency symptom. Bladder training is also commonly called as bladder drill, where the bladder is slowly stretched to be able to hold higher volumes of urine, so the urgency symptoms reduce slowly.

There are many drugs available like antimuscarinics that help in relaxing the bladder, thus reducing the urgency symptom slowly. These medications improve symptoms in some cases and the amount of improvement varies from person to person.

The last resort treatment procedure is surgery. Surgeries include sacral nerve stimulation,bladder augmentation etc. But they are less preferred to other modes of treatments.

Incontinence pads are the largest contributor of the urinary incontinence treatment market. This is mainly attributed to the fact that, patients prefer not to discus the condition with others and hence defer treatment. Thus they help themselves manage the condition by using these pads.

Drugs are the second most preferred mode of treatment and are preferred over surgeries. Surgeries though available, are growing slowly.

Even in the surgical procedures, the use of catheters is higher than all other surgeries available. Catheters don't effectively treat the condition but help in managing the condition. Even in catheters there are two different types like foley catheters and intermittent catheters. The use of the catheters is based on the type of the treatment. Foley catheters are mostly preferred, when the patients has to use it for a long time. But due to higher risk of infection, currently the market for foley catheters is reducing, slowly replaced by intermittent catheters and other surgical procedures.

Slings market is slowly growing. As the incidence of urinary incontinence is higher in women than in men, the market for vaginal slings market has been growing at higher pace. Urethral bulking agents are implantable devices and have many controversies associated with the success of the products. Hence the market has not been growing greatly.

The market for urinary incontinence devices is largely determined by the patient population and their mindset. With increasing awareness, it is expected that the patient population will move from managing the condition to treating the condition. This would ideally help in the growth of drugs and devices market like catheters, slings etc. It is likely expected that in the next five years there would be a higher percentage of population diagnosed and treated appropriately.