Introduction And Understanding Of Urinary Incontinence

This introductory course about incontinence will provide you with the essential advice you need to ensure the best possible outcome of continence care for your customers

A. The Importance of Incontinence in your Pharmacy

Did you know?

1 in 3 women have experienced incontinence at some time in their life 

1 in 10 men experience daily urinary incontinence

(the figures are higher among older men)


Between 7 and 37% of women aged 20-39 report some urinary incontinence ?

These figures prove that a significant percentage of customers in the pharmacy need the right advice and solutions to manage their bladder weakness issues. 

Let us help you advice your customers. 

The incontinence category is the category of the golden shopper

There are three big reasons why you want to attract incontinence shoppers to your pharmacy:

Why people are buying incontinence products in the pharmacy:

1) Over-the-counter > prescriptions 

... because the budgets of the NHS are shrinking

People are receiving less products on prescription. This drives the need for OTC incontinence products as opposed to prescribed products.

2) Pharmacy > Retail

... when people are looking for expertise 

We can help you answer the needs of people looking for security and advice. At the same time, they are looking for a specialised brand and maximum quality - a suited solution for their problem.  



Keep in mind that ...

  • Working in a pharmacy, you play a key role in continence care management. 

  • Customers need your expert advice. 

  • More than that, it is an ideal opportunity to grow your business.

B. What is Incontinence?

What is urinary incontinence?

Urinary incontinence is the unintentional leakage of urine at inappropriate times.

Incontinence is not a disease or a diagnosis. 

It is a symptom of something else going on in the body.

Myth or fact: Small bladders lead to big bladder problems

Let's take a look at how familiar you are with incontinence... 

  • Myth
  • Fact

Myth or fact: Ageing and incontinence go hand in hand

  • Fact
  • Myth

The urinary system and the micturition process, a key mechanism in continence

Glossary of terms

  • Detrusor muscle: the bundles of smooth muscle fibers forming the muscular coat of the urinary bladder, which are arranged in a longitudinal and a circular layer and, on contraction, serve to expel urine.
  • Urethral sphincter: the voluntary muscle at the neck of the bladder that relaxes to allow urination.
  • Pelvic floor: Pelvic floor muscles are the layer of muscles that support the pelvic organs and span the bottom of the pelvis. The pelvic organs are the bladder and bowel in men and bladder, bowel and uterus in women.

What is going on in a healthy urinary system :

The process of micturition - explained

  1. The kidneys filter the blood to remove water and waste from the body. This filtration process produces urine, a mixture of water and nitrogen waste (urea and uric acid) that gradually fills the bladder. 
  2. While the bladder is filling, the brain inhibits any type of voiding. The urethral spincters are contracted, especially in reponse to coughing, sneezing and laughing. The bladder remains relaxed so urine can be stored. 
  3. The bladder is filling more and the urge to void increases. 
  4. When the bladder contains about 150-250 ml of urine, people will start to sense the need to micturate, empty the bladder. Your brain gives an order to contract the bladder and to relax the sphincters and pelvic floor muscles to allow emptying of the bladder.

The normal function of the urinary system can be impaired by several reasons, leading to different types of incontinence

The main physiologic defects causing incontinence are:

  • weakening of the pelvic floor muscles 
  • deficient urethral sphincter 
  • damage to the central nervous system that control the bladder 

Main types of incontinence

1. Stress incontinence - Poor bladder closure

- Caused by weak pelvic floor and sphincter muscles or by damage to the nerves controlling the bladder

- Particularly among women (may follow childbirth or menopause) but it also affects men (for example after prostate cancer treatment)

- Typical leakages during exercise, coughing, sneezing, laughing or any other bodily movement which puts pressure on the bladder

2. Urge incontinence - Overactive bladder 

- It is usually a result of injury to nerves or muscles which help control urinary flow, but can also be caused by some medical conditions

- Sudden urge to micturate along with little control of the bladder (especially when sleeping, drinking or listening to running water). The bladder muscle (detrusor) contracts too early with enough force to override the sphincter muscles of the urethra

3. Overflow incontinence - Poor bladder contraction or blockage of the urethra 

- People may not sense that the bladder is full, resulting in leakage

- Weak bladder muscles are unable to squeeze the bladder empty. Urine left in the bladder is a breeding ground for bacteria. This can lead to repeated urinary tract infections

Incontinence can have different causes and is influenced by several risk factors

Medicines that trigger incontinence

Medicines that trigger inco

Test your knowledge (1/3): Which one of the following statement is true regarding stress urinary Incontinence?

  • It occurs when people are stressed from their job
  • It occurs because of weak pelvic floor muscles
  • It occurs because you don't feel the bladder is full
  • It occurs because of an overactive bladder

Test your knowledge (2/3): Which of the following muscles are key to remain continence?

  • Pelvic floor muscles and urethral sphincters
  • Pelvic floor muscles and diaphragm
  • Diaphragm and urethral sphincters

Test your knowledge (3/3): Pregnancy can be related to ...

  • Overflow urinary incontinence
  • Urge urinary incontinence
  • Stress urinary incontinence

Keep in mind that...

  • There are different types of incontinence (of which stress, urge and overflow are the most common)

  • Incontinence can have different origins and remaining continent depends on multiple factors. In your pharmacy, it is important to make the link between these influencing factors and incontinence. 

C. Understand the Incontinence Shopper

There is not one single incontinence universe. There are three universes and they each require a different approach and communication

Universe 1: Little discomforts 

  • A few drops, irregular leakages 
  • Use of pads or first adapted incontinence solutions for more comfort and by fear of odours

Universe 2: Weak bladder universe

  • More regular leakages
  • Difficulties to control the bladder
  • More regular accidents

Universe 3: Incontinence universe

  • Heavy leakages or total loss
  • Person can be mobile or bed-ridden

Each universe requires a different approach:

Module "Engage with your shopper" will tell you more about how to implement these different approaches

Inco-shoppers can be users or care givers

Definition of a shopper

Someone becomes a Shopper when he/she starts a purchase process. Therefore, the Shopper comes before the consumer whether he is the final consumer or if he buys for someone else. 

When in a buying process for a type of product, naturally each person doesn’t always have the same behaviour. Each person can hide different profiles of Shoppers.

A shopper in a pharmacy can be a user or a care giver. 

Typically, the user is shopping for light and moderate incontinence products (Universe 1 & 2), whilst a care giver is shopping for heavy incontinence products (Universe 3). Their behaviour and type of advice they need will be different .

User

Focused in general on discretion, odour and comfort.

Care giver 

They will also be interested in how to use the product.

Research has proven that pharmacy shoppers are mostly care givers.

Drivers of shoppers to the pharmacy and the diversity of their needs

What drives players in choosing their point of sales?

A Shopper’s potential dominant (but often subconscious) need when he/she undertakes a shopping process 

This need can vary from one occasion to another but will underlie everything about his/her approach, the selection of places, sensitivities and choice 

These needs play an essential role in: 

  • The type of interaction the shopper would like to have with the location. 
  • The manner in which the location will be judged and evaluated

The typical drivers for inco-shoppers to buy their products in the pharmacy are  security and, to a lesser extent, rapidity

Security

  • Looking for guidance
  • Search for a medical solution
  • Search for the best quality
  • Finding the right product

Rapidity

  • Grab and go
  • Purely functional purchase: Looking for a solution to a problem
  • As efficient as possible

The needs of every customer in your pharmacy can still be diverse though:

Incontinence has an impact on different aspects of the consumer's life

Physiological

  • Lack of hygiene and cleanliness 
  • Need to adapt activities, lifestyle
  • Impact on femininity/masculinity and sense of freedom 

Social

  • Fear of accidents
  • Fear that the incontinence product might be seen through clothing
  • Fear of bad odours
  • Something they can't talk about.
  • Feelings of isolation - they may change or limit their social interactions.

Emotional

  • Something personal, psychological
  • A sign of ageing, of losing control
  • Facing feelings of decline
  • A loss of confidence, self-esteem and dignity

It is our joint goal to support people in maintaining their active lifestyle, feeling confident and letting them be seen

Test your knowledge (1/3): Anna is experiencing urine loss every time she sneezes, laughs or jumps. This has been happening for six months. What universe is Anna in?

  • Little discomforts universe
  • Bladder weakness universe
  • Incontinence universe

Test your knowledge (2/3): Paul takes care of his bed-ridden mother who is starting to lose urine more and more. He is not familiar with the different products in the market and would like the necessary advice. Which of the following is correct?

  • Paul will buy his products in the supermarket so he can grab and go
  • Paul will visit a pharmacist where he can gain the right advice
  • Paul will go to a health and beauty store so he can shop discretely and buy the market leader brand

Test your knowledge (3/3): The three universes exist to help us understand...

  • How to perform an assessment of people's incontinence level
  • That it is wrong to think everyone experiencing urine loss thinks, feels and needs the same
  • Which channels people prefer to buy there absorbency products.

Keep in mind that...

  • There is a distinction between a user and a care giver, shopping for incontinence products

  • There exists three different incontinence universes, which all require a different approach in language and advice

  • Incontinence has a significant impact on the social, physiological and emotional aspect of life

  • While everyone has different needs, specialist advice is the main driver for people to shop in the pharmacy

D. Engage with the Incontinence Shopper

Adapt your language and product advice to the respective universe

Little discomfort universe

A few drops/ irregular leakages

Weak bladder universe

Regular leakages

Difficult to control the bladder

Regular accidents

Incontinence universe

Heavy leakages


The right use of wording is crucial to talk to your shopper. This is how to describe the products:

Light absorption products for women

 Men's products

Anatomical protections for bladder 

incontinence products

Customised products can be advised within each universe

Incontinence products by iD in your pharmacy

WEAK BLADDER UNIVERSE

iD for Men: Men looking for extra security 

iD for Men Level 3 is intended for managing bladder weakness and feature a male-specific design with unique extra anti-leak barriers that enhance security.

iD light: Women looking for extra security

iD light pads are specially designed for little discomforts and bladder weakness issues. This iD Light Super is for women who need increased absorbency with extra discretion. Sort and thin with an odour control system for optimal discreteness. The camomille and cotton feel provides outstanding comfort.

Incontinence universe

iD Pants: Bringing a level of discreetness in the incontinence category


A new generation of pants that are as absorbent as a classic product, but much more discreet and comfortable thanks to the innovative design and fabric-like material. The supersoft elastic waistband and lower waist ensures a perfect fit. 


An ideal combination of a cotton- like comfortable feeling and maximum absorbency power.

Easy to use and discreet, specially designed for those who prefer a higher waist, preferred by overweight users

Top tips for managing incontinence: Specific treatments for each type of incontinence

Pelvic Floor Muscle Exercises to Help Stress Incontinence

... are the first line of treatment for stress incontinence in both men and women. 

  • They should be carried out for at least three months
  • Motivation and cognition are important
  • For those that cannot contract their pelvic floor muscles, biofeedback and electrical stimulation can be used 

Bladder Retraining to Help Urge Incontinence

... is the first line of treatment in both men and women for urge incontinence

  • Must be tried for at least a six week period 
  • The aim is to extend voiding intervals to allow the bladder to fill more, increasing the volume and also giving control over the need to void

Good advice is to:

Keep a diary of toilet visits and schedule future toilet visits upfront. Take the initial frequency and add 15 minutes to each interval. Gradually increase the amount of time between bathroom breaks. Visit the bathroom on every foreseen slot, also if you don't have to go. 

Treatments for overflow incontinence will depend on the reason

Good advice: 

  • Allow enough time for voiding
  • Try to void twice
  • Treat any constipation issues (constipation can increase incontinence)
  • Drink fluids (limit caffeine intake)
  • Visit a doctor for medication reviews
  • Consider surgery: prostate surgery/prolapse/fibroids/urethral stricture

Relationship between some conditions and incontinence

Health conditions that can be connected to incontinence

Neurological damage or diseases

  • Lesions of the cerebral cortex (e.g. with multiple sclerosis, stroke, dementia)  may cause the cortical inhibitory control to be lost or impaired  and can cause increased bladder activity 
  • Damage to the brain stem can cause hesitancy and difficulty in voiding leading to overflow incontinence
  • Damage at or below the sacral spinal cord can cause loss of or impaired motor nerve supply to the bladder (e.g. diabetes, pelvic surgery, post radiation treatment for prostate cancer)

Endocrine disorders

  • Diabetes insipidus: deficiency of the anti-diuretic hormone (ADH), where urine volume cannot be regulated and large volumes of urine can be passed daily
  • Diabetes mellitus can cause damage to the peripheral nerves, and may also cause polydipsia (abnormal thirst) with a consequent large urinary output (polyuria)

Surgery

  • Can cause damage to the muscles and pelvic nerves 
  • Risk surgeries: gynaecological, colorectal, neurological or urological

Pregnancy

  • Damage to the pelvic floor muscles, and/or pudendal/pelvic nerve damage during delivery, especially vaginal births can result in stress urinary incontinence

It is important to know as a pharmacist which conditions are related to incontinence, so you can advice the necessary products when necessary.

Test your knowledge (1/3): When you are suffering from incontinence you should...

  • Limit your fluid intake until 50 % of the recommended daily intake
  • Limit your fluid intake until 75 % of the recommended daily intake
  • NOT limit your fluid intake

Test your knowledge (2/3): Bea is suffering from an overactive bladder and often doesn't make it in time to the toilet when she feels she needs to go. What advise would you give her?

  • "Bea, you should take your time when you are voiding and even try to empty your bladder two times when you are on the toilet."
  • "Bea, I would advice you to keep a bladder diary and plan your toilet visits carefully, gradually increasing the time between your visits."
  • "Bea, I would talk to a specialist to see if there is any possibility for surgery."

Test your knowledge (3/3): Someone in your pharmacy is looking for a product to help her father, who has lost all control over his bladder due to a prostate surgery. He still goes for his daily walk and weekly biking tour. What product would you advice?

  • Men-shaped pad
  • Belted or All in One Product
  • Pants

Keep in mind that...

  • Each universe requires different language and products to advice 

  • As a pharmacist, you play a key role in providing continence management tips and promote quality of life 

  • Many health conditions are related to incontinence, providing an opportunity in the pharmacy to promote continence awareness when getting confronted with these conditions

E. Understand the Incontinence Category to Grow your Sales

The incontinence category: the category of the golden shopper

Incontinence is a key category generating traffic in-store

  • Incontinence drives footfall into the store
  • Stocking up is the trigger for the purchase, since they don’t want to run out.
  • They always have at least one pack available at home.

It is a planned category 

  • Purchases within the incontinence category are not impulsive but planned
  • There are less opportunities to influence the shopper in-store
  • It is necessary to create awareness pre-store with activation tools: catalogue, website, advertising, infomercial, sampling.

With opportunities to trade up

  • The cheapest price is not a purchase trigger for this category. The quality-value equation plays an important role in the decision process. 
  • The incontinence shopper doesn’t mind spending more on a good product. 
  • Adapted in-store POS material and services should be considered to catch the shopper's attention in-store.

The shopper journey: pre- and in-store experience

Shoppers can be influenced before and after they enter the store. 

Scroll over the image to see the objective of each stage and what tools are good examples of how to achieve this

Planogram Guidelines

Ideal planogram guidelines

  1. Inco category should be clearly divided in the 3 universes using visual breaks. From the lights products to heavy absorbancy products according to the main path
  2. The men’s products must be separated
  3. Make sure there is space for some samples
  4. Place care products between Weak Bladder and True Inco Universes
  5. Put big packs at the bottom of the shelves
  6. The product with affinities to the Incontinence universe (e.g. pelvic case, commode...) should be placed nearby the incontinence area but not in the inco shelf and not right next to it.

Let a specialist simplify your choice

iD can help you build expertise in the field of incontinence 

This introduction is just the start.  Want to know more about incontinence? We are here to help you. 

Free phone for advise on - 0800 012 9110

iD helps you to advice the right product for the shopper

iD helps you to educate and inform your shopper

  • Educational leaflets for your shopper, customised for each universe
  • Product guide

iD helps you to educate and support the pharmacist

  • Tool box for the pharmacist 
  • Pharmacy hotline 
  • Training

Test your knowledge: The most important universe to separate its products on the shelve from the others is the

  • Little discomforts universe
  • Bladder weakness universe
  • Men's universe

Keep in mind that...

  • The incontinence category drives traffic to your store, inherits opportunities to trade up and is characterised by a planned purchase. 

  • As well the pre-store as the in-store experience is important for the shopper, especially since this is a planned purchase

  • Keep the three universes in mind and preferably seperated when designing the shelve