Gastroenterology

Gastroenterology

Volume 126, Supplement 1, January 2004, Pages S8-S13
Gastroenterology

Dimensions of the problem: prevalence and impact
Economic and personal impact of fecal and urinary incontinence

https://doi.org/10.1053/j.gastro.2003.10.056Get rights and content

Abstract

Failure to control the elimination of urine or stool causes psychological stress, complicates medical illnesses and management, and has major economic consequences. Patients often describe the impact of both fecal and urinary incontinence in terms of shame and embarrassment and report that it causes them to isolate themselves from friends and family. Incontinence frequently results in an early decision to institutionalize elderly relatives because families have difficulty coping with incontinence at home. Not surprisingly, there is an increase in symptoms of depression and anxiety in patients with incontinence as well as degradation in quality of life that has been documented by standardized assessment instruments. The direct health care costs for urinary incontinence are estimated to be $16.3 billion per year (1995 costs). Separate cost estimates for fecal incontinence are not available. There is an acute need for methodologically sound studies to document the economic and personal impact of incontinence to develop guidelines for the allocation of health care resources and research funding to this major public health problem. This need is especially great for fecal incontinence, for which there is much less health care economic data than for urinary incontinence.

Section snippets

Economic impact of incontinence

Health care costs are classified as direct or indirect. Direct costs are those for delivering (or receiving) treatment and include physician and other health care provider fees, hospital fees, costs for medications, costs for continence pads or other appliances, and transportation costs for the purposes of obtaining health care. Indirect costs are those to the individual and ultimately to society from work absenteeism, impaired performance while at work, and changes in job status due to health

Depression and anxiety

The association between urinary incontinence and symptoms of depression is well documented. However, studies have been limited with respect to sex and age representation; as a consequence, it is difficult to extrapolate to the entire population of incontinent persons. In a population-based study of 5701 women aged 50–69 years, Nygaard et al. found that women with severe urinary incontinence were 80% more likely to experience significant depression and that women with mild to moderate severity

Concluding concepts

The limited data available are sufficient for an appreciation of the personal impact and economic burden of incontinence. However, the ambiguity of the data needs to be addressed to marshal the resources to help improve the lives of patients with incontinence. Consideration of the following points may lead to a more comprehensive understanding.

  • Proper economic analysis should be directed toward isolating the cost of fecal incontinence, including medical and surgical options. The analysis should

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