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The Continence Connection Blog

NAFC Names Jean F. Wyman, PhD, RN, APRN, GNP-BC, FAAN, FGSA Continence Care Champion

Holly Kupetis

The National Association for Continence is proud to announce that Jean F. Wyman, PhD, RN, APRN, GNP-BC, FAAN, FGSA is the recipient of the Rodney Appell Continence Care Champion award. Dr. Wyman was recognized for her outstanding work board certified geriatric nurse practitioner with a subspecialty in continence care.  Dr. Wyman has dedicated her career to patient care, research and support of patient education.

Continence Care Champion Interview

1.    Can you provide us with a little more on your background, credentials, education and degrees?

I hold a BSN from Marquette University, a MN in physiological nursing and a PhD in curriculum from the University of Washington.  In addition, I completed a gerontological nurse practitioner program from the University of Washington, and hold advanced nursing licensure as a certified nurse practitioner in Minnesota.

2.    Can you give us any career highlights or special recognitions or achievements, published studies, etc.?

I have received several honors, including being named a Fellow in both the American Academy of Nursing and the Gerontological Society of America.  I also received several recognitions:  Nurse Leader in Aging Award from the American Academy of Nursing, President’s Award from SUNA, a Lifetime Achievement Award from the National Association for Gerontological Nursing, and the Midwest Nursing Research Society John A. Hartford Foundation Award, and am in the University of Minnesota’s Academy of Excellence in Health Research.  I have received numerous intramural, foundation, and federal grants as a Principal Investigator or Co-Investigator related to urinary incontinence or the prevention of lower urinary tract symptoms in women. 

I have published extensively in top tier nursing, urological, and interdisciplinary journals, with 159 peer-reviewed publications, 3 books, and 32 book chapters.  Some of my publications include: the efficacy of bladder training; comparative effectiveness of bladder training, pelvic floor muscle exercises, and a combination of both intervention; outcome standardization in urinary incontinence, including the first papers published on condition-specific quality of life measures; and systematic reviews on nonsurgical approaches to urinary incontinence in women and in adults in community-based and long-term care settings and behavioral treatments in frail older adults.  In addition, I co-edited a comprehensive text on all aspects of urological care in children and adults for SUNA titled:  Core Curriculum in Urologic Nursing.

3.    What was it that drew you to Geriatric Nursing & Continence Care? What was your career path that led you to your current specialty?

I became interested in geriatric nursing in my first staff nursing position after college.  The hospital that I worked at sent me to a professional development program in gerontological nursing.  After I completed my PhD program, I did consultation in a long-term care facility and was asked to work with an older woman who had a stroke and what we would recognize today as urgency incontinence.  However, the nursing staff were very frustrated in caring for her because of her urinary urgency and they felt she could control her leaking accidents since it seemed to happen in the same spot. Because of the poor treatment of her and my going to the literature and not finding much to help guide her care, I thought this was an area that needed research and advocacy.  This one resident has fueled my passion over the past 38 years for improving incontinence care in aging adults.

4.    What achievement(s) in your career are you most proud of?

I am proud of several areas of my work:  1) providing research evidence documenting the benefit of bladder training; 2) standardizing outcome measures such as the bladder diary and condition-specific quality of life measures (first of their kind—Incontinence Impact Questionnaire and the Urogenital Distress Inventory—that have been widely adopted worldwide in research and practice); 3) contributing to international consensus recommendations for continence care in women and aging adult; 4) leading an international conference on Shaping Future Directions in Urinary Incontinence whose papers were published in Nursing Research; and 5) serving as a co-author for the seminal text, Core Curriulum in Urologic Nursing which covers all aspects of urological care in children and adults.

5.    What is most rewarding aspect in your current role?

The most rewarding aspect of my current position which is directing the Center for Aging Science and Care Innovation at the School of Nursing is mentoring future practitioners and researchers.  I particularly enjoy working with students and junior faculty who are developing their careers around improving continence care for women and older adults, and helping them to network with other colleagues across the country who share similar interests.

6.    What led you to teaching and what do you love about that aspect of your career?

I knew that I wanted to teach while I was an undergraduate student.  I enjoy helping others learn and watching their develop confidence and knowledge in whatever I am teaching. 

 7.    What is the most challenging aspect about your role?

The most challenging part is balancing multiple competing career demands as a faculty member, and not having enough time to do everything that I would like to do especially as it relates to scholarly work or practice with adults who suffer from lower urinary tract symptoms.

8.    What is your philosophy on providing the best care for your patients?

My philosophy involves listening carefully to patient, and involving them in decision-making about their care.  A key part of providing the best care is to be empathic to how incontinence is affecting their lives and to identify patients’ goals and preferences for treatment.  No two patients are alike, and care must be individualized to the person’s needs.

9.    What in your opinion are the keys to successful outcomes for the patients you treat?

As a nurse practitioner who subspecializes in continence care, I think the most successful outcomes are when my patients achieve the goals that they identify for themselves, reduce their lower urinary tract symptoms, gain confidence again, and have improved quality of life. 

10.What areas of research would you like to see or conduct to further advance care or patient outcomes?

Right now I am an investigator in the NIH funded Prevention of Lower Urinary Tract Symptoms Research Consortium that is focused on learning more about bladder health in girls and women, including risk and protective factors, and voiding behaviors.  Our preliminary work will lead to prevention studies that are greatly needed in the field.  I am also involved in a study on understanding urinary tract infections (UTIs) in school-aged girls and women. This study will examine the epidemiology, as well as diagnostic and treatment variations for acute uncomplicated UTIs and recurrent UTIs.

11.What is a common misperception you find in your field?

Even in 2018, there are still misperceptions that urinary incontinence is a normal part of aging and that surgery is the only treatment available.  Of even more concern, there is lack of guidance for obtaining help from a health care professional specializes in urinary incontinence.  This specialist could be a physician or nurse practitioner, 

12. What areas do you see need more improvement? Patient Education? Awareness?

Reducing the stigma of having urinary incontinence is still a major problem, with a need for greater public and patient education. In addition, we are still not doing a good enough job in professional education programs about how to assess and manage urinary incontinence and other lower urinary tract symptoms.  A significant area for improvement relates to caring for older adults with chronic urinary incontinence residing in long-term care facilities.  Research interest and funding goes primarily towards cure and prevention in younger and healthier populations, with limited interest and support for studies improving treatment of those who are frail with multiple chronic conditions where cure may not be possible.

13.What does being recognized by NAFC as a CCC mean to you?

I am humbled and honored by this recognition. I am very proud that others deemed my work as qualifying for this special recognition.  To be recognized for my continence care research, practice and education is a pinnacle of my career and fulfills a goal to leave a legacy regarding  how to improve patients’ live who suffer with urinary incontinence.


NAFC Recognizes Inova For Excellence in Urogynecology Care

Holly Kupetis



The National Association for Continence had the honor of recognizing Inova Women’s Hospital, part of Inova Health System, as the most recent recipient of the Center of Excellence award.

Inova is a global leader in personalized health, which leverages precision medicine to predict, prevent and treat disease, enabling individuals to live longer, healthier lives. Inova serves more than two million people each year from throughout the Washington, DC, metro area and beyond.

NAFC's Centers of Excellence (COE) program was established to recognize centers and facilities that excel in providing bladder and bowel health care to patients, and to assist consumers dealing with pelvic floor dysfunction and incontinence issues in searching for an expert.  The COE designation is based on evidence of training, clinical experience, resources, and patient satisfaction statistics that meet established standards.  These rigorous standards ensure that each center that is designated a COE is truly exceptional at providing care for patients with pelvic floor dysfunction and incontinence.

“Inova’s prestigious staff and clinical outcomes sets the bar for Urology care. We were most impressed by Inova’s commitment to quality patient care and their work to ensure those challenged by incontinence are taken care of with the best opportunity for a positive health outcome”, said Steven G. Gregg, Ph.D., executive director for the National Association for Continence. “It is organizations like Inova that make a difference through really pushing standards and practices to the highest level and delivering high patient satisfaction and outcomes as a result.”

Inova provides treatment options for patients dealing with different types of pelvic floor conditions and has pioneered surgical procedures and innovations that are world firsts. “Women have many options for overcoming debilitating and sometimes embarrassing conditions,” said S. Abbas Shobeiri, MD, MBA, Vice Chairman of Gynecologic Subspecialties at Inova Women’s Hospital. “This designation underscores Inova’s commitment, as well as the commitment of our Urogynecologists, Drs. Jefferey Welgoss, Nicolette Horbach and Walter von Pechmann who provide excellent care to the patients we are privileged to serve.”


National Association for Continence is a national, private, non-profit 501(c)(3) organization dedicated to improving the quality of life of people with incontinence, voiding dysfunction and related pelvic floor disorders. NAFC's purpose is to be the leading source for public education and advocacy about the causes, prevention, diagnosis, treatments and management alternatives for incontinence. More information is available online at


Botox for Overactive Bladder and Incontinence

Holly Kupetis

Eric S. Rovner, MD

Professor of Urology, Medical University of South Carolina

Overactive bladder (OAB) is a condition characterized by urinary urgency, frequency with or without incontinence, is often treated with a combination of behavioral therapy, pelvic floor exercises and/or pharmacotherapy. A variety of oral pharmacological drugs and the ability to increase the dose of these drugs(titrate) provide considerable options and flexibility. However, many patients will ultimately fail such therapy. Few options exist for these refractory patients with a condition that can greatly affect quality of life. Sacral neuromodulation (SNM) and posterior tibial nerve stimulation (PTNS) have been utilized with some success. PTNS requires patients to come to the office at least of 12 times over the course of therapy to optimize effects. SNM requires surgery.

OnobotulinumtoxinA is another option. Better known as Botox.  (Allergan, Irvine, CA) OnobotulinumtoxinA is the only botulinum toxin currently available and approved for use in the urinary tract in the US. It is administered using a telescope (cystoscopically) through the urethra, as an intravesical injection using a needle placed through either a flexible or rigid cystoscope. This is most often done as an office based procedure without general or regional anesthesia. After being administered, the therapy takes about three to ten days to take effect, and may last up to six to nine months, after which time a repeat injection is needed to maintain the effect. The exact mechanism by which onobotulinumtoxinA exerts its favorable effects is unclear but it is likely related to relaxation of the bladder muscle (detrusor) as well as perhaps some effects on sensation relating to a decreased sense of urgency to urinate. At least in part, its effects are mediated via blockade of a neurotransmitter called acetylcholine and perhaps other peptides as well. [1]. Several publications have demonstrated the utility of onobotulinumtoxinA in many thousands of patients. (2-6). Success rates in reducing urinary incontinence, urinary urgency and frequency vary from 60-80%. The major side effects of Botox include urinary tract infection and difficulty urinating after injection.

Overall, Botox is an exciting advance in the treatment of OAB and urinary incontinence. There continues to be active research on this medication including improved dosing, and alternative methods of delivering the medication without requiring injection needles.





Eric S. Rovner, M.D. is a Professor in the Department of Urology at the Medical University of South Carolina (MUSC) in Charleston, South Carolina.  He is the director of the Section of Voiding Dysfunction, Female Urology and Urodynamics in the Department of Urology at MUSC.    

He is Board Certified in Urology as well as Female Pelvic Medicine and Reconstructive Surgery.   He is a member of the American Urological Association, International Continence Society, Fellow of the American College of Surgeons, Society of Pelvic Surgeons, and the American Association of GU Surgeons.  Dr. Rovner has served on several committees for the International Consultation on Incontinence.    He served as a member of the AUA/ABU Examination Committee, the AUA Urodynamics Guidelines Committee, and the AUA SUI Guidelines Committee, and is Past President of SUFU.

Dr. Rovner’s research interests include the study of voiding dysfunction, overactive bladder, interstitial cystitis, neurourology and urodynamics.  He has a highly specialized clinical practice within Urology and sees mostly patients with complex voiding problems including urinary incontinence, vaginal prolapse, urinary fistulae and neurogenic bladder dysfunction. He has held several visiting professorships and is the author or coauthor of over 100 peer-reviewed scientific articles, over 25 book chapters, dozens of monographs as well as books on urinary incontinence and urodynamics.  He has been an invited speaker on numerous occasions throughout the United States and the world, and has been the Principal or co-investigator on multiple grants.     


1. Kalsi V, Apostolidis A; Gonzales G; Elneil, S; Dasgupta P; Fowler, CJ: Early effect on the overactive bladder symptoms following botulinum neurotoxin type A injections for detrusor overactivity. European urology 2008, 54(1):181-187.

2. Cruz F, Herschorn S, Aliotta P, Brin M, Thompson C, Lam W, Daniell G, Heesakkers J, Haag-Molkenteller C: Efficacy and safety of onabotulinumtoxinA in patients with urinary incontinence due to neurogenic detrusor overactivity: a randomised, double-blind, placebo-controlled trial. European urology 2011, 60(4):742-750.

3. Herschorn S, Gajewski J, Ethans K, Corcos J, Carlson K, Bailly G, Bard R, Valiquette L, Baverstock R, Carr L et al: Efficacy of botulinum toxin A injection for neurogenic detrusor overactivity and urinary incontinence: a randomized, double-blind trial. The Journal of urology 2011, 185(6):2229-2235.

4. Rovner E, Kennelly M, Schulte-Baukloh H, Zhou J, Haag-Molkenteller C, Dasgupta P: Urodynamic results and clinical outcomes with intradetrusor injections of onabotulinumtoxinA in a randomized, placebo-controlled dose-finding study in idiopathic overactive bladder. Neurourology and urodynamics 2011, 30(4):556-562.

5. Denys P, Le Normand L, Ghout I, Costa P, Chartier-Kastler E, Grise P, Hermieu JF, Amarenco G, Karsenty G, Saussine C et al: Efficacy and safety of low doses of onabotulinumtoxinA for the treatment of refractory idiopathic overactive bladder: a multicentre, double-blind, randomised, placebo-controlled dose-ranging study. European urology 2012, 61(3):520-529.

6. Dmochowski R, Chapple C, Nitti VW, Chancellor M, Everaert K, Thompson C, Daniell G, Zhou J, Haag-Molkenteller C: Efficacy and safety of onabotulinumtoxinA for idiopathic overactive bladder: a double-blind, placebo controlled, randomized, dose ranging trial. The Journal of urology 2010,184(6):2416-2422.

7. Grosse J, Kramer G, Stohrer M: Success of repeat detrusor injections of botulinum a toxin in patients with severe neurogenic detrusor overactivity and incontinence. European urology 2005, 47(5):653-659.




Interview with The 2017 Continence Care Champion Award Winner

Holly Kupetis

Interview with Dr. Timothy Boone

2017 Recipient of the Rodney Appell Continence Care Champion Award

1.)   What lead you to focus on neuroscience and spinal cord injury with veterans specifically?

 I got my Ph.D. in neuroscience and my father was a urologist, so I grew up around urology. Initially, I was interested in becoming an ENT, but my father and colleagues talked to me about how much we still don’t know about in the field of neurourology.  Most of the work I did in neuroscience had to do with speech and the brain and changing to the field [of urology] allowed me to use what I knew in neuroscience and bring that in.  Bill Steers and Rodney Appell were big influences in my career.  Bill introduced me to the power of networking and “who you know,” and he connected me to academic neurourology, the brain and the connection to the bladder.  I met Rodney through SUFU while he was at the Cleveland Clinic and recruited him to come to Houston. 

2.)   What do you believe are the biggest challenges for in caring for patients with neurological conditions and spinal cord injury? 

Neurological conditions include those with MS, Parkinson’s, stroke survivors, brain tumor patients, brain injuries and dementia.  Once of the biggest challenges working with the VA is trying to get patients to the spinal cord center where their care would improve and you are not taking on the whole VA system. Working with vets can be challenging given all they have been through and their issues beyond urology including anxiety, depression and PTSD. Often, the biggest challenge is to get them to do self-catheterization.  They need physical rehab, many have ulcers and malnutrition and are non compliant with catheterization.  They may have survived Vietnam, but they could succumb to renal failure and malignant stone disease if not managed well. Intermittent catheterization and draining the bladder is critical to saving many vets.

3.)   So many patients with incontinence issues believe that it is product of getting older or that it’s just the nature of their condition, and they are resigned to dealing with incontinence on their own. What do you believe could be improved to get treatment for the millions who remain undiagnosed, untreated or unsuccessful in their treatment?

With any patient, regardless of the kind of neurological condition, education is critical. These patients need to know why their condition occurs and why it is important to take control and seek treatment.   Without proper education, it is really hard to get patients to do something like self-catheterization or physical therapy. Buy-in comes with education and with better education comes better compliance.

4.)   Since you have been in practice, what changes have you observed in patient expectations of clinical outcomes?

The biggest change I have observed is the proliferation of advertising and news stories in prime time.  News and advertising about drugs for the bladder, diapers and ED commercials.  This kind of money could have a big impact on research, but the advertising has elevated the awareness for a condition that most patients rarely understood.

5.)   What do you believe are the critical success factors in treating your patients?

I believe in data collection and the use of physical therapy. I have incorporated physical therapy much more into my practice. It is amazing how much more can be done with PT as a part of the treatment plan. PT can do a lot of good for patients in pain and with incontinence and intimacy. I am more educated now on physical therapy and more of a believer in the importance of it and having trained professionals do that.

 It should be a bigger part of the treatment plan for men and women. Physical therapy is something that can empower them, like being healthy and exercising.

There is a lot to be said for the power of this practice. It is important to outcomes.

8.)  What accomplishments in your career are you most proud of?

I am most proud of my trainees and residents.  I enjoy helping them succeed and fostering education with them. It is gratification that is similar to having kids.  Rodney felt the same way. He was big on education and he was close to the fellows he trained.  Your greatest pride is seeing the the success of the ones you participated in training and educating.

9.)  What kind of advances or changes in the field of urology and urology care would you like to see over the next 10 years?

Technology has evolved so much, with wireless and bluetooth technology changing the way our equipment operates. This has advanced the field in many ways and I embrace that change. I think now with phones present everywhere and always in peoples’ hands that apps for urologic conditions should become more successful.  Apps could provide reminders for timed voiding and voiding diaries. Even help with self- diagnosis for conditions like nocturia with simple metrics to encourage finding the proper diagnosis and treatment will be possible. These kinds of new apps would be a tremendous application for everyone in reach of a phone regardless of age. There will be new discoveries in pharma, new classes of drugs that are more targeted and work a lot better. I am hopeful we will see that, too.

10.) You were just selected as the 2017 SUFU Rodney Appell Continence Care Champion. Can you tell us how it feels to be named a Continence Care Champion after your fellow friend and colleague?

My connection with Rod is the highest honor.  Rodney was a good and trusted faculty member.  Rodney was always the one to volunteer to do anything including the thankless jobs. He always raised a hand or offered to take calls at a public hospital. He was glad to do it and was selfless in that regard. He was not a wallflower. We learned that you better not ask him a question if you were not prepared for his answer. He always had an opinion.  He always had a great story to tell and was hilarious to be around.  






NAFC Names Continence Care Champion 2017

Holly Kupetis

NAFC Names Continence Care Champion

Dr. Timothy Boone recognized for lifetime of medical contributions

Charleston, SC (February 24, 2017) – The National Association for Continence had the honor of naming Timothy Boone, M.D., Ph.D., as the most recent recipient of the Rodney Appell Continence Care Champion Award at the February 24th meeting of the Society of Urodynamics, Female Pelvic medicine and Urogenital Reconstruction in Scottsdale, Arizona.

The award is the among the most prestigious recognitions in the field of continence care, conferred upon those whose distinguished careers and outstanding contributions in research, clinical practice and patient education have made them role models for others in the discipline.

“It’s a tremendous privilege for us to present Dr. Boone this award,” said Steven G. Gregg, Ph.D., executive director for the National Association for Continence. “We were particularly inspired by the more than 20 years of work he has done with spinal cord injured veterans at the VA Spinal Cord Injury Units in Dallas and Houston – and that’s just a small part of what has made his career as a healer and researcher so genuinely notable.”

Currently, Dr. Boone serves as the chair of the Urology Department at Houston Methodist Hospital and a member of the Methodist Neurological Institute in Houston, Texas. He specializes in the treatment of patients with incontinence following prostate surgery, women with complex voiding disorders and bladder problems related to neurologic disease including spinal cord injury, stroke, multiple sclerosis and Parkinson's disease.

He is also an active researcher, having written more than 100 publications focusing on mechanisms of sensory control and dysfunction in the bladder and urethra related to spinal cord injury, diabetes or obstruction. He is equally well-known for the hundreds of lectures he has given regionally and nationally while serving as a visiting professor in the urology departments of multiple academic institutions.

Dr. Boone is a member of the American Association of Genitourinary Surgeons, Clinical Society of GU Surgeons, American Urological Association, Texas Urological Society, Society for Neuroscience, Society for Urodynamics and Female Urology, and the AOA Honor Medical Society. Moreover, Dr. Boone was elected as a Trustee to the American Board of Urology in 2006 and served as President of the American Board of Urology from 2011 - 2012.


National Association for Continence is a national, private, non-profit 501(c)(3) organization dedicated to improving the quality of life of people with incontinence, voiding dysfunction and related pelvic floor disorders. NAFC's purpose is to be the leading source for public education and advocacy about the causes, prevention, diagnosis, treatments and management alternatives for incontinence. More information is available online at



Benefits of using an OAB Care Pathway In Your Practice

Holly Kupetis

How many patients have you talked to about Overactive Bladder in recent months? Chances are the number is lower than what it should be. Most people who live with Overactive Bladder don’t get treated. In a recent NAFC survey, it was found that 4.5 out of 10 adults don’t seek help for OAB 1 . Some learn to live with their symptoms while others suffer with a miserable quality of life. Sometimes, lack of seeking treatment is due to the patient’s own embarrassment. Often, patients are unaware of the many treatment options available to them. In the NAFC survey mentioned above, 26% of patients who didn’t seek treatment made this claim 1 . And, lack of treatment can pose serious risks to patients – people with undiagnosed OAB have reported loss of confidence, loss of self-esteem, and loss of intimacy 1 . This is where a Care Pathway can really help. Care Pathways aren’t new – they’ve been around for a long time for various disease states and, essentially, provide patients and physicians with a proven path of care so that they understand all of their options at the start of treatment, and know their next steps if conservative treatments don’t work.

A Care Pathway is a great tool for both patients and physicians to use as they work to find a treatment that works. The new OAB Care Pathway, sponsored by Medtronic, does just that. This Care Pathway is modeled after the OAB Guidelines created by the American Urological Association (AUA) and the Society of Urodynamics, Female Pelvic Medicine & Urogenital Reconstruction (SUFU).

The first step is to determine that your patient does in fact suffer from OAB. As with most treatments, starting with a conservative approach is best. Lifestyle changes, such as improving diet and exercise, and strengthening the pelvic floor, can often make a big impact in a person’s symptoms. Of course, protective absorbent products should be recommended if leakage is a problem. If lifestyle changes fail, oral medications are a common next step, and a mainstay of therapy. These medications can help, but some patients may experience side effects that are too much to handle. In fact, studies have shown that many patients with OAB do not stay on medications long term – only 28% of patients remained on medications after 6 months in one study 2. Unfortunately, all too many patients think this is their last option and many do not see a physician again. This is where a Care Pathway can really help a patient and physician who aren’t sure what to try next. Luckily, patients who fail oral medications still have other advanced treatment options.

Advanced therapies can play a big role in the treatment of OAB. Sacral Neuromodulation is thought to target the nerves that are responsible for bladder function. Additionally, injected medications (Botox) block the signals that trigger OAB by calming the nerves and bladder muscle. Both of these may be treatments your patient may want to explore after trying oral medications. And, if these options don’t work, surgical procedures may be an option.

More education around options and knowing that there are advanced levels of treatments that are available to patients can help you not only in finding a new solutions for them, but may also help you get them to a better place faster. Knowing the proper transition of treatment options can also help to guide you when referring to a specialist.

We urge you to print out the OAB Care Pathway below and review it with your patients.

1 Leede Research, “Views on OAB: A Study for the National Association of Continence.” December 16, 2015.
2 Yeaw J, Benner J, Walt JG et al Comparing adherence and persistence across 6 chronic medication classes. J Manag Care Pharm. 2009:15(9): 724-736 

Disposable Incontinence Products Market size to exceed USD 12 billion by 2024

Holly Kupetis

December 13, 2016

Disposable Incontinence Products Market size was over USD 8 billion in 2015, and is expected to grow at CAGR of over 5% and exceed USD12 billion by 2024.

These products help control involuntary evacuative functions of urination or defecation along with odor protection. These are used to treat patients with urinary tract and nephrological disorder such as chronic kidney disease, kidney stone, and benign prostatic hyperplasia. The incontinence product comprises urinary catheters, adult diapers, pull up pants and urine bags to drain and collect urine from the bladder. 

Increasing geriatric population, growing disposable income and rising prevalence of kidney diseases such as chronic kidney diseases, bladder infection and othernephrologic injuries will drive global disposable incontinence products market size. 

According to National Association for Incontinence, about 25 million people suffer from urinary incontinence in U.S., while 200 million people suffering globally. Globally, women are at higher risk than men. Furthermore, the global rise in diabetic patient population will boost disposable incontinence products market share.

Innovative customized products are extremely effective and efficient in preventing accidents of leakage. They are manufactured as inconspicuous as possible enabling an incontinent patient live a fully active life without the fear of having an embarrassing accident in public. The market has paved way for well-designed and engineered products which not only look good but are also effective in management and control of urine leakage.

Increasing awareness has played a significant role in market penetration with growing acceptance of incontinence products by consumer as well as general public. In U.S., companies such as Kimberley-Clarke have used celebrity endorsements to promote incontinence products for females. The fact that, more number of people are accepting the social stigma associated with incontinence products will ease disposable incontinence products market penetration during forecast period.

Continuous usage of incontinence products was found to have developed rashes in patients resulting in various skin diseases. The severity of side effects associated its continuous use and higher treatment cost is anticipated to contain market growth during forecast timeline.

U.S. disposable incontinence products market growth is attributed to rapid rise in adoption of home health care products. Home health care products account for over 60% of industry revenue. High healthcare expenditure and increasing acceptance of incontinence products will accelerate demand.

Europe disposable incontinence products market share, with its high number of geriatric population dominates the industry in terms of revenue. It is estimated that 25 million suffer from overactive bladder in people exceeding 40 years of age.
Increased life expectancy in the most of the developed countries will fuel growth.
APAC incontinence industry will be driven by China, Japan, India and South Korea.
India is set to witness growth owing to increasing population, improvement in healthcare facilities, better life-style, and more adaptability of incontinence products. Japan and South Korea, with their advanced diagnostic service landscape are expected to foster regional revenue. 

Emerging countries such as Brazil, South Africa, and Argentina has a potential growth opportunity for incontinence market owing to the huge population base of incontinent patients and limited access to such products and the associated healthcare facilities. The Middle-East countries such as Saudi Arabia, Kuwait, Bahrain owing to their highest diabetes prevalence rates, are anticipated to emerge as one of the potential markets for incontinence products. 

Some of the major players in this industry are C.R. Bard, B Braun Melsungen AG, Kimberley Clark Group, Covidien, Coloplast, First Quality Enterprises Inc, Medline Industries Inc, Svenska. The key market players are constantly searching for novel products to expand their product portfolio, increase market share, and build more customer base.

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Enuresis or “Bedwetting” Urinary Incontinence in Adults Young and Old

Holly Kupetis

Enuresis, or bed-wetting, is commonly associated with children but night time incontinence also affects adults, both young and old. 

Night time incontinence or “bedwetting” requires medical attention starting with primary care providers.  When asking about urinary history, providers may consider inquiring about any recent incontinent episodes along with any history during childhood.  This would help uncover a problem and save the patient the embarrassment of bringing it up.  Simply asking if there is “any problem with bowel or bladder” may not uncover an issue a patient is uncomfortable talking about.  In young adults, bedwetting is uncommon and can be indicative of something more serious.  In the elderly it is not as unusual, but is not considered a normal part of aging.  Incontinence can be managed in a variety of ways.

Causes of bedwetting in younger adults might be:

·      Diabetes – new or undiagnosed

·      Medication side effects

·      Sleep apnea, or not awakening to the sensation of a full bladder

·      Manufacturing large amount of urine at night

·      Underdeveloped bladder

·      Urinary tract infection or kidney/bladder stones

·      Chronic constipation

·      Weak pelvic floor muscles (mostly females)

·      Neurological disorder or injury

In older adults, causes might also include:

·      Bladder cancer or tumor

·      Prostate cancer or enlargement

·      Overactive bladder

·      Weak pelvic floor muscles

·      Dementia

PCPs should start with a complete physical examination that includes lab analysis of urine and blood.  A referral to a specialist might be needed where additional tests would be ordered such as an abdominal ultrasound, neurological exam and other urological procedures.

Treatment of bedwetting in adults centers on the root cause.  Many times the incontinence is reversible once the underlying cause is indentified.  Determining the origin is often the biggest challenge but definitely worth pursuing.  Until there is a diagnosis and treatment regimen, it is important to keep patients dry and comfortable during the night.  Here are ways to achieve this.

Absorbent products: Adult protective underwear (or adult pull ups) works wonders in protecting skin, bedding and clothing from urine when the need is moderate.  For the best performance of these products, make sure they are the correct size and worn comfortably snug.  If protective underwear is not enough protection, a “brief” product can also be worn for heavier need.  They are comfortable to wear and are available at drug stores, medical equipment providers and on line.   Go to for more information.

Kegels exercises:  Pelvic floor strengthening has proven to help adults of all ages with urge incontinence and bedwetting.  A stronger pelvic floor could reduce the number of bedwetting episodes and allow a person to get to the bathroom in time to void.  A physical therapist trained in incontinence care can be very helpful with these exercises.

Here are some other ideas, but patients should speak to their doctor before trying:

Set an alarm to awaken during the night to toilet.  If the patient is wet before the time of the alarm, set the alarm to an earlier time until finding the ideal hour of the night to toilet.

Watch fluid intake:  Limiting after-dinner fluids will likely reduce urine production at night.  But PLEASE NOTE: if someone is very physically active into the evening hours, or could become dehydrated for any reason, this would not be recommended.

Prescription Drugs:  Medications to control incontinence is directed at treating the underlying cause.   In cases where there is urge incontinence, some medications may help to relax the detrusor muscle contractions of the bladder.  This type of incontinence is more common in older adults, but can certainly effect younger and middle-age patients.  For those suffering from a lack of vasopressin (a chemical that keeps the body from eliminating too much fluid), Desmopressin is a drug that replaces vasopressin in the body.  This is often associated with diabetes insipidus, brain tumor or head injury.  Careful assessment by a specialist would be in order in this case.

Night time incontinence may differ with younger and older adults but can be treated and managed in most cases.  Perseverance and motivation on the part of both patients and providers are key to managing night time incontinence.  Providers should stress that this is not the patient’s fault and it happens to others as well.  A provider should also emphasize that incontinence can be managed and assure patients they will search for the underlying cause and proper treatment.

About The Author

Christine Pruneau RN, BSN, RAC-CT

Christine has 25 years of experience in clinical education for a long term care and home health. She is a frequent speaker on the subject of continence management and has a special interest in restorative health in both adults and children.  Christine is the Clinical Director for Home Care Division at First Quality Healthcare.




Holly Kupetis

Sally was 56 when she first decided to invite her Dad to live with her. He, then 80, had been suffering with slight forms of dementia for a few years, but his episodes had increased greatly and she decided that the time had come where he simply could not live on his own.  Being an only child, most of the burden of care for her father fell on her.  And while she was happy to do it, it brought with it many challenges.  The extra time needed to help him with his daily activities, accompanying him to doctor’s appointments, researching medical needs and performing tasks that were new to her were just a few of the issues. A bigger challenge was balancing the demands of her father with her full time job. And while her boss was understanding, she found she was forced to reduce her hours at work in order to be available to her father when he needed her, creating a greater financial strain on her family.

Sally’s issues are ones faced by many who find themselves in a caregiver role to a parent or loved one.  And with a population that is aging quickly these issues are likely to be felt by far more of us in the future.  The AARP estimates that by 2050 there will be only 3 potential caregivers for every person aged 80 and above. That’s a drastic difference from today’s 7-to-1 ratio.

Why the sharp decline?  In just 10 years, the oldest of the Baby Boomer generation will be slipping into their 80’s, and with them, the need for additional care. Unfortunately, with the population expected to grow at just a 1% pace over the next several years, the caregiver ratio simply won’t be able to keep up. The AARP estimates that over the next several years we’ll see a steady decline in the ration of caregivers to older adults, with the sharpest decline happening as the Baby Boomers reach their 80’s.

What are the implications here? In the coming years, caregivers will need more support than ever before.  The greater number of caregivers will create an increased need for nationwide Long Term Services and Support.  And workplace policies will need to accommodate flexible work schedules to allow caregivers the extra time they so desperately need. And, care for the caregivers themselves will need to be addressed to ensure that they have the tools to take care of themselves, as well as their loved ones.  Things such as providing extra funding or tax credits to caregivers, creating more resources for caregivers to ensure they have the tools and skills needed to care for their loved ones, adjusting FMLA laws to allow for greater workplace flexibility and time off, and making adjustments to medicare and medicaid to cover caregiver coordination services are just a few of the things that can be done to avert this growing crisis.  Putting these types of resources and policies in place is crucial in the coming years if we want to support the caregiving community and our growing, older population

Surgical Treatment of SUI and/or Prolapse

Holly Kupetis

Dr. Donna Deng is the Director of Female Reconstructive Urology and Neuro-Urology for Kaiser Permanente Northern California

There are two main types of incontinence—stress and urgency. Treatment for them is very different.  Before operating on a patient I try to remind them that this is their quality of life, if it doesn’t bother them, it doesn’t bother me.  The patient guides treatment, and my job is to explain the treatment options, surgical and non-surgical.

Surgical treatments for stress incontinence can be divided into two categories—urethral bulking agent injection or some type of suspension (sling). The urethral injections are in the form of collagen or Durasphere. Suspension surgery is when a sling is used. There are three main ways to perform suspension surgery. The first is Burch suspension, where tissue around the urethra/vagina is lifted up. This can be done by making a cut in the abdomen or laparoscopically. The other two are the pubovaginal sling and the mid-urethral sling, which are implanted through the vagina. These use different types of material, and most commonly now is synthetic mesh.  The surgeon and patient will decide what material is best for the patient.

Like any surgery, continence surgery has risks. It is common that the surgery may have fixed the stress incontinence, but symptoms of frequency, urgency or urge incontinence may persist or appear. Other risks are not being able to fully release all urine, vaginal mesh erosion, vascular and bowel problems, and significant bleeding. A patient needs to think about the risks before going into surgery because there are different ways to perform anti-incontinence or sling surgery. The risks vary.

Surgical treatments for urgency incontinence include using Botox and nerve stimulation implants (InterStim). They are used to calm the bladder. Botox lasts about six months and will need to be reinjected. The InterStim is safe and reversible and can last from three to five and up to ten years (depending on the size of the battery), but it requires a little more surgery than injecting Botox into the bladder. Patients who receive neurostimulator need to be aware that they cannot have an MRI and will set off alarms in airports.

Prolapse is usually not detrimental to health. Often there is a little bit of falling, but if it is not affecting the patient’s quality of life, my advice would be to not undergo any extensive reconstructive surgery. Surgery for prolapse is not a cure all. The outcome of this type of surgery varies with every patient. Lifting through the vagina or abdomen needs to be tailor made for each person.

Surgical treatments are the same for the old as for the not so old, and results are similar. There is no reason not to proceed with surgery based on chronological age. Each person is different, and chronologic age is not a good indicator of how healthy someone is.

Dr. Deng has disclosed that she has no financial interests related to this topic.

About The Author:

Dr. Donna Deng is the Director of Female Reconstructive Urology and Neuro-Urology for Kaiser Permanente Northern California, caring for nearly 4 million people. Prior to this recent move, she was Associate Professor of Urology at the University of California San Francisco. During this decade long tenure, she helped develop the use of stem cells in the treatment of urinary incontinence and bladder function, as well as teach and mentor countless medical students and residents in the art and science of Urology.  She continues to lecture at national meetings and publish in peer-reviewed journals and major textbooks.


Holly Kupetis

Details Patients' Treatment-seeking Behaviors, Coping Methods, Management Efforts and Sources of Information on OAB

In December 2015, NAFC partnered with Medtronic to conduct a study with diagnosed and undiagnosed patients suffering with Overactive Bladder. The objective of the study was to better understand OAB, coping strategies and their management approach to the condition.  
Findings from the study were quite revealing, and much of the information may be helpful to healthcare providers seeking to better understand their patients – not only those who seek out their assistance for OAB but also those who are reluctant to so do.  Here’s a brief summary of what the study uncovered:
Impact On Quality Of Life:

  • The study revealed that 58% of men and 74% of women (including both diagnosed and non-diagnosed respondents) tended to be bothered by OAB symptoms (rating of “bother me a great deal”).
  • Among the diagnosed and non-diagnosed, lifestyle issues affected the most among patients were confidence and intimacy.  Travel, self-esteem, and general health feelings were also affected. 
  • More than half of those diagnosed with OAB use 4 coping strategies: making sure they are located near a bathroom, avoiding drinks before bed, monitoring fluid intake and using pads. The non-diagnosed tend use the same strategies, however at lower rates.
  • Women are more likely than men to use a number of strategies to cope with OAB.  These strategies include pads, dietary modifications, Kegel exercises and staying away from activities with family and friends.

Disease Management/Treatment Insights:

  • The internet is the leading source of information for both diagnosed and non-diagnosed OAB sufferers, with WebMD as the leader followed by
  • Prescription medications are used 4 times more often by women (33%) than men (7%).  Approximately 1/3 of men and women have tried medications, but are no longer using them.  Satisfaction levels with OAB treatments are low, with lack of effectiveness and side effects cited as the top reasons for discontinuing OAB treatment.
  • About half of women and only 37% of men are aware that nerves play a role in causing OAB.  Treatment awareness is largely limited to medications, dietary/behavior modifications and catheters.

Discussing Bladder/Bowel Health:

  • Among undiagnosed women who have not discussed their concerns with their physician, embarrassment was the top reason.  This was followed by patients being uncomfortable to talk about it, patients’ sense that other health issues were more important to discuss, the idea that OAB is just a part of getting older, and the belief that nothing can be done for those with the condition.
  • Men’s top reason was that they felt other, more serious health issues were more important to discuss.  They also frequently stated that they believed it was a normal part of getting older and that nothing could be done about it; in fact, they noted these reasons more often than women.
  • With 54% of non-diagnosed women and 71% of non-diagnosed men citing they have consulted a physician about their urination issues, this suggests that diagnosis and screening guidelines, along with a common referral standard may be important to better serve the undiagnosed/untreated population. 






Patients were screened and those that qualified replied to an online questionnaire about bladder health and OAB symptoms, implications and treatment options.  Of the 356 that completed the survey, 153 reported a physician had diagnosed them with OAB. The remaining 203 respondents all had reported symptoms of OAB, but have not been diagnosed by physician. Respondents ages ranged from 18-65+, with 60% of the respondents age 35-54 and 30% age 55+.


The non-diagnosed patients self identified through the use of a series of questions regarding the frequency of need to void urgently, the number of times per day, and the days per week the urgency occurred and the degree to which the problem was considered bothersome. Questions follow the standard diagnosed questions published by the American Urological Association and others.

Ask The Expert: Hear from our 2016 Continence Care Champion Award Winner – Dr. Christian Winters.

Holly Kupetis

QUESTION: Since you have been in practice, what changes have you observed in patient expectations of clinical outcomes?

DR. WINTERS: "In my view, patients have always wanted the same thing - safe and effective treatment of their conditions. What I have always found most appealing about my practice is that I need to do the best I can to select the best treatment for each individual. That’s what I view as the “art of our science”. Patients with very similar conditions may do best with different treatments based on a variety of factors, including their goals and expectations. To me, that hasn’t really changed. What is a bit different is that patients come with more information – some good and some bad – and we have to do our best job to help them make the most informed decisions. At some level, it’s the same process but the conversations continue to evolve. Another difference is that patients are expecting our treatments to not only be effective, but as minimally invasive as possible. Many of our patients are now wanting quicker recovery and faster return to work / or other activities. So, it’s a more comprehensive and encompassing discussion – I think that’s been a great development over time. "

QUESTION: So many patients with incontinence issues never seem to see the right physicians.  They seem to approach either primary care or gynecologist.  The data suggests that this initial consultation does little to address issues of incontinence.  What we can do to help patients find the physicians that are more knowledgeable and able to address their health concerns?

DR WINTERS:  "I view this as great opportunity for clinicians involved in the care of women with pelvic floor disorders. In my view, we need to “raise all boats”. What I mean is that we need a multi-faceted approach to improve access to pelvic health for all of our patients – men, women and children. I think part of this is enhancing efforts to collaborate with our primary care clinicians to improve the comfort level in having the conversation with our patients regarding pelvic floor disorders and in their basic evaluation and treatment. I’m always afraid of our patients in rural areas who may not have easy access to specialty care never seeking any treatment because it’s harder to access it. If we can increase the dialogue at the primary care level, I’m hopeful that these patients will have improved access to care. At the specialty level, we need to improve our access as well. We need to lead efforts in clinical and patient education – “how to start these conversations” – and we need to be cognizant of our accessibility. These issues can be improved by “outreach clinics” as well as more accessibility to our primary care clinicians who are treating these patients. Hopefully this “networking” can lead to integration of pelvic floor treatments – even across health systems. So, I think we as specialists need to support our patients and primary care clinicians on the “front end” by education them to initiate conversations and treatment. And, we need to be accessible on the “back end” to our patients and clinicians where more complex treatments are needed."

QUESTION: We hear that patients wait upwards of 7 years before seeking treatment for conditions like OAB. What can be done to to decrease the time to treatment?

DR WINTERS:  "Much of what I mentioned above would hopefully decrease this interval of time. Also, we need more research and development as our treatments for OAB have much room for improvement. We have very different patients with different symptom complexes entering the same “treatment algorithms”. Can we do better refining selection of therapies? Can we improve our therapies? Can we learn more about how these conditions are affecting our patients and what prompts them to treatment? We can. I believe if we are able to improve and refine our treatment approaches, this too will have a positive impact in decreasing the time to treatment. But at the end of the day, I think its about getting the conversation started."

Physical Therapy Care for the Pregnant & Postpartum Mama

Holly Kupetis

Physical Therapy Care for the Pregnant & Postpartum Mama

Lizanne Pastore PT, MA, COMT

            Pregnant and postpartum mothers comprise a significant segment of our population that is too often underserved by our medical community.  As we all know, a woman’s body goes through profound changes during pregnancy.  Bodily systems are taxed to the max.  The vascular, respiratory, endocrine, and certainly the neuro-musculo-skeletal systems are overloaded with extra stressors.   They say pregnancy is like training for a marathon, but when the marathon ends with the birth of baby, that’s only the first finish line, because mom has to lace up her running shoes again and continue running.  She must take care of her newborn, plus any other youngsters already at home; maybe she has to get back to her former job soon too.  The finish line is ethereal.

                  And as Mom is lugging those heavy, awkward car seats and strollers and lifting loads of laundry and bending deeply and often to maneuver ever-heavier infants into and out of cribs, she is doing so with less-than-optimal muscular and skeletal strength and form, not to mention her sleep deprivation!  Her ligaments are still lax; she probably has a bit of rectus abdominis diastasis making her core even weaker; her tendons and nerves are still mushy making her more at risk for things like carpal tunnel syndrome, tendonitis, and sciatica.  (All that extra fluid from pregnancy takes a toll on connective tissue.)  

                  And let’s not forget her pelvic girdle.  Pubic symphysis, sacroiliac joint (SIJ) or coccyx pain, pelvic girdle and hip movement dysfunctions, pelvic muscle or pudendal nerve pain, incontinence of bladder and/or bowel, pelvic organ prolapse (POP) are just some of the maladies that can affect the pelvic floor and pelvic girdle during or after pregnancy.

                  These pelvic issues are common, but they are not “normal,” as many women are led to believe.  “Oh, leaking?  That’s normal.  All my friends have leaked, it should get better.”  Stress urinary incontinence (SUI), for example, is extremely treatable, especially if addressed quickly.  But if a busy mom ignores her leaking and begins preemptively voiding or gripping her pelvic muscles to avoid leaks, she could actually turn her “straight forward” SUI into an urge scenario, creating muscle tightness or bladder dysfunction and making her case harder to treat.  

                  Similarly, intermittent SIJ pain or pubic pain can become more severe the longer left untreated.   POP, again, while common, is not normal, and is highly distressing to new moms, who hadn’t expected to experience such blatant anatomical changes.  Pelvic concerns are huge, both physically and emotionally for a new mom struggling to care for a new baby.  She hadn’t factored in the care she might need following birth; rarely is she forewarned that she might need help adjusting to her new “body-after-baby.”    

                  But the great news is that pelvic floor physical therapists are experts in treating the pregnant and postpartum mom.  We help many of these women return to fully functioning, active, healthy lives.  In a perfect world, every pregnant woman and new mom would be able to see a pelvic PT, but our world isn’t perfect.   So remember to include a physical therapy referral when your next pregnant or postpartum mama enters your office.  Assure her that her complaints, while common, are not normal but that there is help out there.  Let’s support our moms!

                  Get to know the pelvic specialists in your area; here are 3 great links to help: