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Understanding key to management

Common conditions

Understanding key to management

More than 14 million people in the UK have bladder problems, according to figures from NHS England. Symptoms can be distressing and limiting, but many people are too embarrassed to ask for help. As a result, they may be buying unsuitable products – or nothing at all. 

The role of pharmacies in the incontinence category often centres around providing care for those who experience the more severe effects of the condition. However, according to Stephanie Hickford at TENA, incontinence impacts different people in different ways. “For some, it may not be an especially severe condition in itself,” she says, “but the perceived social taboo around incontinence can harm a person’s social confidence.”

Pharmacy teams can play a crucial role in supporting customers and helping them find a better quality of life. The key lies in understanding the different symptoms that may occur, being familiar with the management products that are available, and knowing when to refer customers to their GP.

There are several types of bladder incontinence, or bladder weakness, the most common being:

  • Stress incontinence – urine leaks when the bladder is put under pressure, such as when coughing or laughing
  • Urge incontinence – a sudden, intense urge to urinate that cannot be stopped
  • Overflow incontinence – an inability to completely empty the bladder, resulting in leaking
  • Total incontinence – the bladder cannot store urine, so leaks constantly. 

Urine leakage is generally categorised as light, moderate or heavy:

  • Light (could be described as ‘little and often’): customers may be purchasing panty liner style products
  • Moderate (enough to soak substantially through underwear): they may benefit from higher absorbency pads and pants
  • Heavy (full bladder emptying): these customers may benefit from much higher absorbency products.

Statistics published in Reviews in Urology suggest that between three and 17 per cent of women report experiencing ‘moderate and severe bother’ from urinary incontinence, with severity rapidly increasing between the ages of 70-80. Men also suffer, but the prevalence is said to be between 3 and 11 per cent overall. Urge incontinence accounts for between 40 and 80 per cent of all cases in male patients, while stress incontinence accounts for less than 10 per cent of cases and is often a result of trauma, prostate surgery or neurological injury. Incontinence in men also increases with age, although the prevalence of severe incontinence in men aged 70-80 tends to be around half of that in women. 

A test for chemical markers

A study carried out by the University of Portsmouth has identified chemicals in urine specific to overactive bladder, and a test for these chemical markers is under development. Dr John Young from the university’s School of Pharmacy and Biomedical Sciences says: “The first step has been to identify chemicals in urine that are specific to overactive bladder. The next step is to develop a gadget for use in GP surgeries, pharmacies and nursing or care homes which is simple to use, accurate and doesn’t need to be sent to a laboratory for processing. “If successful, it would save millions of patients from painful procedures and long waits for a diagnosis.”

Supporting customers

According to Frances Kelly, qualified nurse and account manager for Ontex Healthcare, which makes the iD pants range, many people are too embarrassed to consult their GP or practice nurse about incontinence. However, she says it is advisable that pharmacy staff do recommend that they do so. 

Knowledge is the key to confidence, so the more pharmacists and their staff are educated, the more they’re able to assist their customers

“Unfortunately,” Ms Kelly continues, “some will continue to need continence products to manage their leaks. These are available in a wide range of styles, sizes and absorbency levels, which can be confusing for the shopper – this is where pharmacy staff can really make a difference. It is essential that staff involved in supporting shoppers with their choice of products have an understanding of the different types of continence problems that affect the bladder.”

Bladder weakness can be a sensitive topic to discuss in the pharmacy. Research has found that many patients do not seek advice for their issues with incontinence, with 45 per cent admitting it causes them regular embarrassment and negatively affects their happiness. This results in many people suffering in silence or using inappropriate products to manage their symptoms. 

Community pharmacy teams have a huge part to play in providing discreet advice and signposting products. “TENA believes that knowledge is the key to confidence, so the more pharmacists and their staff are educated, the more they’re able to assist their customers,” says Stephanie Hickford. “That’s why we are committed to supporting pharmacy teams, and provide a variety of training materials across all aspects of the category, from education about bladder weakness itself to category management.”

Four quick tips

TENA has the following suggestions for how pharmacy teams can support customers: 

  1. Make sure incontinence products are easy to find and visible to pharmacy staff too, as this will enable you to spot customers who may need assistance
  2. If you spot someone hovering around incontinence products, approach them in a calm manner, and help them in a discreet way. It is important that once communication has started, staff speak to customers with empathy, reassuring them that they are not alone and that many men and women experience bladder weakness
  3. It is important to understand that each person’s incontinence is different – advice should be tailored to the individual. There are a variety of reasons why a customer may experience bladder leakage: it could be a result of recent surgery, of being overweight, being pregnant or suffering from a lung condition that leads to heavy coughing. Speak with the customer to understand the level of urine leakage they are experiencing and how often. This will enable you to recommend the best solutions
  4. Pharmacy staff should familiarise themselves with the different demographics of people on the shop floor and adapt their approach accordingly. It is also important to recognise that a customer may not be buying for themselves – they could be caring for a friend or relative. 

Initially, treatment for bladder incontinence focuses on approaches that don’t involve medication or surgery. These include lifestyle changes such as losing weight, reducing caffeine intake and learning pelvic floor (Kegel) exercises. 

Kate Charlesworth, a specialist physiotherapist in pelvic health, says: “I would love to see pads sold alongside information about pelvic floor exercises. A shelf of pads and a rack of leaflets on pelvic floor exercises should go hand in hand. Women need to know they don’t have to put up with bladder incontinence. While pads are part of the answer, they are not the whole answer.” Ms Charlesworth says GPs used to prescribe Aquaflex vaginal cones for pelvic floor training: “Pharmacies could potentially stock these for safe use.”

Sarah Scudamore, an advanced postnatal trainer with a BSc in sports therapy, says that simply advising women to try pelvic floor exercises is not enough, and that they may be ineffective, depending on the reason for the problem. “I personally don’t recommend Kegels for all women,” she says. “Without an assessment, there is no way of knowing whether their pelvic floor muscles are tense or weak.”

Pads and leaflets on pelvic floor exercises should go hand in hand. Women need to know they don’t have to put up with bladder incontinence.

If the customer is suffering from a prolapse, for instance, squeezing is not the solution. “There is an issue with telling women to Kegel,” says Ms Scudamore. “Physios report that most can’t do this exercise correctly without much better guidance and visualisation.” She points out that it’s also important to consider bowel habits when addressing bladder incontinence as constipation is one of the biggest factors in prolapse.

In addition to other lifestyle changes, Ms Scudamore recommends advising customers to address their stress levels and posture when looking for relief for bladder problems. She explains: “Stress creates more tension in muscles of the core and pelvic floor, while factors such as spending large amounts of time at a desk without moving can have an effect on overall health as well as the pelvic floor.

P3pharmacy category panel views

“This is not a popular category for our branch and we don’t get many requests. Customers tend to order incontinence products in bulk online. My advice to improve your category would be to stock more female than male products and to have a good variety of sizes. Do some market research to see what your customers actually want before you commit to stock. For example, younger customers often prefer a thinner, more discreet product. Small sample packs are a good idea too if a customer wants to try a product before they commit to buying a large pack.”

Sarina Mughal, Day Lewis, Knightsbridge

“This is a really important area for us. Our older customers like to come in and get their supplies. We do prescription deliveries and customers will often order by the case load. TENA is the best seller, but Always does well too. Customers are often confused by the droplet system and ask us to explain it. Men used to be embarrassed about buying these products for their wives or for themselves, but that seems to have gone now. It’s really important to stock a good range with lots of sizes. Keep male products in store too.”

Lindsey Fairbrother, Goodlife Pharmacy, Hatton, Derbyshire

“We stock a limited range of TENA and have regular patients who rely on us for their incontinence supplies. This is an important category for our elderly customers and, with the Discreet range, for younger people too. We are often asked about the level of protection different items offer. With limited space, we find it difficult to promote these items, but rely on our staff discussing options by placing a few items conspicuously in the shop area designated to this category. Most of our range is, unfortunately, in the stock area.”

Gareth Evans, Wansford Pharmacy, Peterborough

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Common conditions