Community pharmacists are ideally placed to advise customers on common, yet often taboo, subjects, such as urinary incontinence, as many people are still reluctant to ask their GP for help. Many women don’t use the right products to protect against leaks, using femcare products instead. This provides pharmacists with an opportunity to discuss the topic. Key brands such as TENA and Always Discreet continue to launch innovative products to keep the market moving and to help pharmacists drive sales. So which products should pharmacists be focusing on to suit customers’ needs?
TENA recently launched a new night-time protection product – TENA Lady MiniNight – for the one in six women who experiences night-time bladder weakness but wants a smaller, more discreet pad. According to TENA, this will address the rapidly growing night-time incontinence segment, which increased 14.6 per cent in volume and 13.1 per cent in value year on year in 2016.
“We know just how crucial pharmacy teams are in providing the right support, reassurance and guidance when it comes to making the bladder weakness category more accessible for customers,” says Donna Wilson, TENA training and brand manager. “Just one in 10 women uses a specific night protection product, with the result that a quarter of women have experienced product leakage.”
With one in four men over 40 experiencing urine leakage, the male market is an emerging trend that pharmacists should also look to take advantage of. The male urine leakage sector is experiencing strong growth in pharmacy at 8.2 per cent year on year, offering huge growth potential. Many men still assume that bladder weakness products are only available for women, so increasing visibility is the best way to encourage more men into the category.
According to Ms Wilson, pharmacists can consider dual-siting products, so that men who are looking to purchase urine leakage products can look in the male fixture before the intimate hygiene fixture. “This would help capture men, and also women purchasing products on behalf of their partners – driving potential sales in this emerging growth area,” she says. “This will help to challenge a reluctance to seek advice, encouraging purchase straight from fixture. Pharmacy teams can also use samples to demonstrate how the product works and show its key benefits, giving customers a very clear reason to buy. Samples will also increase dwell time, both at fixture and in the pharmacy in general, which is especially important for men who rarely visit their local pharmacy or GP.”
In June 2016, a survey by 3M in association with the Cystitis and Overactive Bladder Foundation revealed that more than 50 per cent of 800 home-based sufferers and their carers said they experience sore and broken skin caused by exposure to urine and faeces when wearing incontinence pads. Products formulated for nappy rash should relieve the symptoms, but customers may prefer to use adult-specific brands. Pharmacists are ideally placed to offer advice on suitable products, such as Cavilon Barrier Cream and Multi-Gyn IntiSkin. “About 45 per cent of the people we surveyed are using creams to treat the symptoms of IAD,” says Victoria Murray, 3M clinical manager. “However, they may be using all-purpose moisturisers, which don’t provide the protection needed to prevent the condition.”
Elaine Miller, who has turned her physiotherapy speciality of continence into a comedy show at the Edinburgh Fringe Festival, says macerated skin can be very fragile, so care must be used when applying rub-on creams. “The spray format of the pH-neutral Multi-Gyn IntiSkin is useful for people with poor mobility or skin breakdown risk,” she says. “Ultimately, our aim should be to establish the cause of the person's leaking and then direct them towards products that will help and advice to manage the secondary effects of incontinence.”
Pelvic floor strengthening aids can help if incontinence is caused by a weak pelvic floor, in both men and women. But just because products are available on prescription doesn’t necessarily mean they are recommended by the healthcare professionals who work in this area. Ms Miller says some incontinence products are excellent with good evidence behind them, but others would be better replaced with a dab of snake oil.
Katie Mann, specialist physiotherapist and spokesperson for the Chartered Society of Physiotherapy, says before using any pelvic floor products, it’s essential that customers are assessed by a healthcare professional. “Seventy per cent of patients can get significant improvement or even cure with the help of physiotherapy, which is available on the NHS or privately,” she says. “Pharmacists should signpost customers to pogp.csp.org.uk to find a suitable physiotherapist in their area. Customers need to be assessed for suitability for equipment, especially if they have dermatological problems, such as lichen sclerosis, or prolapse. The ‘Educator’ provides a visual way of seeing whether people are doing the pelvic floor exercises properly. There are more complicated biofeedback machines too. Elvie is a pelvic floor exercise tracker and quite expensive but good technology. Weighted cones (eg Aquaflex) provide resistance and are like weighted tampons. But cones aren’t suitable for everyone, such as women with a significant prolapse. Electrical stimulation units claim to do pelvic floor exercises for you, but are not suitable for women who have had an abnormal smear test. They are used by physios, but will only work muscles that can’t be worked themselves.”
Ms Miller says compliance is the challenge with any healthcare product that needs to be used regularly. “There is no evidence to say that using a pelvic floor gadget is more effective than doing pelvic floor exercises alone,” she says. “However, anecdotally, it seems that if a person invests money in a pelvic floor strengthening device, then they are far more likely to do their exercises effectively and in the long term. Useful tools can be something as simple as an app, a mirror or a biofeedback device. Apps such as the NHS-endorsed squeezyapp.co.uk and pelvicfloorfirst.org.au are examples of good evidence-based technology.”