There are an estimated 13 million Americans who suffer from incontinence with 11 million of them being women, according to the Agency for Health Care Policy and Research (AHCPR). In terms of dollar amounts, $16.4 billion is spent every year on incontinence-related care and $1.1 billion is spent yearly on disposable adult incontinence products. For years, urinary incontinence (UI)—the partial or complete loss of bladder or bowel control—has been thought of as an aging problem. Although more than 50% of elderly persons living at home or in long-term care facilities are incontinent, UI is not merely linked to age but in fact has several causes, such as pregnancy and childbirth, menopause, prostate surgery, pelvic trauma, spinal cord damage, caffeine or certain medications. There are four main types of incontinence—stress incontinence, urge incontinence, mixed incontinence (a combination of the first two) and overflow incontinence.

As medical advances are helping to push the general population’s life expectancy upward, the market for adult incontinence products is expected to increase at a rapid rate and possibly even overtake the booming disposable baby diaper market. “If you take a look at the total retail segment for adult incontinence, it’s a $583 million category,” said Heike Hartwell, director of product management for Paragon Trade Brands, Norcross, GA. “It’s still relatively small compared to other absorbent categories. It is, however, one of the fastest growing categories, with a growth rate of about 10% per year.”

Peter Zajaczkowski, North American R&D manager for SCA Hygiene, Eddystone, PA, agreed. “I think what’s happened in the past is that baby diapers have tended to be the major area of focus and have seen more product innovations. But I think you may start to see some of that go the other way toward the adult incontinence market,” he said.

‘I’ Is For ‘Innovation’
Keeping up with the race for product innovations in this fast-growing market is keeping most manufacturers busy these days. Issues such as leakage protection, skin care, comfort and discretion decide which products are going to be bought and which are not. “Customers continue to want products that provide the utmost dignity and discretion for the wearer,” explained Julie Lawrence, director of marketing for Paper-Pak Products, Washington, GA—a company that last year acquired the “Attends” brand from Procter & Gamble, Cincinnati, OH.

For its part, P&G has held on to its Japanese “Attento” business, which has also felt the impact of both heightened customer requirements and an increasing older population. “In Japan, the market for adult incontinence products is growing rapidly due to an increasing aged population. It has been growing steadily for the past decade,” said Tami Jones, spokesperson for P&G. “Many manufacturers, including P&G, have introduced improved types of adult incontinence products,” she said.

On the retail side of the market, there has been a greater amount of highly engineered products designed to better match the exact application, or level of incontinence, due to the fact that it is primarily the user who is doing the purchasing. According to Bill Hemann, president of Hospital Specialty, Cleveland, OH, “It’s the retail side that is driving the innovation of matching product with need.” Mr. Hemann went on to explain that there have been a lot of new product entries over the past five years, beginning with briefs and underpads to beltless undergarments and the latest innovation of a one-piece pull-up product. Mr. Hemann predicted that retail will become an even bigger outlet as the delivery of geriatric care becomes more home focused, rather than nursing home focused.

As innovative products take shape, some manufacturers have reported the decline of older products in the market. According to Paragon’s Ms. Hartwell, added absorbencies in higher performing pads—which make up about 50% of the entire adult incontinence product mix—are taking the place of guards. In addition, the area of serious incontinence, which typically concentrates on briefs and undergarments, is being invaded by the advent of pull-on pant products, which are modeled after disposable training pants for children. “We are seeing the emergence of a new segment—pull-on adult pants—which is affecting the marketshare for both briefs and traditional undergarments,” she stated.

SCA’s Mr. Zajaczkowski sees pull-on products as having a significant impact on the market. “They fit in with more discretion and are easier-to-use. As you see baby boomers getting older and the income level of the consumer potentially increase, products that provide more discretion and comfort that are more underwear-like will become more popular,” he said.

The movement of pull-on products into the adult incontinence market is a prime example of how innovative features that were first developed within the disposable baby diaper market are now taking off in the adult incontinence market. New features such as aloe and breathability for skin wellness, inner leg gathers for leakage protection, rapid acquisition layers for liquid management and odor control and thinness for discretion all had their beginnings within the baby diaper market. “The adaptation of technology that has existed in baby diaper and training pant areas is starting to move into the adult incontinence market,” Ms. Hartwell of Paragon explained. “The baby diaper and training pants markets are the blueprints for adult incontinence.”

New product innovations are also causing a gradual shift away from the use of feminine hygiene and other absorbent products toward specifically targeted adult incontinence products, according to Mary Lippert, director research and development for adult care for Kimberly-Clark, Dallas, TX. “Customers are looking for containment, comfort, cost and convenience and we want to continue to provide them with normalcy and dignity,” she added.

Ms. Hartwell agreed, “We are seeing a definite shift from using feminine care products for the treatment of incontinence to actually using incontinence products.” She attributed this shift to better-developed products, consumer education and distribution gains within both grocery and mass merchandise retail outlets. “The consumer is aware that the products are out there and are finding them easier to purchase,” she added.

On The Institutional Side
As for the institutional side of the market, some manufacturers contend that the financial sensitivity of the business has kept it from seeing a lot of innovation. “Cost control is very key,” said SCA’s Mr. Zajaczkowski. “I don’t think you see as much in terms of product development on the institutional side as you see on the retail side,” he said.

Although the need for products with features that appeal to customers is a bit heavier on the retail side of the market, the institutional market has its own customer needs to handle. According to Ms. Lawrence of Paper-Pak, the institutional market segment accounts for approximately 60% of all adult incontinence products. This market has a large impact on manufacturers as they must take into consideration not only the needs of the user, but of the needs of the purchaser, who in most cases is dealing with restricted funds. According to Hospital Specialty’s Mr. Hemann, “Institutional venues, such as long-term nursing homes, are specifically concerned with more cost-effective solutions, especially since Medicare’s new prospective payment system dramatically reduced reimbursements.”

To offer some background information, in 1983, the U.S. government instituted the prospective payment system (PPS) in an attempt to revise the way Medicare paid hospitals for treating elderly patients. Under PPS, each illness requiring hospitalization is classified into a category with a set amount of Medicare coverage. This allows hospitals that treat patients less expensively to absorb the extra funds, but if a treatment is more expensive they must take the loss. In this way, hospitals are forced to treat patients as economically as possible, resulting in a slow adoption of new products and innovations.

“The effect of prospective pay has had a tremendous downward pressure on pricing, not just in the adult incontinence category but in all categories,” Mr. Hemann stressed. “You operate a business based on one set of economic criteria and there’s a sudden change that substantially reduces your revenue, such as reduced reimbursement on a product,” Mr. Hemann continued. “As a result, you have to deliver the same kind of service with less revenue so something’s got to give. Consequently, nursing homes have to look for ways to save money somehow, so they look to save in any product category.” Mr. Hemann went on to explain that from an institutional standpoint, the market has become much more competitive. “Everyone is getting squeezed—the nursing home has less revenue so the distributor gets squeezed and the manufacturer gets squeezed. It has a backward rippling effect,” he concluded.

For manufacturers providing products to the institutional market, having products covered under health insurance policies such as Medicare would be beneficial to both their customers and users—whether they are purchased for nursing homes or over-the-counter for home healthcare. “If adult incontinence products are fully reimbursed it would mean that our customers could focus on quality outcomes for their patients/ residents,” stated Paper-Pak’s Ms. Lawrence. “It would mean that only providing the best care would impact their purchase decision.”

According to K-C’s Ms. Lippert, incontinence products are considered “medical devices,” although they are exempt from regulation. “Incontinence products are not currently covered under health insurance policies from a North American perspective, although there are some instances where users can get reimbursement,” she said. However, this is not the case in Europe, “European incontinence product users are reimbursed so it depends on where you are in the world,” Ms. Lippert added. “This is something we are constantly watching. We are making sure that we keep our finger on the pulse of what is going on.” Similarly, in Japan, according to P&G’s Ms. Jones, adult incontinence products are included with medical expenses as tax-deductible items.

The Future Of Adult Incontinence
Between an increasing aging population, heightened consumer demands and a financially sensitive institutional market, how will the adult incontinence market fare in the future? “I would say these products will play a more significant role because the demographics support the growth of the category both in North America and globally,” said Mr. Hemann of Hospital Specialty. “As other economies develop and there’s more personal disposable income, I think the category will grow because more people will be able to afford these products.”

In addition to economics, on the institutional side of the market customers are looking to offer users the best level of care within certain economic constraints. “A focus on trying to provide dignity and comfort will be a driving factor in the institutional market,” said SCA’s Mr. Zajaczkowski. “Cost control is still going to be a key issue, but providing products that maintain healthy skin condition will also be an important factor to doing well in the market.”