My-qup Medical’s Anna Echegaray and Dr Laura Lagares underline how the impact of ABL goes far beyond the patient.
In 1948, the World Health Organization (WHO) defined health as a ‘state of complete physical, mental and social well-being, not merely the absence of disease or infirmity.1 It is thus important to consider all aspects of health and wellbeing, as well as our cultural approaches to notions of taboo, in order to be able to address them.
Quality of life impact
Bowel incontinence or accidental bowel leakage (ABL) affects nearly 10% of the adult population.2 Even so, there are many patients and physicians who remain unaware of this condition.3 ABL is defined as the ‘unintentional loss of stool or flatus in a person with a development age of at least four years.’2 The inability to control this important bodily process can result in a loss of confidence, dignity, self-respect and, indeed, composure. These consequences are compounded by the social stigma attached to ABL and the inherent embarrassment or secrecy similarly attached to the condition. The issue is further fuelled by the belief that ABL is something untreatable or a normal part of ageing, keeping patients from consulting a health professional or seeking advice to start with.
Although it is estimated that ABL affects around 10% of adult population in developed countries, the prevalence of ABL increases with age. It goes from approximately 3% in the age group from 20 to 29 years, to 16% in people aged 70 or over, and as high as 47% in nursing home residents.4 Taking into account the inverting population pyramid in these countries, ABL prevalence is expected to increase significantly.
Even though there are multiple forms of treatments for ABL, from surgery to diet, they are not fully effective for all patients,2 with their many unique circumstances. Because ABL may have several causes, finding a cure for all types is extremely complex and not foreseen for the near future. This can place a great burden on patients to individually manage their incontinence themselves in order to be ‘socially continent’ and to live normal lifestyle. Given that a complete cure is not realistically achievable, the goal is therefore to foster the best possible quality of life through the effective management of the situation.
From an analysis of existing literature and patient interviews, a set of the main points and issues has been defined. It has been found that from the outset it is important for the patient to recover their confidence to go out again, to avoid sick leave and even depression, and to foster a sense of normality. Then, there is the need for complete discretion; discretion and odour control are fundamental, as patients are usually too embarrassed to talk about their condition.
The market value for retail sales of adult incontinence management products totalled €118.1m in 2016 and grew to €132.5m in 2017.5 Current key trends in this market include the higher penetration of high-end products, the launch of new products, and the increasing adoption of home healthcare products. However, there are other factors which can hinder the growth of the market, for instance the lack of awareness about advanced continence care products.6
The great majority of people affected with ABL uses hygienic pads, or adult diapers in the more severe cases, to manage this condition. Most of them are disposable products, which results in the generation of large quantities of difficult-to-recycle items. The main problems here are the different layers, the mixed organic-inorganic composition, and the faecal or urinary content. Therefore, pads and diapers are usually perceived as a problematic non-biodegradable waste.
In recent years, several initiatives have brought back the use of reusable diapers and pads. However, in institutions such as nursing homes (which are one of the largest consumers of these kinds of products), its management could potentially be a public health problem, as some faecal pathogens are resistant to regular laundry processes. Moreover, the use of cotton, the main compound of most reusable diapers, may have a more significant environmental impact than their disposable counterparts because of the amount of water, fertilisers and pesticides used in the cotton crop and the chemical-intensive production process.7
The importance of biodegradable products
In the past, the life cycle of products has tended not to have paid attention to the issue of disposal. Nowadays, companies are more aware of the environmental impact of their products and consider the life after disposal in the design process. The use of biodegradable materials is an example; the global bio plastics market was USD$ 19.54bn in 2016, and this is estimated to reach USD$ 65.58bn in 2022.8
The need for disposable products is undeniable, and they have to be cheap in order to compete against reusable options. For this reason, plastic has been used widely across industries and, with this, plastic pollution has become a dramatic global issue.
While the environmental impact of this has been known for decades, traditionally it was more associated with the physical objects. Now, studies are focusing more on the chemical problems associated to plastic degradation. The disposed products that end up in the sea produce a ‘chemical cocktail’ that is affecting wildlife as the animals ingest it. Plastic is not biodegradable, instead, it breaks into particles so small that they can travel from the stomach and into the bloodstream.
The recovery of plastic is complicated; it can be incinerated to produce energy or can be separated. As stated previously, the separation of plastic on products composed of layers is very complex. For this reason, it usually represents a big part of the urban waste sent to the landfills in developing countries.9
The use of biodegradable products to manufacture solutions for the management of ABL must be forthcoming, not least because of the fact that global sales of adult diapers reached 17,689.3 million units in 2015 and the market is expected to grow by almost 50% by 2020.10
The public’s awareness has forced companies to manufacture more sustainable products in other fields. However, in the United States, only 12% of people older than 60 appear to be considerably concerned about the contamination caused by household refuse.11 This means that this demographic, which is the main consumer of adult diapers, remains relatively inactive when it comes to demanding better solutions for the environment.
In conclusion, ABL is a hidden condition that affects millions of people globally. It has a huge impact on the quality of life of the sufferers and those closest to them. ABL may also have important indirect social and economic effects due to the isolation of those with the condition and the time they may take away from the workplace. The individual management of this condition through the use of different products creates a huge amount of difficult-to-manage residues, leading to an alarming environmental impact.
Taken together, these issues make the rise of awareness of this condition and its management mandatory, promoting the creation of new solutions that meet the requirements of the users while reducing the environmental impact.
- Preamble to the Constitution of the World Health Organization as adopted by the International Health Conference, New York, 19-22 June, 1946; signed on 22 July 1946 by the representatives of 61 States (Official Records of the World Health Organization, no. 2, p. 100) and entered into force on 7 April 1948.
- Whitehead et al., Am J Gastroenterol. 2015 Jan;110(1):138-46
- Brown et al., Int Urogynecol J. 2016 Nov 14.
- Ditah et al., Urogynecol J Pelvic Floor Dysfunct 17:407-17
- Adult Incontinence in Spain, source: Euromonitor International
- Global Continence Care Market: Industry Analysis & Outlook (2017-2021). Koncept Analyitcs
- Kendyl Salcit. Why cloth diapers might not be the greener choice, after all. The Washington Post. May 8, 2015
- Biodegradable Plastics Market 2017-2022 – By Type, Application, Regions – Market Size, Demand Forecasts, Industry Trends and Updates. Research and Markets
- Espinosa-Valdemar et al., Resources, Conservation and Recycling 2014. 87:153-157
- Adult Diapers Market (Pad Type, Pants Type, and Flat Type Adult Diapers): Global Industry Perspective, Comprehensive Analysis, Size, Share, Growth, Segment, Trends and Forecast, 2015 – 2021. Zion Market Research
- Share of adults who worry about the contamination of soil, water and the general environment by household refuse in the U.S. in 2017, by age group. The Statistics Portal.
Anna Echegaray and
Laura Lagares, PhD
This article will appear in SciTech Europa Quarterly issue 26, which will be published in March, 2018.