Millions of Spaniards suffer from this disease, but most don't know it (and part of the blame lies with Concha Velasco).

An estimated 60 million people in Europe live with urinary incontinence (UI), a condition characterized by malfunctioning of the muscles or mechanisms that control the bladder and urethra, which leads to involuntary urine loss . While it affects both sexes, the prevalence is doubled in women: an estimated 3%–23% of men suffer from this dysfunction, while the percentage increases to 11%–52% in women.

If we analyze the data in Spain, it is estimated that nearly three million people in Spain live with this condition , particularly affecting institutionalized older women with chronic illnesses, multiple medications, or reduced mobility, where the prevalence reaches 89.5% . However, despite these figures, experts believe that UI remains a highly underdiagnosed, undertreated, and stigmatized condition, which seriously hinders access to adequate care.

In this context, the Alliance Against Urinary Incontinence (ALiNUR) was born, formed by nine scientific societies and patient associations with the support of the medical technology company Becton Dickinson. The main objective of this initiative is " to promote a comprehensive approach to urinary incontinence, focused on prevention, early detection, and equitable access to effective treatments, including innovative ones, and on strengthening coordination in primary care," explained Àngels Roca , patient and president of the ASIA Incontinence Association, one of the organizations that created ALiNUR, in a presentation to the media.

Along with the emergence of the Alliance , a consensus document was also created, drafted by all members: Challenges and Proposals for Improving Female Urinary Continence in Spain . In this guide, experts highlight the need to develop a specific approach that responds to the multiple unmet needs of this condition. Among these, they highlight the importance of implementing specific training programs for healthcare professionals, as well as educational initiatives related to the condition for patients and their families, so that they are equipped for rapid diagnosis and disease management.

“Strengthening the training of family physicians and promoting the roles of liaison nurses and case management nurses is essential for the management of urinary incontinence. Not only in terms of diagnosis and follow-up , but also to improve coordination between levels of care, continuity of care, and patient care,” emphasizes María Victoria García , treasurer of the Spanish Society of Geriatric and Gerontological Nursing (SEEGG) and a member of the Alliance. “The promotion of specialized units for the management of urinary incontinence would facilitate each patient receiving the most appropriate care based on their clinical situation. This is especially relevant for the most complex cases,” concludes García.

To achieve this adaptation of patient care and guarantee rapid and optimal access to treatment, ALiNUR calls for ensuring that women suffering from this condition have access to all therapeutic alternatives available on the national market, including innovative therapeutic solutions. Therefore, it is also crucial to encourage research into this pathology in diverse populations.

“Having up-to-date data on prevalence in our country through a representative sample would facilitate a better understanding of the magnitude and impact of urinary incontinence on health. Innovation in this area would significantly contribute to the development of new treatments and healthcare devices that could offer effective, safe, and accessible solutions , especially for patients receiving palliative care,” emphasizes Dr. Irene Díez Itza , president of the Pelvic Floor Section of the Spanish Society of Gynecology and Obstetrics (SEGO).

Addressing female UI in our country generates an economic impact in terms of both direct and indirect costs. In Europe, the economic burden is estimated to exceed €69 billion annually.

In Spain, the use of absorbent products alone accounted for 59% of the total number of sanitary products prescribed in 2022, with its consequent environmental impact, generating more than 172,000 tons of waste annually from the disposal of single-use diapers, whose complete degradation can take up to 500 years.

It's also important to highlight the associated mental health problems that often accompany this condition. On a psychosocial level, recent studies show that up to 30% of women with UI experience symptoms of depression , a direct consequence of the stigma, loss of autonomy, and deterioration in quality of life .

“A fundamental factor contributing to this impact is the stigma associated with urinary incontinence. Many women feel ashamed and fear being judged , so we don't share this with healthcare professionals, or even with our own people. This situation contributes to social isolation, low self-esteem, and emotional problems such as depression,” explains the president of the ASIA Incontinence Association . “Implementing social awareness initiatives would significantly contribute to reducing this stigma, as well as fostering more understanding environments adapted to the needs of those affected,” Roca concludes.

The challenge in geriatric age

UI affects between 20% and 25% of the elderly population , with figures exceeding 50% in nursing homes . However, only a minority of patients consult a doctor, reflecting significant underdiagnosis and underreporting. This situation is contributed to by factors such as a lack of health education, low awareness among professionals, and the misperception that UI is an inevitable consequence of aging.

An underdiagnosis that also plays a significant role in the so-called "Concha Velasco phenomenon," a term used by healthcare professionals at the ALiNUR presentation to criticize the normalization of urinary incontinence following an advertising campaign in which the actress participated. This leads many patients to not believe they may have a serious problem, so they don't go to the doctor, according to all the experts who signed the new consensus document.

Experts point out that effective management of UI in this group requires a multidisciplinary approach , combining pharmacological and non-pharmacological treatments, especially in patients receiving palliative care. In institutionalized settings, the high prevalence also poses additional challenges in terms of resources, staff training, and care protocols.

“UI remains largely invisible in the care of older adults . It is essential to promote interventions focused on the dignity and quality of life of those who suffer from it,” concludes the SEEGG member.