Prevalence, Socioeconomic, and Environmental Costs of Urinary Incontinence in the European Union - Beyond the Abstract

Background

Urinary incontinence (UI) and continence health are crucial for overall well-being, often wrongly associated solely with old age.¹ Among the general population, the prevalence of being incontinent at least once in the past 12 months with any type of UI ranges from 25% to 45%^2,3 indicating its widespread impact. This condition not only hampers independence and productivity in daily life,¹ but also poses a significant economic burden, yet remains largely unquantified at the EU level. Health inequities across EU Member States remain a significant driver for coordinated action at the EU level. Access to continence care varies widely—particularly in terms of reimbursement for physiotherapy, medications, protective materials, and surgical interventions, as well as access to specialist services.

These disparities, which disproportionately affect women with gynaecological-related continence issues, highlight gaps in the realisation of women’s right to health—an emerging EU priority. Although non-communicable diseases are on the EU agenda, continence health remains overlooked, presenting a clear opportunity to advance gender equity and reduce variation in care across the Union.

During the analysis design, authors noted a dearth of recent literature on the economic impact of UI in the EU, with studies dating back 15-17 years and primarily focused on select EU countries.^6,7 Surprisingly, only three studies in the last decade quantified the economic burden of UI, with the majority based in the US and only one in Europe.^8–10 This gap is striking considering UI's preventable and treatable nature,¹¹ offering opportunities to mitigate symptoms early and reduce healthcare costs. Additionally, there was a scarcity of standardised prevalence data from reputable sources like the Global Burden of Disease or World Health Organization, necessitating reliance on individual peer-reviewed studies.

Economic analysis approach

The economic burden analysis included all 27 European Union countries, adopting a societal perspective that considered both direct and indirect costs. These included expenses for incontinence pads, medical consultations, diagnostics, treatments, and productivity losses due to absenteeism for both patients and informal caregivers. Additionally, the analysis estimated the costs and environmental impact of UI waste disposal,¹² recognising its significance amidst the global climate crisis. Data for this analysis were sourced from literature, interviews with clinical experts, and surveys from 13 national urological societies. An uncertainty analysis was conducted to evaluate the potential impact of variability in key parameters.

Firstly, the analysis revealed significant disparities in how UI prevalence data were documented across EU studies, driven by methodological variations, cultural factors, and inadequate data collection. Few studies reported age-standardised rates.¹³ The most commonly reported category of UI in the literature was 'any' UI, which was used to facilitate the economic calculations. While prevalence varied widely among countries, consistent trends emerged: women generally experienced higher rates than men, and prevalence increased with age for both genders. Women typically reported UI at younger ages, around 25 years and older, whereas men's estimates were more common from age 40 onwards.

The economic analysis revealed that UI imposed a substantial burden across all EU countries, totalling EUR€69.1 billion in 2023 (lower estimate EUR€26.1 billion, upper estimate EUR€133.4 billion). This amounts to approximately half the economic burden of diabetes, which cost the EU around EUR€149 billion in 2019, and two-thirds of the economic burden of cancer, which totalled about EUR€100 billion in 2020. Notably, caregiver costs were excluded from the published literature, and thus were also initially omitted from the analysis results comparison purposes (see Figure 1).

Figure 1. Economic burden of UI males and females combined in 27 EU-member states in 2023, billion Euros.
Note: Data supporting figure excludes caregiver costs.

The economic burden for females was four times higher than for males and increased by approximately 16% when considering informal caregiver support, often provided by family members. With caregiver costs included, the total economic burden reached about EUR€80 billion in 2023. In terms of direct costs, incontinence pads, medications, and physiotherapy accounted for the largest share. Productivity losses, including caregiver costs, made up about 42% of the total burden. If no action is taken, the analysis projects a 25% increase in the annual economic burden of UI by 2030, reaching EUR€86.7 billion (EUR€32.8 billion–EUR€167.2 billion) without caregiver costs and EUR€100.2 billion (EUR€40.8 billion–EUR€188.6 billion) with caregiver costs. Per-patient costs, including caregiver costs, were estimated to rise from EUR€1,700 in 2023 to EUR€2,129 in 2030 (see Table 1).

Table 1. Total per patient, per year costs in EU countries with and without caregiver costs, in 2023 and 2030.

The waste disposal results were also noteworthy. Recycling or incinerating incontinence pad waste incurred similar costs across all countries, amounting to EUR€83.4 billion and EUR€83.3 billion respectively in 2023. However, the study suggests that transitioning to 100% recycling of incontinence waste could slash the carbon footprint of continence health in Europe by 157.2 million kg CO2e in 2023 and accrue a cumulative reduction of 1.1 billion kg CO2e from 2024 to 2030. This underscores the environmental benefits of preventing UI.

The authors acknowledge that the primary study limitation was inconsistent prevalence data reporting and, as such, advocated for enhanced surveillance to bolster future UI research. These results and their noted limitations served as the basis for the guidance for continence health policy reform in the EU.

In parallel to the economic analysis, the EAU also worked with a multistakeholder alliance of non-commercial stakeholders such as patient organisations and medical societies to develop a manifesto of 10 main action points. The alliance encourages the EU and EU member states to:

1. Develop a comprehensive EU continence health strategy
2. Give individuals full and equitable access to continence health solutions
3. Guarantee access to toileting facilities in public and private spaces
4. Improve the number and accessibility of trained healthcare providers
5. Find and fund sustainable continence care solutions for health systems
6. Support informal caregivers
7. Understand the interconnections of continence and related health domains
8. Improve funding for continence health research
9. Run public awareness campaigns
10. Encourage public-private partnerships to improve continence health  
    
    

To follow on from this manifesto, an Interest Group on Continence Health has been inaugurated in the European Parliament in June 2025 and a guide for policymakers has been produced.^14,15

Take home message

1. Triangulate Health Ltd, Doncaster, South Yorkshire, UK.
2. European Association of Urology, Arnhem, The Netherlands.

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