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Adult incontinence products; competing for the future.


The adult incontinence products market had a good year in 1990. Sales grew and provided for healthy cash flows.

Funding went to further refine positioning in retail stores, increase advertising, continue couponing and underwrite research and development of products that address more specifically the needs of the adult incontinent population and address public concerns over possible damage to the environment. Funds were also made available for renewed campaigns into grocery stores and supermarkets, where sales, according to early SAMI figures, grew at an astounding rate of 253%.

But don't be misled by such impressive figures. A few such "miracle" stories circulated, as such stories always will to warm the hearts of shareholders and reassure insecure managers. But, ultimately, they are just a part of popular myth, as in the story of the neighborhood company whose revenue grew 1000% the first week of operation. That story, by the way, centered around my childhood lemonade stand, where sales went from $1 to $5 in one glorious week.

This year's miracle story was the supermarket/grocery store market, where sales grew the aforementioned 253%, from $268,000 to $943,000. Encouraging, but not substantial.

A Year of Planning, Refinement

The past year was a time of planning and refinement of current lines rather than for splashy introductions of new products. Reassured that current styles of adult incontinence products are indeed profitable and accepted, manufacturers are developing improved products for the 1990s. Look for smaller, slimmer two-piece systems of pads with reusable or disposable holders of unusual variety. Look for pads that address flex, stress, load and, especially, mobility.

Also look for new one-piece undergarment type products such as that described by Ahr & Pierce's Procter & Gamble patent. A few companies, such as Pope & Talbot, got off to an early start with a complete line of improved adult incontinence products. The "Ensure" or "Full Life" line includes technological advances such as thermal bonded cores and, on its adult undergarments, hook and loop type fasteners.

A new entrant, First Quality Products, Great Neck, NY, entered the disposable AI products field in early 1990, while Cascades PSH, Drummondville, Quebec, Canada, purchased Health Tec, Palmer, MA. P&G closed is Cheboygan, MI adult incontinence lines and reportedly moved one of them to its Modesto, CA plant and the other to its Greenville, NC facility. All in all, however, there were no major introductions of radically different styles of disposable AI products (for a rundown of AI activity, see the accompanying sidebar on page 34).

In contrast to disposable baby diapers, there were no large scale advertising campaigns promoting disposable AI products as "biodegradable" and, hence, this product category was spared the investigations and backlash of public opinion that disposable baby diapers incurred. However, AI products did come under fire from the State of New York Attorney General's office, which accused P&G and K-C of misleading advertising (for more on this story, see page 40). Denying any wrong-doing, both companies withdrew current advertising and agreed to revise it. This leads one to ponder what is "normal" in New York.

It is also interesting to note that no disposable adult diapers were packaged in compact, or "Berlin pack" packages, as they have been called since P&G first introduced the concept in Germany. Perhaps this was to avoid packaging so large that it would resemble an entire segment of the Berlin wall rather than just a brick.

The Total AI Market?

Every year we attempt to estimate the dollar value of all products that are purchased (not sold) to treat adult incontinence. Hard figures are always difficult to find as people are mortified to talk to strangers about their incontinence and manufacturers are secretive about their sales. Table 1 and 2 are theoretical approximations of the total dollar value of all products purchased to treat adult incontinence.


(sales of body-contacting products

million of dollars, manufacturer's level, 1990)


 Institutional (mostly diaper style) 211-215
 Retail (mostly undergarments) 244-280
 Underpads for beds (90% institutional) 115-118

Feminine pads (est. used for incontinence) 355-537 Baby diapers (est. used for incontinence) 1023-1023 Reusables Institutional and Retail


 Hospitals 120-125
 Nursing Homes 40-48
 Retail 60-62

Other Paper towels, washcloths, homemade clothing,
newspaper, plastic baggies, rubber bands ? - ?
Total 2408-2676



(millions of dollars - manufacturer's level)
Year Institutions Retail Range Markets
1986 235 104-110 339-345
1987 250 132-145 382-395
1988 269 165-181 434-450
1989 288 200-220 488-508
1990 305 244-280 549-585
1991 (proj.) 323 264-315 587-638

The percentages of baby diapers and feminine hygiene products purchased for this use were taken from Swedish surveys done almost a decade ago. At that time, it was estimated that 28% of all disposable baby diapers and 32% of all disposable feminine hygiene products were purchased to treat adult incontinence.

These figures are admittedly old. As the "graying" of our population continues and the percentage of elderly to total population increases along with it, the incidence of incontinence is increasing. Dr. John DeLancey, of the University of Michigan Medical School, was quoted as saying that "so pervasive is the problem (of incontinence) that 50% of all sanitary products are sold not for menstruation, but for incontinence (excluding tampons)."

It makes sense that as more and more people suffer from incontinence for the first time that they too would initially use products that are the least embarrassing and least stigmatizing to buy. With such growth possible, it could be that the figure in Table 1 is conservative by as much as $200 million. Hence, a range is offered.

In order to simplify the presentation, not too many variables have been offered in these figures. But, to retain the percentages used in past years they are adjusted within a range. As with all figures, use them with caution.

Heightened Public Awareness

The 1980s were a decade when adult incontinence "came out of the closet" and into the public consciousness. Product development, packaging, advertising, distribution and education were all necessary. "Bladder control" is now an accepted topic for the news media. Advertising of AI products broke through the taboo placed on them by magazine such as Modern Maturity; articles continue to appear in news columns such as Ann Landers and in newspaper, magazines and, most recently, on a segment of the television news magazine 20/20.

Books have appeared for professionals and the public. Among them: Nursing for Continence, by Katherine Jeter, Nancy Faller and Christine Norton, which recently won the American Journal of Nursing's "Book of the Year Award;" Overcoming Bladder Disorders, by Rebecca Chalker and Kristene E. Whitmore; and Staying Dry: A Practical Guide to Bladder Control, by Kathryn Burgio, K. Lynette Pearce and Angelo J. Lucco. And there is always the ever-popular HIP Resource Guide to Continence Products and Services, 4th Edition, by Lisa L. Verdell and John M. Bouda.

Inside The 1990s

Although penetration of the total potential AI products market by disposable AI products is still small - estimated at between 10-12% - there are signs that the market could grow at a much faster rate but for one important consideration - reimbursement.

Until disposable AI products are reimbursable under Medicare and Medicaid, their market share will not reach its full potential. In addition to the concerns for planet Earth - source reduction, compostability and recyclability - the most important dollars and cents activity that the nonwovens industry could pursue is to bring pressure upon Medicare and Medicaid to make disposable AI products reimbursable.

The AI product market is unique. Lobbying for reimbursement of disposable baby diapers would range from difficult to impossible, but it can be successful in the adult market. In European countries where disposable AI products are reimbursed by government agencies, penetration by products is vastly higher than in the U.S.

INDA, Association of the Nonwoven Fabrics Industry, along with every manufacturer of disposable AI products and every supplier of materials from glues to superabsorbents, should be encouraging their customers to lobby their state and federal lawmakers, lobby the Health Care Finance Administration and support non-profit education organizations and advocacy groups for incontinents.

Unless the nonwovens industry is prepared to take a proactive role in securing reimbursement, categories of products that traditionally have been reimbursed and some new techniques that are receiving much publicity will begin hammering away at the disposables small market share. These emerging competitors to disposables range from pharmaceuticals to behavior modification programs.

Facing The Competition

New challengers to disposable AI products will appear in the 1990s. In addition to the disposable baby diapers and disposable feminine hygiene pads and the durable reusable urologicals such as catheters and bags, a new generation of drugs and training techniques is emerging.

Many adults suffering from incontinence are excited about new technologies that have received much media attention during the past year. Articles in the Wall Street Journal and the New York Times have appeared describing some of the new surgical techniques and pharmaceutical drugs to treat incontinence. On April 17, 1990, the WSJ carried news of two new drugs to help incontinent patients - terodiline, licensed by Forest Laboratories, and DDAVP, sold by Rorer Group. Terodiline, tradename "Micturin," reportedly blocks the flow of calcium into sphincter muscle cells. Calcium is needed to trigger bladder contractions.

DDAVP, an anti-diuretic, reportedly helps prevents enuresis by decreasing the amount of urine produced and may be useful for treating certain types of more general incontinence. The New York Times listed some of these treatments as the "Latest Weapons in the War on Incontinence." They also included collagen injections to damaged urethras, biofeedback and behavioral modification and Kegel exercise training weights to strengthen damaged pelvic floor muscles.

Business Week (Oct. 8, 1990) published an article entitled "A Cure for One of Life's Most Embarrassing Ills," describing incontinence as "the No. 1 reason behind (sic) admissions to nursing homes and accounts for 10% of the cost of nursing home care." The article went on to quote the National Institutes of Health as saying that "society spends more than $10 billion a year to manage urinary incontinence - $1 billion of that just for adult diapers." Its estimate of the cost of adult diapers is exaggerated.

The article described Mentor Corp.'s Teflon-based paste called "Urethin." Injected around the sphincter muscle, it helps to support a weakened sphincter. In a titillating close, the article ended by saying "the procedure requires no surgery and is permanent." This, undoubtedly, is cause for much hope, real and imagined, among sufferers of incontinence.

Finally, there is "bladder training," sometimes called "behavioral training." After years of being scornfully dismissed by the medical community as something between shamanism and carnival sleight-of-hand, on Feb. 5, 1991, Dr. J. Andrew Fantl of the Medical College of Virginia Hospitals, announced the results of a study conducted with funding from the government's National Institute on Aging and the National Center on Nursing Research. The results should end public and professional misconceptions: Bladder training in older women with urinary incontinence of detrusor instability (urge incontinence), urethral sphincter incompetence (stress incontinence), or both, works efficaciously in 44-100% of cases.

So surprising were the findings that Dr. Fantl and his colleagues have received additional funding to further study the effectiveness of bladder training and to develop specific teaching protocols (for further study, refer to the Journal of the American Medical Association, February 6, 1991, Vol. 265, No. 5).

All of these new treatments will take time before they are accepted and used by professionals and sufferers alike. In the meantime, disposable adult incontinence products manufacturers have the knowledge and the capital to strengthen their positions, develop their markets and secure a place for their products in the arsenal of "Weapons Against the War on Incontinence."

Staying HIP

one of the leading organizations for helping incontinent persons is expanding as the need for its unique services by suppliers and users continues to grow

HIP, our favorite self-help organization, reports it is growing, almost thriving, as the problem of incontinence becomes more public and, thanks in part to its efforts, more understood.

Dr. Katherine Jeter, executive director of HIP, which stands for Help for Incontinent People, recently told Nonwovens Industry that the non-profit organization has expanded its staff and headquarters in Spartanburg, SC and has even gone so far as to add a toll free telephone number (800-BLADDER) to improve its accessibility.

Among the other news out of HIP:

*Dr. Jeter reported that the U.S. Agency for Health Care Policy and Research has mandated that certain guidelines for the treatment of incontinence be developed and published by January, 1992. These are to include guidelines for standards of care for home and institutional incontinence care and could have a significant impact on absorbent products.

*HIP has accepted membership in a recently-formed national coalition called Get Real. The organization, based in Phoenix, AZ, was formed to address the concerns of working mothers. The first issue it is monitoring is that of disposable diapers vs. reusables; Get Real represents the concerns of working mothers over the attacks being made on disposables.

*HIP now has three full time staff members, one part-time and three regular volunteers.

*Dr. Jeter and her staff recently edited a book called Nursing for Continence, which, she said, would be of interest "to anyone from any company that wants to know anything about continence." The book, available from W.B. Saunders, Philadelphia, PA ($25.95), contains demographic information, treatment plans, causes of incontinence and a research guide.

*HIP has also initiated an Industry Council comprised of experts from incontinence supply companies, including Procter & Gamble, along with a host of device suppliers and pharmaceutical companies. This volunteer group, which meets two or three times a year, contributes its business expertise to HIP.

The North American Incontinence Market: The Players, Their Products

a review of new products, new programs at the major suppliers to the retail and institutional markets

Dri-Pride Div., Weyerhaeuser, Tacoma, WA: While there has not been a large amount of new product development revealed in the past six months, there has been significant marketing activity. Director of marketing Julie Kruger-Lutz told Nonwovens Industry that the company has beefed up the in-service programs for its "Provide" line of incontinent products; the line includes three different briefs, as well as pad and pants systems, underpads and skin care products. Among the new programs is a series of video tapes that provide information for incontinence patients.

Dri-Pride, which currently focuses on nursing homes with its Provide line, is coming out with retail packaging for sale primarily to home health care dealers.

One of the more interesting developments in the industry is Dri-Pride's "Provide Advantage" program, which acts similar to an airline Frequent Flyer program in that it offers bonus points for every case of incontinence products purchased. The points can be redeemed for other health care merchandise, such as a wheel chair for 420 points. Ms. Kruger-Lutz said the program, initiated last July, has been very well received by the company's institutional customers.

Hospital Specialty, Cleveland, OH: The latest at Hospital Specialty was the introduction last fall of premium plus "ultra" type incontinent products incorporating superabsorbents. An undergarment product similar to but less expensive than "Depend" (in 30 and 36 count packages) is also being introduced early this year. An adult wipe was also introduced last year, reported senior vice president George Murphy. All of these are under the company's "At Ease" incontinence product label and they are all manufactured in two plants in Kentucky and Phoenix, AZ. Hospital Specialty has also upgraded to tri-folded, compressed packaging, which has reduced its size by one-third.

Mr. Murphy said the company's At Ease label is targeted directly at Depend and is priced at 10-15% less. He cited one example where At Ease incontinence products sold at Phar-Mor discount outlets outsell Depend 5:1.

"The market is up, up and away," Mr Murphy said. "The recession comes along and we do better." He naturally attributed this to the lower unit cost of the At Ease products. "The secret to success in selling private label and getting the necessary volume is having realistic price points and having quality that allows your customers to compete with the brands. The whole thing is value and price points. You have to give the retailer the ammunition to work with."

Humanicare, North Brunswick, NJ: The most activity reported at Humanicare in the past year has been the growth of its "Free & Active" genderized system of pants and pads. President Tony Gegelys said the patented system has benefitted in the past year from increased advertising and promotion.

Humanicare's other main incontinence item is its "Dignity Naturals," a product promoted as 98% degreadable in soil in 60 days, according to independent tests. Studies are now being conducted on its activity in landfills. The pad is basically a cotton nonwoven wrapped around a pulp interior. Humanicare's incontinence products continue to be sold in Canada through an agreement with Squibb. Its line is also available in parts of Latin America and through a few accounts in the Far East.

ICD, King of Prussia, PA: The manufacturer of the "Surety's" line of incontinence products as well as private label entries has been introducing in phases new "ultra dry quilting" on its incontinence line. In August, 1990 it unveiled its belted product and its incontinence briefs and in January it brought out self adhesive liners and shields with the new technology. According to Lee Johnston, incontinence product development manager, the new technology is based on a new copolymer generation of superabsorbent along with a revised pulp fiber and quilt pattern embossing. Among its attributes: quicker absorbency, greater fluid retention, better fluff stability, reduced gel feel and better fluid dispersion. ICD, which sells into both retail and institutional outlets, has yet to offer compressed packaging for its incontinence line.

Johnson & Johnson, Personal Products, Milltown, NJ: The primary activity at Personal Products, according to a company spokesman, was the completion of the national expansion of its "Serenity" product. The company continues to promote the comfort and superior protection without bulk of Serenity as compared to other, more conventional incontinence products.

Kimberly-Clark, Dallas, TX: Surprisingly, the largest retail marketer of adult incontinence products said there were no specific new products or existing product innovations in the past six months on its "Depend" line of shields, undergarments, briefs and underpads. Like rival Procter & Gamble, in December it was forced to respond to the New York Attorney General's demand that it revise some of its incontinence packaging and advertising (see article on page 40 for more details).

Medical Disposables, Marietta, GA: There are a large number of new incontinent products under development at Medical Disposables, reported executive vice president Scott Sigler, with much of this developmental effort centering on the dual factors of cost and the environment. "We are looking at managing incontinence with less material," he said. "This is particularly important in institutional settings because the people that run nursing homes and hospitals dispose of so much at one time. There are a lot of political and business costs involved."

The newest incontinence products at Medical Disposables were introduced last summer in both retail private label and branded markets under its "Sure-Care" line. The new undergarment is being offered in both superabsorbent and thick pads, with the superabsorbent version being the most popular. "The market is still growing in the retail segment and moving into new distribution channels," Mr. Sigler said.

Pope & Talbot, Portland, OR: The past nine months have been important ones for Pope & Talbot as it introduced its entire incontinence product line with thermal bonded core technology. Its shields, liners and belted undergarments now incorporate this process, which is promoted as making the product thinner, more absorbent and more discrete for the wearer. Pope & Talbot remains primarily in the retail market. In the past year it has also test marketed an incontinence branded product called "Full Life;" the results are currently being evaulated and the company has not indicated whether it will continue in this direction.

Procter & Gamble, Cincinnati, OH: Similar to the response from rival Kimberly-Clark, a P&G spokesperson reported the company has not unveiled any significant product improvements on its "Attend" line of adult incontinence products. Much of its recent efforts have been spent in complying with the New York State Attorney General's ruling that P&G's print advertising better spread the message that incontinence is a treatable problem and sufferers should consult a physician (see article on page 40 for more details).

Professional Medical, Greenwood, SC: The largest manufacturer of underpads in the country last fall introduced a new product called "Wings Maxima", a 30 x 30 inch very, very absorbent, comfortable, smooth underpad, according to Birge Sigety, president and chief executive. He said the company, which offers quite an array of underpads for the retail and institutional incontinence market, created a new proprietary technology for the product and built its own machine to produce it. The lining of Wings Maxima is a soft, tear resistant fabric designed to soothe the skin and a superabsorbent offers the absorbency; the product is designed to complement Professional Medical's Wings Contoured Incontinent Brief," whose features include a moisture indicator, multi-strand elastic gathers, refastenable tape tabs, odor reducing agents and a "Polypuff" superabsorbent. The company continues to produce its established "Polygard" line of underpads as well.

In other incontinence areas, Professional Medical has enhanced the absorbency of its "Wings" briefs with advances in the polyester nonwoven topsheet and some changes in the actual construction of the brief. In the packaging area, the company updated its packaging to produce a more square, more aesthetically pleasing package late last year. This improvement was made on Wings as well as its "Ultigard" and "Unigard" incontinence products.

"This market is continuing to grow nicely for us," Mr. Sigety told Nonwovens Industry, while agreeing that much of the marketing effort remains focused on education. "The problem of adult incontinence among ambulatory and home based people is coming more to the fore and people are realizing there are products out there for them." He reported continuing double digit growth in this market for Professional medical.

Incontinence market manager Clyde Shew explained that the company's landmark Willpower program, which has been in existence for about 18 months, has been widely accepted as a program to help incontinent people become continent. It was born out of a corporate attitude that its incontinent items are medical products and should be sold and marketed as such. "Our approach is more from a medical standpoint, not from the paper standpoint many of our competitors have," he said.

Scott Healthcare, Philadelphia, PA: Traditionally concentrated in the institutional segment, Scott Healthcare has spent much of the last 18 months absorbing and sorting out its acquisition of the Johnson & Johnson "Skin Caring Brief" line. The transition is apparently nearing completion and the company is expected to step up activities in the incontinence area with its "Promise Skin Caring Brief." The cornerstone of Scott's incontinence business remains its two-piece pad and stretchable pant Promise system.

Universal Converter, Oconto Falls, WI: As a private label marketer primarily to the institutional market, Universal is planning to expand into the retail segment later this year. The move is being made as a means to diversify its product line from its institutional base. It already has the facilities for packaging retail products.

The company's product line includes full size briefs and undergarments and now the company is making "Trim Fit," a smaller sized pad that it had discontinued producing but has revived due to growing customer demand. The company still makes thick absorbent products but has increasingly turned to superabsorbents in its incontinence line.

Whitestone Products, Piscataway, NJ: Whitestone is currently introducing a larger, more comprehensive line of "Bio UltraShield Plus" biodegradable underpads. They are now available in large and extra large sizes in both regular and premium absorbencies and, like other Whitestone products, are available in bulk, prepacks and retail packaging.

Whitestone is promoting Bio Ultra-Shield Plus underpads as "the only biodegradable products of their kind on the market." Packaged in biodegradable plastic bags, the pads also have a "biodegradable" plastic backing. In addition, the pads with premium absorbency contain superabsorbent polymers.

Whitestone has also recently added an expandable waist to its UltraShield superabsorbent briefs and has added a belted undergarment and stress incontinence shield to its line.
COPYRIGHT 1991 Rodman Publications, Inc.
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Copyright 1991 Gale, Cengage Learning. All rights reserved.

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Title Annotation:includes additional articles on organization expansion and the North American market for adult incontinence products
Author:Bouda, John M.; Jabobsen, Michael
Publication:Nonwovens Industry
Date:Mar 1, 1991
Previous Article:State initiatives impact nonwovens industry.
Next Article:Meeting the demand of the retail market: a look at critical issues for the incontinence products manufacturer.

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