Urinary incontinence (UI) is a significant public health problem that affects patient well-being and places a substantial economic burden on both families and health care systems. Individuals with UI often experience poor quality of life, and the need for ongoing management leads to increased financial strain. The cumulative costs associated with continence products and continence-related medications underscore the importance of recognizing UI as a major issue with personal, family and societal consequences. Even though, UI imposes a substantial economic burden, yet patient-level out-of-pocket expenditure—particularly for continence products—remains poorly characterised. This study aimed to quantify out-of-pocket costs for continence and pharmaceutical products in routine clinical practice and to examine their associations with UI severity, incontinence phenotype, and socioeconomic factors.

This prospective, cross-sectional observational study included consecutive adult patients assessed at a tertiary functional urology clinic.The study was approved by the local Ethics Commitee and the patient signed the informed consent.  UI severity was assessed using the International Consultation on Incontinence Questionnaire–Urinary Incontinence Short Form (ICIQ-UI SF) and categorised as mild, moderate, severe, or very severe. Monthly out-of-pocket expenditure on continence and pharmaceutical products was self-reported. Costs were analysed per severity, incontinence phenotype, neurologic status, and socioeconomic characteristics. Multivariable linear regression models were used to identify independent predictors of expenditure.

A total of 318 patients were included (mean age 66.7 ± 12.3 years; 69.8% female). mixed urinary incontinence was the most common phenotype (60.7%), followed by stress and urge urinary incontinence. Monthly expenditure on continence products increased progressively with UI severity, ranging from €10.3 in mild to €70.1 in very severe incontinence (p < 0.001). also increased with severity, from €16.0 to €48.4 per month. Continence product costs were higher in urge urinary incontinence than in stress urinary incontinence and were greatest in urge-predominant mixed incontinence. Pharmacotherapy expenditure was strongly associated with incontinence phenotype, with highest costs observed in pure urge UI, in urge-predominant mixed UI and neurologic UI. Neurologic status, employment, lower educational attainment, and poorer financial status were independently associated with higher continence product expenditure (€41.9 vs. €20.7) and pharmacotherapy (€51.1 vs. €18.7).. In multivariable analyses, UI severity remained the strongest predictor of continence product costs. whereas incontinence phenotype was the main determinant of pharmacotherapy costs

These findings indicate that the financial burden of urinary incontinence is driven largely by symptom severity and clinical phenotype. Out-of-pocket spending on continence products increased steadily as incontinence became more severe, while pharmacotherapy costs were more strongly influenced by urge-related and neurologic forms of incontinence. The higher expenditure observed among patients with neurologic disease and among more socioeconomically vulnerable groups suggests that the burden of routine incontinence care is not evenly distributed and may reflect both greater clinical need and inequalities in access to effective treatment.

Urinary incontinence imposes a substantial and ongoing patient-borne economic burden, particularly in those with severe symptoms, urge-predominant phenotypes, and neurologic disease. Recognising these out-of-pocket costs as a core component of disease burden should encourage earlier intervention, more effective treatment pathways, and fairer reimbursement strategies to reduce long-term dependence on continence products.

Continence 19S (2026) 102664
DOI: 10.1016/j.cont.2026.102664