With fertility rates dropping in developed regions each year—the U.S. fertility rate is at an all time low at 1.73 births per woman, according to recent data from the U.S. National Vital Statistics System—coupled with rapidly aging populations, manufacturers of adult incontinence products have a reason to be optimistic. The market for adult diapers, absorbent pads, disposable underwear and other products is growing fast.

According to market tracker Euromonitor International, global retail sales of adult incontinence products reached nearly $10 billion in 2019 (2019 fixed exchange rate, real value), or 24 billion units (where 1 unit=1 pad, 1 pant). Global retail sales are expected to exceed USD $14 billion by 2024. “All regions see growth in demand, supported by demographic shifts (aging), better condition awareness, better product access, improved incomes, as well as innovation across product formats,” says Svetlana Uduslivaia, head of Home & Tech Americas at Euromonitor.

In the U.S. alone, the incontinence market reached an estimated $2.2 billion in 2019 and sales are projected to hit $2.76 billion by 2024, according to market researcher Mintel.

“In nearly all developed economies incontinence is the star of the absorbent hygiene market,” says Jamie Rosenberg, senior global analyst, Mintel. “For example, the U.S. (like many other high-income countries) is a rapidly aging society and because age is a main determinant of incontinence and a highly predictable market growth driver, the category will continue to grow in-step with an aging population.”

Along with aging, other factors that can increase the chances of incontinence are childbirth, obesity, PTSD, diabetes, Parkinson’s disease and prostate surgeries. The wide range of incontinence sufferers has opened up the market for new product formats. Some of the latest new product launches include light incontinence pads, absorbent disposable underwear, male guards and products specifically for accidental bowel leakage.

Today, one recent trend in the market is that more feminine hygiene brands are branching out into the light incontinence category. One of the clearest examples of this was when Procter & Gamble re-entered the incontinence market in 2014, after more then a decade away, with its popular Always brand. Three years after the launch of Always Discreet pads, liners and underwear, the brand expanded its incontinence offerings with Always Discreet Boutique, a bladder leak underwear with the look, feel and fit of real underwear. With its attractive, underwear-like design, the line takes bladder protection out from under the bathroom sink and into the underwear drawer, the company says.

“From a competitive standpoint, more brands are moving into the fast-growing light bladder leakage arena,” Rosenberg explains. “The Always brand’s strategy of embedding products for bladder leakage within a sanitary protection brand has proven to be a boon, not just for P&G, but for the category as a whole. This is because many women who previously used period products for this purpose are trading to products that better handle urine.”

While Always is still outgrowing its peers, the brand’s rate of growth declined from 24.1% in 2018 to 14.4% in 2019, according to Mintel. Rosenberg says this is because more brands are addressing light bladder leakage and are innovating for significantly improved comfort, aesthetics and discretion. “Products keep getting thinner without compromising absorbency or leakage protection and this is a much needed move to bring supply instep with demand,” he adds.

Within the last year, Mintel has found that the percentage of women using period products for bladder leakage has declined by 3% while those who say they are now using dedicated incontinence products has grown by 7%.

“As of October 2019, equal numbers of U.S. women were using period products and incontinence products for bladder leakage; while this is an improvement, it also indicates that there is still significant growth potential ahead,” Rosenberg points out. “The advent of multi-fluid products (bladder leakage and periods) will further drive this growth. Mintel finds that 65% of women aged 35-54 would try these products.”

Eduardo Leal, engineer & consultant, Diaper Testing International & Richer Investment, says that the continuous growth of the incontinence market translates into opportunities for innovations and brands that propose new market interactions. “Brands with an already existing market in feminine hygiene expanding into light incontinence makes sense, especially when they have already created a brand presence in connection to women, with women being more likely to be incontinent than men,” he explains.

Just like in other absorbent hygiene categories, natural products are beginning to emerge in the adult incontinence space. “Until recently, products that claim more natural positioning were more pronounced in categories like feminine care and baby diapers. Adult incontinence is starting to enter the ‘natural’ segment,” Uduslivaia says.

One of these brands, Cora, a modern women’s wellness company whose products include natural and organic tampons, pads and other personal care items, expanded its portfolio last year to include light bladder leakage pads and liners made with organic cotton, patent-pending absorption technology and a sleek design. Meanwhile, Natracare, a brand that’s been in the organic cotton feminine care market for 30 years, also recently added light bladder leakage products to its range.

“These brands’ extension into natural bladder leakage products provides a glimpse of how incontinence could follow the evolution of other absorbent hygiene categories, where niche brands test the consumer demand for natural, and after an observation period, big brands cautiously test natural products within their own portfolios,” says Mintel’s Rosenberg.

Because incontinence represents most of the growth potential in the absorbent hygiene market, he believes there will be more of this crossover from both eco-focused femcare companies and mainstream incontinence brands, just like in natural femcare and baby diaper launches from companies like P&G and K-C. “The emergence of stand-alone natural incontinence brands could also be in the cards,” he predicts.

Everybody Wants A Piece
Growth potential in the incontinence products market has increased competition, with industry veterans ramping up innovation and newcomers trying to shake up the market with unique new products.

Leal believes that the market wants to replicate The Honest Brand phenomenon that occurred in the baby diaper market to the adult incontinence market. “Seeing how the baby diaper market is still bringing new brands and proposals constantly into play, I could expect the adult incontinence market to behave in a similar fashion, especially as the population ages and the market grows,” he says.

A recent entrant is the brand Because, which was started by two Silicon Valley executives who believed there was a lack of innovation in the market. Founders Luca Gualco and Alex Suvacioglu partnered with urologists at Stanford Medical Center in California to develop cutting-edge new materials for its pads and underwear, which the company says are 25% more absorbent and fit a wider range of body sizes compared to leading brands. Recognizing that the needs of an incontinence sufferer can vary between day and night or even from day to day, Because has based its subscription model on a multi-product box so users can vary their product styles based on their needs.

Another newcomer is Nexwear.com, which recently launched a line of stylish disposable incontinence products. Nexwear’s new line provides leading-edge absorption, odor control and complete discretion. Pads and briefs for men and women are available in cool grey or champagne and ship directly to customers’ homes in discreet packaging, on a customized schedule. The products are silent while in use, come with discreet disposable pouches and arrive on customer’s doorsteps in plain packaging.

Meanwhile, Parentgiving Inc., a retailer of caregiving products for the aging, launched its first private label product, Dry Direct Ultimate Underwear. Dry Direct Ultimate Underwear tests for over 40 ounces of absorption capacity, three times the absorbency of incontinence underwear found at brick and mortar stores and far more than competing premium products, the company says.

Adam Greenberg, who in 2002 started an online adult incontinence business NorthShore Care Supply, says most of the growth in the market is attributed to e-commerce with low single digit growth in brick and mortar stores. “There are 10,000 people turning age 65 every day on average and age is the number one risk factor for incontinence. The longer someone lives, the more likely that some life event or illness will result in symptoms of incontinence,” he says. “With Kimberly-Clark’s Depend brand the long established market leader, many startups have pegged adult inco as ‘ripe for disruption’ and are competing with subscription-only approaches and marketing campaigns more geared for millennials who are now having children and starting to experience incontinence.”

During this period of market transition, Greenberg says that they’re also seeing interest from many European and Asian manufacturers to enter the U.S. market. “Additionally, we’ve noticed much less loyalty to long established national brands as most retailers are heavily marketing their private label equivalents, often with features not available from the national brands,” he adds.

Greenberg believes that NorthShore has succeeded as the main alternative when consumers’ needs were no longer being met by the store brands. “We hear the same complaints about store brands today as 18 years ago, but the percent of people dissatisfied with store brands seems to have grown exponentially,” he says. “The number one complaint is that consumers want products that will reliably prevent leaks. Additionally, they want many sizes, styles, fashionable designs and most of all they want someone to help guide them through the frustrating process of finding the best product for themselves or their loved ones.”

Greenberg, who is a Board Certified Patient Advocate, says his company has a patient-centered approach. “We embrace the patient advocate approach in everything we do…products, customer service, educational content, which builds high brand loyalty from people who have been disappointed by leaks from so many other products and shamed by the ‘hands-off’ approach of most other stores that shy away from engaging due to fear of embarrassing the customer.”

The company offers its own private label NorthShore brand as well as a selection of other premium brands to complement its line. It carries a full line of absorbent products for light to total bladder and/or bowel incontinence, but has a much wider selection in moderate to heavy absorbencies for which there are few options available at traditional retail stores.

“We have many new products in the pipeline and expect that our catalog will look very different in five years as our products become more and more differentiated from what large CPG companies are selling, which is mostly geared for women with light stress incontinence,” he explains. “Our focus is on the other 75% of the market which include men, women and children with moderate to heavy urinary and/or bowel incontinence where retail options are almost non-existent today.”

With a better than 50% share, Kimberly-Clark’s role is to lead category development by offering innovative solutions for adult incontinence and reducing the social stigmas that get in the way of people finding the best solutions to manage this confidently, according to Kubica Guevara Koo, global marketing director, Adult Care, Kimberly-Clark.

“The need for adult incontinence products is growing across markets globally as aging populations expand and awareness grows,” she says. “More people in the world need protection for bladder leakage than there are babies needing baby diapers. With the category only about a third penetrated in the U.S., there is considerable room to grow.”

K-C is focused on growing category penetration by reducing the social stigmas around incontinence, engaging people 1:1 with relevant content and showing how its brands, Poise and Depend, can help them continue to live active lifestyles. “Increasing awareness and conversations around incontinence empowers consumers to seek answers and products to help them live their lives with confidence,” Guevara Koo explains. “Poise is committed to help women understand what’s going on, why it’s happening, and what to expect so that they can manage it the right way.”

Last year, K-C introduced Poise Ultra Thin Active Collection pads and liners with wings designed to stay in place and adapt to women’s bodies. Made for women on-the-go, Poise Ultra Thin Active Collection incorporates FlexLoc core technology for comfortable protection, which allows the pads and liners to instantly absorb while locking in wetness and odor.

In other new product news, Hartmann, an international supplier of medical and hygiene products, recently added a new value line in its pull-up category, MoliCare Premium Mobile Pants. The pants look and feel like regular underwear with their anatomical shape, soft material and elastics for a comfortable fit and discretion. The absorbent core neutralizes odor and holds liquids quickly for a dry feeling, and high-quality materials and its cuff system deliver maximum leakage protection.

Hartmann also reacted to a recent change in the Spanish health care system with the launch of Lindor pants. Ilka Lohaus, vice president marketing at Hartmann Incontinence Management, says pants/adult pull-ups were a private pay product in the Spanish market until the end of 2016. “At this point, a local competitor was allowed by the Spanish Health ministry to launch a range of pants products as reimbursed incontinence products,” he explains. “Given that pants are the most convenient form for consumers, the reimbursed pants segment has since grown rapidly. In parallel, Nielsen data confirm that the private pay pants segment sold in retail have declined significantly.”

Another manufacturer innovating in the market is Principle Business Enterprises (PBE) with its Tranquility brand. “As the incontinence market continues to grow, so does the necessity for specialized products to meet the unique demands of consumers,” says Andrew Stocking, president and COO of Principle Business Enterprises. “Tranquility has invested in research and development over the past few years to evolve our products to meet these needs.”

PBE recently introduced product enhancements for the Tranquility Product Family including the redesigned Tranquility and Select Personal Care Pads for improved comfort and fit with three levels of absorbency and availability in three different sizes per each brand. Additionally, the Tranquility AIR-Plus Bariatric Brief now fits 4-5XL sizes to serve wearers with a 70-inch to 108-inch waist. This brief is the largest incontinence product on the market, according to Stocking. Tranquility has also developed the new Tranquility Male Guard to provide a discreet, in-underwear solution for men with moderate incontinence.

“Product innovation and enhancements will remain a focus in the coming years as we continue to explore opportunities to serve the changing demands of consumers,” he says.

Hans Bergh, global brand director of Essity’s incontinence brand TENA, observes that the market continues to grow and competition is increasing. “There is an increased focus on value based decision making in the health care sector, with a strong focus on clearly defined outcomes to evaluate the performance of incontinence products in the care pathway of toileting and containment,” he says. “Sensor and digital technology enables improvements in the assessment and delivery of the care for toileting and containment, especially for the care dependent persons. Essity is focusing its efforts in advancing the knowledge and increasing standards of care.”

An example of its efforts in this area is TENA Identifi, which integrates an innovative data logging and transmitting device with the disposable TENA Identifi Sensor Wear to electronically track resident voiding patterns in real-time. Over a 72-hour assessment period, TENA Identifi tracks the voiding patterns and volume at each product change, then graphically converts the data into actionable, evidence-based reports that provide a good base for appropriate product selection. This, in turn, empowers staff and caregivers to make more informed decisions on individual continence care without having to rely on manual recording processes.

A Sensitive Subject
While there has been improved dialogue and normalization on the urinary incontinence side, sufferers of fecal incontinence continue to face great challenges when it comes to managing their conditions. Today, the majority of products on the market cater to various levels of urinary incontinence, but, more recently, some new companies have stepped up to develop solutions intended to improve the lives of the fecal incontinence sufferer who also has an active lifestyle.

Earlier this year at the Consumer Electronics Show (CES) in Las Vegas, Triple W, an innovator of connected health devices, featured a “sneak peek” of a prototype of the DFree bowel sensor, the first wearable device for bowel incontinence.

The DFree bowel sensor monitors bowel and intestinal movements with a safe and noninvasive ultrasound sensor and notifies users (or a caregiver) via smartphone or tablet when it’s time to go to the bathroom. Triple W has been working on this product for over a year, according to Ty Takayanagi, VP of Marketing and Business Development.

Last year Triple W received the “Best of CES 2019” award in the Digital Health category for its first product, the DFree bladder sensor. With DFree (which stands for diaper-free), people managing incontinence can live their life with peace of mind from accidental leaks. Seniors and people with disabilities who need to manage a loss of bladder or bowel control have an alternative to disposable diapers or pads and medications with the DFree line of ultrasound sensors for incontinence, the company says.

“There are over 500 million people worldwide suffering from incontinence,” says Takayanagi. “The only solutions that are available to these people are diapers, medication or surgery. We believe that our product offers a different and a more effective way to manage incontinence.”

Currently Triple W is working on a next generation sensor that combines the ultrasound sensor and battery into one unit. “We expect our product to become much smaller in the future with the advancements in battery and sensor technology,” he says.

Another product generating a lot of buzz is the FEUR System, a unique fecal incontinence protection system. Three sisters developed the system after their mother contracted the Clostridioides difficile (c. diff) infection years ago. “Time after time, mom was put into embarrassing situations in which there was no advanced warning of a bowel movement,” says Barbara Barat, partner, Vemarei, LLC. “Mom tried many of the urinary products that are common on almost every store shelf but of course those had their own set of problems; how do you remove it when you’re not at home and keep yourself clean?”

The FEUR System fecal urgency pad cinches and is highly absorbent. At the onset of a bowel movement the wearer pulls the cord and the pad immediately begins to cinch, encapsulating fecal matter. Once the pad is fully cinched, fecal matter is contained and disposed of in the accompanying plastic bag. The product also comes with two personal wipes and one surface wipe for cleaning.

Barat believes fecal incontinence has been ignored in the market. “There is an obvious need for products to help consumers who suffer from fecal urgency or bowel incontinence,” Barat says. “Most companies seem to be of the opinion that anyone who deals with these issues must be bed-ridden. Our target demographic is the active person. Someone who needs to be able to change a soiled pad when they aren’t at home, perhaps at a friend’s house or in a public restroom. The FEUR System allows the wearer to change, cleanup themselves and any surfaces that may be soiled and dispose of everything discreetly.”

In November, Vemarei’s FEUR System received INDA’s Hygienix Innovation Award. “We are thrilled with the win,” Barat says. “This may sound hokey but we gave the beautiful award to our mom. She has it proudly displayed in her living room. We’ve worked really hard at creating the FEUR System and are sure it is a great product. Seeing it recognized at the conference was terrific.”

Others in the industry are also noting the importance of a product like the FEUR system.

“Fecal incontinence is still a condition that is regrettably riddled with taboo,” says Leal of Diaper Testing International & Richer Investment. “I was happy to see a contender for the Hygienix Innovation Award be a fecal incontinence protection product. Solutions such as the FEUR System demonstrate that the need for innovation is still present in this market sector. Hopefully, as awareness of fecal incontinence increases and the market becomes more educated to its needs, the feedback that manufacturers and brands receive from consumers grows similarly to what we have experienced from urinary incontinence products.”

Currently, Vemarei is engaging with consulting firms in the hopes of finding a meaningful partnership or licensing agreement to produce the FEUR System at a larger scale.