It gets joked about, it gets shrugged off, but for nearly 1 million Kiwis incontinence is a distressing condition which can impact every aspect of their lives.
There are treatments but in New Zealand there's frustration that Southern Cross Health Society has been refusing to fully fund an option that's quick and simple — Bulkamid. It also doesn't have the risk of serious complications associated with an alternative treatment — a sling made of mesh.
The procedure using Bulkamid involves an injection of a gel-like bulking agent into the urethra, the tube that carries the urine from the bladder. The injection increases the volume of the tube so it partially closes and reduces the urine flow.
Giovanni Losco from Urology Associates in Canterbury is all in favour of it.
"The wonderful thing about bulking agents are that they're really simple, they only require a day-stay, there's no incision at all, and the risk of complications is very, very minimal."
Dr Losco isn't against the use of mesh, he believes accredited surgeons can carry out the procedure with minimal risk of problems down the track, but he accepts problems can occur and that many women would rather not take on this risk.
People like Anya (not her real name) are wary of using mesh after hearing reports of the serious complications that can arise with its use.
So she was excited to hear there was an alternative procedure that could help.
"Given my younger age, this is what my doctor recommended."
Anya is a 39-year-old farmer and is typical of many women who have incontinence, in that her symptoms began soon after having her children.
"It's when I do anything physical, I really try my best to hold on, it's not like I flood but I leak everywhere."
She put in her application to Southern Cross Health Insurance.
The insurer agreed to fund the approximate cost of $7000 for the actual procedure but not the $3000 or so for the bulking agent.
But since you need the bulking agent to actually do the procedure — Anya was unimpressed.
"When you pay your premiums for years, you just hope what you need for surgery is covered."
She tried to argue her point, asking to speak to someone more senior at Southern Cross, but to no avail.
When Anya came to Fair Go, we queried the decision with Southern Cross, who then gave Anya the good news that the bulking agent would be funded.
With just a couple of days until her surgery was scheduled it came as a huge relief.
"I was amazed and very happy, I don't know if it's just an exception for me or for everybody."
Nor did Fair Go, so we went back to Southern Cross to find out.
The company's chief medical officer Dr Stephen Child explained that a decision was made in 2019 to fund the procedure but not the bulking agent, because a study had shown the success rate of the treatment was only 40%, much lower than the success rate for mesh.
However, a new study in 2021 showed the success rate for Bulkamid had improved, at which point Southern Cross decided to fund the bulking agent too.
That was the first step. It then took time for the decision to be put into practice, with the final step being a negotiation between Southern Cross and individual healthcare providers or clinics to agree on a price for the bulking agent.
Agreement in Auckland only
That's where things are at now. Southern Cross has come to an agreement with doctors in Auckland, but not anywhere else in the country.
Losco is unimpressed. He said nine urologists in Canterbury are able to get funding elsewhere.
"My experience has been that all funders except Southern Cross will fund it, so that's private insurers and Te Whatu Ora and ACC."
The Auckland-only funding has affected another long-term Southern Cross customer, we'll call her Katie, who had a similar experience to Anya.
"I went to Southern Cross and they approved everything except for actual bulkamid."
As a mum Katie said she's keen for something simple and quick, with a shorter recovery time, and low risk.
"It does seem strange they are willing to a pay higher amount for something more risky that may have complications down the line," she said.
Katie would rather wait than opt for mesh so where does that leave her?
"That leaves me with the prospect of having an accident any moment," she said.
As of now, that leaves patients outside of Auckland having to effectively "pay the price", as they're unable to get full funding for the treatment they want.
However, Southern Cross said as a not-for-profit organisation it has a responsibility to get agreement on a price that is fair and reasonable.
"We are trying to get the best price for our members, to keep claims and therefore premiums as low as possible," Child said. "We think that's what our members would want us to do."
Child said there is an option now though for people like Katie.
"As of today, women outside of Auckland can travel to Auckland for treatment with Bulkamid that will be fully funded, depending on their policies, and Southern Cross will help with travel by paying an allowance, and hopefully shortly we'll be able to agree contracts for treatment in each local area."
Anya said that's what women really want. She's now had her procedure and it's been a success. She's even back to playing netball accident-free and hopes other women will soon be able to have the same experience without having to travel.
Katie, however, said with a young child and a full-time job travelling to Auckland is not an option, so she'll wait to see if Southern Cross and clinics outside of Auckland can come to an agreement.
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