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Incontinence products: how to choose

by Diane K. Newman, DNP, FAAN, BCB-PMD

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Incontinence products are very useful for managing urinary and bowel incontinence. Choices include disposable or reusable incontinence pads and underwear, shields, guards, briefs and underpads, all of which absorb and contain urine and stool. These products offer protection from the embarrassment of urine and stool leakage. Many new incontinence treatments are available and people who are having problems with urine and stool leakage should seek treatment information from their physicians and nurses in addition to using these products.

Absorbent incontinence products are designed to "soak up" urine and stool. They protect clothing, furniture and bedding and can help people with incontinence maintain their dignity, self esteem, comfort and, sometimes, even their independence. They are made with various degrees of absorbency and range from thin panty liners to bed pads.

Types of incontinence pads

  1. Perineal pads (called panty liners) are designed with an adhesive strip that allows them to be firmly fixed to underwear.
     
  2. Many incontinence undergarments have elasticized legs and use a belt attached to the garment with buttons or Velcro that holds the pad in place.
     
  3. A very popular product that is often seen in the most active older adult patient is protective underwear that is pulled on like cloth underwear and has a "natural feel." A nice addition to this product is refastenable tabs that allow changing without removal of outer clothing.
     
  4. Briefs or adult diaper-like products come with elasticized legs and self-adhesive tabs that secure the brief. 

Also See:

Absorbencies of incontinence pads

Manufacturers design absorbent products for light, moderate or heavy leakage; but because there are so many brands, it's difficult to compare one with another. Many women use sanitary napkins (perhaps as much as 30 percent of sanitary or feminine hygiene pads are purchased for urinary incontinence), especially young women with minimal leakage or leakage that occurs only with physical stress.

Photo: Courtesy of Coloplast/Conveen
collecting pouchesSock-like drip-collecting pouches (left) are available for men and most find that they are both comfortable and discreet. Pouches and drip collectors are typically held in place by adhesive strips inside underwear briefs and offer protection for men with moderate urinary incontinence such as occurs after a prostatectomy. afex system

afex (right) is an innovative breakthrough for male incontinence management. Designed by those who have incontinence and tested by urologists, afex provides comfort, convenience, and confidence, while being very cost effective.Its receptacle is latex-free and ergonomically shaped for a loose fit and ventilation. It has a soft double-walled liner with drain holes to reduce skin exposure to residual urine and prevent backflow onto the body.

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The afex collection bag doesn't require tubes or leg straps.The "turn-n-click" design makes attaching simple and quick, plus two convenient stability tabs allow you to secure the bag as needed. The bag is double-sealed to contain odor and can handle up to 16 ounces. The "one-touch" horizontal port makes draining the contents easy and efficient. For more information, See: Managing Male Incontinence with afex.

Types of Products Amount Absorbed
Perineal and sanitary pads Light urine leakage
up to 3/4 cup, 4 to 6 ounces
Pouches, drip collectors and guards Moderate urine leakage
up to 1 3/4 cups, 10 ounces
Undergarments, protective underwear Moderate to heavy urine leakage
up to 2 ½ cups, 17 ounces

One of the side effects of using absorbent products can be persistent feelings of loss of independence and self-respect. Not too many people are comfortable with the idea that they use adult diapers. Some people who are chronically ill or bedridden truly need diaper-like products even though their bulky, "childlike" design may appear undignified or primitive. "Diapers are for babies, not me, and I don't like being treated like a baby," is a refrain I hear from many of my patients. Fortunately, newer absorbent products fit the body better and can't be detected under clothes. These adult undergarments with special pockets for disposable pads allow a person to manage their wetting problems and still maintain their dignity.

Disposable Pads and Adult Diapers

Disposable incontinence products are more expensive than washable products, in general, and can cost anywhere from $200 to $400 per month, depending on the amount of bladder loss. This is a large expense for a person on a fixed income. Some people are forced to make their own homemade pads from tissue paper, towels and other materials. Unfortunately, Medicare, HMOs and insurance companies don't tend to cover the cost of absorbent products and their disposal adds to environmental pollution. However reusable products may not be as "skin friendly" as disposable ones.

Reusable Garments and Pads for Urinary Incontinence

Incontinence garments (sometimes called adult diapers) that are washable usually have an outer layer of plastic, rubber or synthetic material for protection and can be pulled up, snapped on the side or open down the front. They are usually less expensive to use over time than disposable garments. Because of their waterproof outer layer, many women find washable garments uncomfortable because they don't "breathe". Such women often prefer cotton underwear with a perineal pad in the crotch to collect urine leakage.

Various types of adult diapers and pads
Courtesy of Kimberly Clark makers of Depend and Poise products


Tena Flex-i-fitDuring treatment for urinary and bowel incontinence, absorbent products may be very helpful; but they can also be a deterrent to continence by giving the wearer false confidence and allowing an attitude of acceptance. People who use absorbent products over a long period of time may lose their determination to seek evaluation and treatment for incontinence. Further, if these products aren't used properly over a time, they can contribute to breakdown of skin and infections.

Diapers and pads should be changed frequently to avoid the skin's exposure to urine and to eliminate the buildup of odors.

Sometimes, a person's weight and resulting pressure on the absorbent material can cause fluids to leak out the sides of garments (side-seepage.) Accordingly, a person's sitting position may help avoid side-seepage.

 

Underpads/Bedpads for Urinary Incontinence

Special underpads or drawsheets can make a huge difference for caregivers who are dealing with bedwetting by keeping the mattress dry. Both disposable and washable pads are available in supermarkets and they can be ordered through catalogs or online. Various large chain stores such as JC Penney and Sears sell their own brands.

Many of my patients or their caregivers have asked me to recommend the best type of product for them. There is no simple answer that works for everyone because factors such as the type and severity of incontinence, personal preferences, product quality and cost, availability of caregivers to help with changing the product and the person's skin condition should all be considered when making this choice. The absorbent capacity of products also varies and is not standardized. Furthermore, there is little research available that compares one product to another. Ultimately, most consumers make their choices based on trial and error, budgetary considerations, and whether or not a product is available in the care setting.

Most new products contain a super absorbent polymer that turns urine into a gel, which prevents leaking or the escape of odor. Other products are designed to wick away moisture so the skin stays dry and free of irritation. This type of product will have a significantly positive impact on skin problems for people who are managing incontinence but consumers should be aware that not all products use this new technology.

There are books on urinary incontinence that can be good resources as they discuss these conditions in more detail: The Urinary Incontinence Sourcebook and Managing and Treating Urinary Incontinence, Second Edition by Diane Newman, CRNP.

References

Newman, DK. Managing and Treating Urinary Incontinence. Health Professions Pr. 2002.

Posted December 2003
Last updated March 2013

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