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Discreet products for women with urinary incontinence

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VOL: 101, ISSUE: 18, PAGE NO: 56

Debra Evans is information co-ordinator, PromoCon, Disabled Living, Manchester

In recent years, the powerful social taboos surrounding loss of bladder and bowel control are being eroded, partly as a result of health promotion campaigns, the influence of the media and changing attitudes in society (Getcliffe, 2003). However many women still choose to deal with the problem themselves, possibly because of embarrassment, the availability of absorbent pads in high street shops, poor knowledge about management options, low expectations of treatment or fear of surgery (Jolleys, 1998).

 

In recent years, the powerful social taboos surrounding loss of bladder and bowel control are being eroded, partly as a result of health promotion campaigns, the influence of the media and changing attitudes in society (Getcliffe, 2003). However many women still choose to deal with the problem themselves, possibly because of embarrassment, the availability of absorbent pads in high street shops, poor knowledge about management options, low expectations of treatment or fear of surgery (Jolleys, 1998).

 

 

With such a high prevalence of urinary incontinence in the UK it is likely that many health care professionals will have female relatives, friends and colleagues with continence problems. It is essential that every opportunity is taken to promote continence and encourage these women to seek help from their local continence service. Regaining continence is the ultimate goal, and for many women this is achievable, although products may be required to manage bladder weakness.

 

 

Although the use of continence products play an important role in boosting confidence and self-esteem White (2001) reminds us that ‘personal expectations cannot always be satisfied [and that] the emotional effects of using a product can influence the way it is used and how effectively it functions’. Providing or suggesting appropriate products enables women to participate in everyday activities that are often taken for granted by those who are not incontinent.

 

 

Female devices
Pelvic floor exercises performed correctly and regularly will improve, if not cure, bladder problems for many women. There are a number of products available to help women identify their pelvic floor muscles, ensure they are exercising the correct muscles and that indicate if there is an improvement in continence (Fig 1).

 

 

The Pelvic Educator (Neen Healthcare) will indicate if the muscle contraction is effective, while other products, such as vaginal weights (Aquaflex Cones - Neen Healthcare), Be Content (Blueprint) and Lady Cones (Premier Medical) can assist women in exercising their pelvic floor muscles. These products also indicate when an improvement is made, as heavier weights are used as the strength of the muscles improves. An alternative product, which indicates improved muscle strength, is ‘Myself’ (BES Rehab) (Box 1).

 

 

Pads
Disposable pads are the most common method of managing urinary incontinence (Fig 2), and a wide variety of continence pads and pants (one and two-piece) is available in the UK. However, cost bears no relation to quality or effectiveness, and absorbency cannot be measured by the thickness or size of a pad.

 

 

An evaluation of disposable pads for women with light incontinence identified that the three most important features of such pads was whether they leaked, how well they fitted and control of odours (Clarke-O’Neill et al, 2003).

 

 

Developments in the product design and manufacturing process have resulted in disposable pads that are more discreet; for example, cotton-feel backings that reduce ‘rustling’, built-in odour control and skin protection properties are now common.

 

 

Women who have severe urinary incontinence can use large, shaped pads or an all-in-one product (diaper style). For this patient group, not only is it essential that the product is effective, but manufacturers need to design products that are not bulky and show through clothing. A product design that is increasing in popularity is the disposable pull-up pant. It is available in two designs: a full brief (Paul Hartmann, Paperpak, Shiloh Healthcare, SCA Hygiene, Abena, Ontex, Tyco Healthcare) and another with a high-cut leg - Tena Discreet Pants (SCA Hygiene). These are particularly suitable for women with mobility or dexterity problems, and they can help to maintain independence. In many cases, the appearance of a product can dictate whether or not it is acceptable to the user (Boxes 2 and 3).

 

 

Pants with a built-in pad
As an alternative to disposable pads, the continence services are frequently offering patients with light incontinence reusable pants with an integral absorbent pad. Generally, these are a plain white, full brief that is merely functional and offers no choice. However, there are several companies that supply a variety of designs (Fig 3). These include high-cut, pretty, feminine designs (Shiloh Healthcare, Hi Line, EMS Medical), full briefs, with or without lace (Vernagroup, Tyco Healthcare, P & S Healthcare), dark-coloured briefs (Arelle Products, EMS Healthcare) and one company that has a thong in its product range (Hi Line) (Fig 4). It is essential that women are made aware of the full range of garments available: it is unlikely that a 23- year-old woman is likely to wear the same style of product as one in her 70s.

 

 

Catheters
Catheter valves - Women who manage their bladder problems with a urethral or suprapubic catheter have the option of attaching the catheter to a catheter valve (Fig 5) (of which there are seven currently available) or to a leg bag to allow free drainage of urine.

 

 

If a catheter valve is to be successful, the patient needs to have an adequate bladder capacity, be able to remember to empty her bladder regularly and able to open the valve. Many women prefer this option, as it does not restrict the type and design of clothes they can wear - even swimwear can be worn. It is also worth noting that different valves have different mechanisms for emptying. This is important for women with limited dexterity, as trying different valves may enable them to continue to use this method of continence management if their condition deteriorates.

 

 

Leg drainage bags - If leg bags are used, the Discreet Thigh Bag (Manfred Sauer) may enable women to wear shorter skirts and dresses, and even shorts (Fig 6).

 

 

Intermittent catheters and accessories
There is a wide range of companies that manufacture intermittent catheters for women. People who use these products to manage their incontinence are likely to use the catheter they were prescribed initially unless there is a problem, yet there are a number of products available to help women self-catheterise (Fig 7). A variety of mirrors is available in different sizes to help these women visualise their urethra: most companies that supply intermittent catheters will also provide free handbag-size mirrors (Coloplast, Astra Tech, Shiloh Healthcare, Hollister). Mirrors that illuminate the urethra are also available (Promedics, White Rose). Leg dividers are available (Manfred Sauer) for women who find it difficult to part their legs and maintain the required position while inserting the catheter (Box 4).

 

 

Conclusion
Numerous products are available for women to manage their incontinence and it is clear that no single product will suit all patients’ needs. It is important that women have a choice of products and are able to review how appropriate these are if their circumstances change over time.

 

 

Footnote
- PromoCon: an integral service of Disabled Living Manchester, which provides impartial and unbiased information relating to continence products and services.

 

 

4 St Chad’s Street, Cheetham, Manchester MB BQA Helpline: 0161 834 2001 Email: promocon@disabledliving.co.uk Web: www.promocon.co.uk Related articles
Evans, D. (2005)Lifestyle solutions for men with continence problems. Nursing Times; 101: 2, 66-64.

 

 

Evans, D. (2005)Discreet products for children and teenagers with continence problems. Nursing Times; 101: 12, 50-52.

 

 

- ‘Choosing and using incontinence pads’ will be the subject of the next Skills article in this series, and will be published in the Continence supplement of July 19

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