Selecting the right product
VOL: 101, ISSUE: 02, PAGE NO: 61
Debra Evans is information co-ordinator, PromoCon, Disabled Living, Manchester
Selecting the right product
A multiprofessional approach is taken to continence care, although it is nurses, because of their involvement in the provision of continence products, who have the greatest potential to improve the quality of life for people with bladder and bowel problems.
There are over 4,500 products available in the UK for managing continence problems. White (2001) notes that the key to improving management is to ensure that a product is suitable for the purpose for which it is needed. However, a recent study identified that there was a lack of written information available about continence products, and ignorance among professionals about them (Paterson et al, 2003).
The case studies in this article illustrate why it is important that patients are recommended products that suit their individual needs. The correct product can play a ‘significant role in relieving the physical and emotional strain experienced by patients, their families and carers’ (White and Evans, 2001).
The case studies are from male patients, or health care professionals working with them, who contacted the PromoCon helpline (see address on p64).
Essence of care
The benchmarks for continence and bladder and bowel care suggest that ‘patients should have access to appropriate needs-specific supplies to assist in the management of their incontinence’ (Modernisation Agency, 2003). Budgetary restraints may make it impossible to supply even the basic management products free of charge, but providing information to patients or directing them to where they can obtain information does not incur a cost.
Thomas (2003) suggests there is a ‘continence lottery relating to the supply of disposable continence aids’. It is essential that the health care professional is able to guide a patient through the maze of products so that he can find those that complement his lifestyle.
For many men, urgency (a sudden compelling desire to pass urine that is difficult to defer) and frequency (patients who consider that they void too often by day) can dominate their life. Their work routine, visits to the shops or taking part in recreational activities such as bowls, will be governed by a careful mapping of accessible, convenient, public toilets. Some men will cease to take part in the activities they want to so that they can concentrate on what is essential. However, many male urinals (Fig 1) can be used discreetly in a car or wheelchair, when travelling or at the cinema, for example. Some are available on the Drug Tariff.
Several urinals incorporate super-absorbent materials that solidify urine, such as the Wee Jon (Wee Jon) or Travel Eze (Craig Medical), so that after use the complete product can be disposed of at a time that is suitable to the user. The Uribag (Manfred Sauer) is a very discreet urinal - when not in use it folds away, taking on the appearance of a 35mm film case.
Other products, for example, the Beambridge Draining Jug and the Beambridge Funnel (Beambridge Medical) have been designed to hold large amounts of urine - a two-litre drainage bag can be connected to the urinal. These products are particularly suitable for men who need to use the toilet several times a night and do not want to disturb the rest of the family. They are also useful when a toilet is not easily accessible; for example, when on holiday.
Sheaths There are a large variety of sheaths available:
- Self-adhesive sheaths;
- Sheaths with separate adhesive strips;
- Sheaths with applicators.
These are made in a variety of graded sizes - 18mm-40mm in diameter and in various lengths. A variety of sheaths should be shown to the patient to help him decide which product he prefers. Clear sheaths are popular with many men. A 500ml or 600ml drainage bag that attaches to the leg can be used with a sheath. There are bags that can be used for specific activities, such as swimming, or if the patient wants to wear shorts, for example, the 450ml Discreet Thigh Bag (Manfred Sauer), which is worn on the thigh (Case study one, p61).
Body-worn urinals A body-worn urinal consists of a cone that fits over the penis (it is similar to a sheath but does not adhere to the penis), a flange, a drainage bag, and a belt or pant system that secures these items to the body (Fig 2). The product is available on the Drug Tariff and is prescribed by an appliance practitioner.
This type of urinal was introduced over 50 years ago and may not be visually attractive to patients. However, it can be used to promote independence while managing incontinence at the same time. These urinals can greatly improve the quality of life of older men, and they can easily be removed when the person wishes to urinate in the conventional way. They are particularly suitable for a man whose penis is retracted and who finds it difficult to manage disposable pads (Case study two, p62).
Disposable continence pads Disposable continence pads are the most common method of dealing with bladder and bowel problems (Fig 3, p62). But patients comment that the pads ‘rustle’ when they move or walk, and they are very self-conscious about this noise. Several manufacturers have now introduced a ‘cotton feel’ backing to some products in their portfolio - mainly the small, shaped pads and pull-up pants. Ontex (Euron) have now introduced this backing to its large, shaped pads and intend to use the same manufacturing technique with its all-in-one products.
Other issues that patients are not happy about in relation to disposable continence products include
- The colour of the backings;
- Excess material at the waist.
It may be possible for a patient to use one product most of the time but to change to a specific product for certain activities (Case study three, above right).
Several companies have products specifically designed for men with light to moderate incontinence. One manufacturer (Paul Hartmann) has three different designs of products for males and has produced a patient guide. Showing the guide to a patient will reassure him that he is not the only man with a problem.
Reusable absorbent products There are a variety of reusable products available for men with light incontinence, ranging from an anatomically shaped pouch, Discreet (Tyco Healthcare), that can be held discreetly in place with conventional close-fitting underwear, to Y-fronts and boxer shorts with a built-in pad (Fig 4). Once again, the visual appearance of these products will determine if a patient will use them. Men who do not have continence problems choose underwear for its appearance, comfort and the image they wish to portray. Thus, if a man has worn designer boxer shorts before becoming incontinent he is unlikely to want to wear Y-fronts, even if he has become incontinent.
Conclusion Cowley (2001) notes that fear and embarrassment about the possibility of being incontinent in public could lead to an individual becoming isolated and possibly depressed.
The three case studies have highlighted the importance of choosing a product specific to the needs of an individual patient. This is not to suggest that it is possible to provide patients with a selection of products to suit every conceivable activity in which they wish to participate. But it is possible to offer sufficient information to a patient that will enable him to make an informed choice that will help enhance the quality of his life.
Case Study One
David is 36 years old and has multiple sclerosis. He suffers with urgency but had not spoken to any health care professional about this because he presumed it was a symptom of multiple sclerosis and that he had to put up with it. He has an 11-year-old son who plays for both the local and school football teams, but David had never been to watch him play in case there were no toilet facilities available at a match: he thought it was inappropriate to urinate behind a bush.
The local continence adviser suggested that David use a sheath if he was somewhere where toilets were not accessible. As a result, David is now able to attend all his son’s football matches and has even been to watch Manchester United on several occasions.
This product made a difference to both David’s and his family’s quality of life. David feels that his general health has improved, and he no longer feels excluded from family activities because of the constant need to use the toilet.
Case study Two
Thomas is 87-years-old and has mobility problems. He is incontinent of urine and uses disposable continence pads, but cannot change them himself. Thomas wanted to attend his granddaughter’s wedding, but did not want to embarrass himself if his disposable continence pad leaked, and was anxious in case his daughter stained her dress when she was changing his pad. He did not want to be a nuisance, he said.
Because Thomas had a retracted penis, a sheath was not suitable, therefore he was assessed for, and prescribed, a male body-worn urinal. Thomas was then able to got to the wedding and had a wonderful time: he did not have to worry about leakage or being changed. Using this product has given Thomas a new lease of life. He is now able to visit the pub regularly with his son.
Case Study Three
Carl is 27 years old and used to attend the gym regularly before an accident left him with bladder and bowel problems. He had been provided with all-in-one pads from his local continence service and generally these were effective in managing his incontinence. However, he found he was no longer able to go to the gym because the pads were bulky and the excess backing material at the waist was visible when he used certain gym equipment - the bike and the weights - and when he was doing the warm-up and cool-down exercises. The solution to his problem was the Tyco Supreme Undergarment (Tyco Healthcare). This gave sufficient absorbency for one hour in the gym, and the tight-fitting broad elastic waistband ensured the product did not show above his shorts.
PromoCon 4 St Chad’s Street, Cheetham, Manchester M8 8QA. This is an integral service of Disabled Living, Manchester, and provides impartial and unbiased information relating to continence products and services.
PromoCon Helpline: 0161 834 2001