VOL: 97, ISSUE: 30, PAGE NO: 58
Colleen Morrison, RGN, Dip HE Nursing, BSc, is continence nurse adviser, Coleraine Community Clinics, Coleraine, County LondonderryContinence products should be issued to clients only after an initial continence assessment (Department of Health, 2000). This should include a consideration of the client's symptoms, investigations and treatment options. If, following this assessment, the use of disposable body-worn pads is indicated, it is important that nurses have knowledge of the wide range of products available and their indicated use.
Continence products should be issued to clients only after an initial continence assessment (Department of Health, 2000). This should include a consideration of the client's symptoms, investigations and treatment options. If, following this assessment, the use of disposable body-worn pads is indicated, it is important that nurses have knowledge of the wide range of products available and their indicated use.
Comfort, dryness and discretion will be the main aim of containment management and therefore the main factors to be considered in the selection of incontinence pads will include the client's degree and type of incontinence, their level of mobility and dexterity, their level of dependence and the patient's own choice.
Most modern disposable products contain pulp and super-absorbent powder which absorb urine away from the skin and keep it trapped within the pad. The use of these pads is recommended as they are said to reduce the wetness of the skin, maintain the pH of the skin as near normal as possible and ensure the separation of faeces from urine, minimising the potential of faecal enzymes to cause skin irritation (Le Lievre, 2000). Pads containing super-absorbents come in many shapes and sizes, beginning with panty liner/sanitary type-shaped pads used for the management of mild incontinence.
A few of these products are now available straight off the shelf at pharmacists and supermarkets. This may encourage clients to buy products without first seeking an assessment of the cause of their incontinence. In this way treatments to improve or cure the problem may go unattended, and the importance of an initial assessment must be reinforced.
With the introduction of smaller sanitary-shaped super-absorbent products, insert pads, which were traditionally worn inside 'marsupial' pants, have become much less popular. Urine is passed straight through the hydrophobic fabric of the marsupial pants, without being absorbed, to go straight into the insert pad in the pouch beneath. Norton (1996), however, stated that in practice this process is not always effective as the material does hold some dampness. She also stated that some people disliked the idea of wetting their pants directly and preferred to have a changeable pad next to the skin.
Pouch pads have been designed specifically to meet the needs of men with light incontinence. These are placed around the penis and scrotum and are worn inside mesh pants or the client's own close-fitting underwear. The male anatomy does not lend itself well to the successful use of pads for light incontinence, and some men may find the pouch pad awkward and difficult to maintain in place.
Rectangular pads are available in a wide range of sizes and in a variety of absorbencies, extending to accommodate moderate and heavy incontinence. The popularity of these items has reduced greatly in recent years in favour of smaller pads and shaped pads with pants. A much cheaper option than the latter, the rectangular pad remains a cost-effective product to address faecal soiling, but the pad in use must be changed straight away.
For moderate to heavy incontinence shaped pads are the most popular choice. They are shaped to conform to body shape, provide a snug fit and ensure the distribution of materials evenly. With a plastic back to protect clothing and bedding from soiling, they are generally one size and colour-coded according to their absorbency. All have varying features; these include wetness indicators, channels designed to lock away urine and anti-leak cuffs to contain faecal leakage. As with all pads, however, these special features will only be appreciated if the pads are correctly fitted, and for this purpose specific criteria have to be met (pictures 1-12).
All-in-one pads are also available for heavy incontinence. Like shaped pads they too are colour-coded to indicate their absorbency and may include elastic leg gathers to secure the fit, anti-leak cuffs to prevent faecal leakage, a reinforced super-absorbent core to lock away urine and wetness indicators. All-in-ones are not worn with pants and have to be fitted for size. Correct fitting is essential.
These pads have been found to have a place with clients who are restless and intolerant of shaped pads/pants and for those who are highly dependent, but their similarity to a nappy makes them unacceptable to the majority of clients.
Manufacturers are constantly refining the style and design of body-worn absorbent products. It is important that cost constraints do not limit the trial and usage of new products, as this may discourage companies from continuing to be creative in the development of better products. Cost considerations alone are not conducive to client care and the latter must always be paramount.