Part 6: Urinary Incontinence--A Guide to Product Selection

Sonya Lytwynec, RegN, BScN
Nurse Clinician,
Southwestern Ontario Regional Geriatric Program,
Continence Outreach

Urinary incontinence can be successfully treated in some individuals.¹ There are, however, many individuals who remain unresponsive to behavioural, medical or surgical treatment and continue to experience chronic urinary incontinence. These individuals can benefit from improved continence management, using incontinence products that enable them to maintain social acceptability, skin integrity and comfort.

The focus of this article is to identify the factors that influence product selection and describe the key features of products that may guide the health care professional in meeting the specialized needs of individuals and caregivers.

Incontinence products may be utilized in addition to other treatment modalities to promote comfort and security. For example, supplementing toileting protocols with the use of absorbent disposable diapers and moisture barriers may be effective in reducing the risk for skin breakdown.²

Selecting the most appropriate product can be a complex task. The tremendous growth in the number of companies and the ever-changing array of products, devices or accessories on the market, over the past ten years, poses a particular challenge for elderly clients, caregivers and health care professionals. In addition to the challenge of familiarizing oneself with the wide array of products, little scientific literature exists to guide the selection of the most effective product.³

The factors that influence product selection include the severity and type of incontinence, lifestyle, product effectiveness, appearance, cost, ease of use and availability. For example, the elderly individual with functional incontinence related to cognitive and mobility impairment may benefit from a pull-on, absorbent brief versus one with tab enclosures.

Incontinence products can generally be categorized into absorbency products (e.g. pads and briefs that absorb urine) or conduction products (e.g. catheters and urinary drainage systems) as well as devices, behavioural training adjuncts, toileting aids, skin care products and specialized clothing and accessories (see Table 1). Newer, absorbent products include disposable booster liners and briefs for extended use, and washable medical-grade sheepskin for greater skin protection. A growing trend indicates an increase in use of the coude tip, two-day catheter for men with enlarged prostates, as well as all latex-free products.

Comparison studies on the costs and benefits of utilizing disposable versus reusable products (reusable products include items that are fully washable as well as washable briefs used with a disposable pad) are inconclusive. Hu et al., reported that there was no significant difference between the per day products costs for the two forms of management.⁴ Other concerns, such as the impact of biodegradable properties of plastic or latex on the environment, the unpleasantness of cleaning the products, as well as the time required to do so, may also influence the selection of products.

Personal bladder ultrasounds are useful for detecting residual volumes of urine for those individuals with overflow incontinence requiring intermittent catheterizations. The device is fairly simple to use, however, patients with cognitive and mobility impairment may require caregiver assistance. Cost may be a deterrent for some, the device costs $8000 (US) on average.

Devices are products that are designed to prevent urine leakage and include pessaries and urethral caps for females with prolapse and compression devices for men such as penile clamps and electrical nerve stimulators. Consultation with a knowledgeable healthcare professional is essential for anyone wanting to use compression devices. Side effects such as circulation problems will need to be carefully monitored. The effectiveness of urethral caps on female stress urinary incontinence requires more clinical study. The success of this device will depend on the patient's degree of cognition and manual dexterity. Electrical stimulation devices such as transvaginal and transrectal pelvic probes, afferent percutaneous nerve stimulators and surgical implanted sacral nerve stimulators can be used to deliver small electrical impulses to reduce or eliminate urge incontinence.

There are a plethora of skin care products available, including peri-cleansers (e.g. Aloe Vesta Perineal Skin Cleanser), moisturizers (e.g. Hollister Skin Conditioning Crème, Aloe Vesta Skin Cream) and barrier products (e.g. No-sting Barrier Film). Some cleansers do not require rinsing and may leave a protective film layer on the skin. Any skin problems, such as fungal yeast and bacterial infections require further investigation by the physician. Other products, such as specialized clothing (e.g. jumpsuits with back enclosures) may alleviate the burden of caregiving. Accessories, such as deodorizers, lubricant wipes, leg bag holders, and catheter guides can be invaluable aids in the management of incontinence.

The Canadian Continence Foundation has recently published an invaluable and practical guide that describes incontinence products and available resources entitled "Mission Possible: Your Canadian Undercover Guide to Incontinence Products for Health Care Professionals and the Public."⁵

These products are available from pharmacies, retailers, home health care dealers and manufacturing outlets. Many product sales representatives offer product samples for trial and will provide home delivery for a minimal cost.

The success of obtaining the most appropriate incontinence product for each individual can be enhanced by utilizing recognized resources and may require experimentation.

References

1. Borrie MJ. An introduction to urinary incontinence--Part I of V. Geriatrics & Aging 1998;1(1):23.
2. Schnelle JF, Adamson GM, Cruise PA, et al. Skin disorders and moisture in incontinent nursing home residents: Intervention implications. J Am Geriatr Soc 1997;45:1187.
3. Fantl JA, Newman DK, Colling J, et al. Urinary incontinence in adults: Acute and chronic management. Clinical Practice Guidelines, No. 2 Update. Rockville MD: US Department of Health and Human Services. Public Health Service Agency for Health Care Policy and Research. AHCPR Publication, No. 96-0682, 1996.
4. Roe B. Clinical nursing practice: The promotion and management of incontinence. Prentice Hall 1994:143.
5. Trumbull A, Trumbull L, Klag M. Mission possible: Your Canadian undercover guide to incontinence products. The Canadian Continence Foundation, 1994. Contact: PO Box 66524, Cavendish Mall, Cote St-Luc, Quebec H4W 3J6 (514) 932-3535. http://www.continence-fdn.ca/