All About Incontinence Pads

ALL ABOUT PADS

History of continence product supply

Readers may wonder why I have been asked to write ‘All About Pads’. I worked as a Continence Advisor for 16 years in the NHS, and although provision of pads was only a small part of my role, it was a part that was the heart and soul of my continence service. Curing my patients or improving their symptoms was paramount, but when this could not be achieved, better management of symptoms became the gold standard. Absorbent continence products was a term which seemed to give ‘pads’ some sort of respectability, and access was essential for patients who suffered from leakage. In the early 1980’s this may have been all that was on offer for some incontinent patients. Asking why there was leakage, identifying and treating the cause was an emerging, new clinical specialty. During my time as a Continence Advisor, I have seen what may be described as revolutionary developments in the assessment and treatment of incontinence. Alongside this, highly efficient absorbent products have evolved from manufacturers, ensuring that for those who continue to experience leakage, there is an effective way of preserving dignity and a quality lifestyle. 

In the late 1980’s, not all products were of such high quality and many patients relied on a marsupial pant and pad system to maintain dignity, whatever their degree of leakage, although there were a small number of manufacturers who were developing innovative product ranges, however these were seen as expensive by the then current health care authorities. Patients would be given what was available, so consistency in supply could not be guaranteed.  Usually products were collected from a Health Centre or Clinic, without much supervision from health care professionals, a clerk often making the decision about product supply. Rectangular, plastic-backed, recycled paper sheets were sometimes used to protect beds and chairs. Bed pads, as they were known, became the most misused product ever supplied, with sightings reported in cat litter trays, budgie cages and inside freezers during defrosting, to name a few. Assessment was at best, a form filling exercise usually ending with the issue of an absorbent product, and reassessment, a philosophy saved for a brave new world. Men largely relied on the same choice of products as women, and incontinence had even more of the taboo subject status it sadly still attracts.

 Where are we now? 

Regarding the continence product scenario in 2006, it is something of a postcode lottery. We often hear about ‘postcode lottery’ in the media with regard to new, possible life-prolonging, treatments as an option to premature death but depending on where you live and the Health Trust, which provides your health care, you may or may not be able to access that possible lifeline. Of course the supply of continence products is not that contentious an issue. Only to those who depend on products to enable them to manage their bladder or bowel symptoms, and those who care for people with continence problems, it is.

Continence products are supplied (and paid for) by the Health Trust, which provides other health care in your community. The products in many Trusts will be delivered direct to the patients home, although some still ask for patients to collect from a central point. How this works in a nutshell, is that the supplier is periodically chosen by a group of people from the Trust, including clinical specialists such as continence advisors, procurement managers (previously known as purchasing managers) and financial representatives. A user or user-group representation will be on this decision making panel. Many other considerations may play a part in the decision, such as the level of customer support or training offered by each manufacturer. The aim is to select a comprehensive product range, along with any other pre-requirements determined by the Trust, at an acceptable price. All manufacturers products will have been subject to trials by the Trust for effectiveness and acceptability during this process.

Products used to absorb urine are tested independently using criteria set down by the International Organisation for Standardisation (ISO). Therefore, all absorbent products have an ISO capacity, which is the absolute maximum the product will hold under laboratory testing. This standardisation allows Trusts to compare ‘like for like’ across all manufacturers, by comparing products with similar ISO capacities.

The actual level of product supply is very much down to the Trust and the individual continence services. We are all aware of the reported overspends in Primary Care Trusts, and therefore budget holders, such as continence advisors are under constant pressure to reduce the costs of their service. Here we have the effects of the ‘postcode lottery’. Some Trusts will only supply to certain patient groups, others will restrict the number of products that they will supply in 24 hours.

Most continence services will supply to ‘clinical need’, which means that if there is a proven clinical reason whereby a patient requires more products than the maximum Trust allocation, this will usually be sanctioned by the continence service.

All products are supplied on an individual basis, following assessment of the symptoms, or perhaps more accurate to say by individual ‘prescription’. The nurse who looks after the care of the patient will be responsible for prescribing appropriate products for the individual needs

Product essentials

As a possible future user of continence products, what do I want from a product, which is designed to absorb or contain bodily fluids?

I want something, which doesn’t leak, doesn’t rustle when I walk, is discreet so can’t be seen through my clothes, and contains urine or faecal leakage and odour. I would like it to be comfortable too.

Preventing leakage

Of course, it is essential that the product does not leak. Whether a product is used for a slight urinary leakage or severe double incontinence, it must contain the loss. Therefore, the skills and knowledge of the person who prescribes the product are critical. Knowledge of the product range available in the Trust is paramount to ensure the patients’ needs are met and the most effective use is made of resources.

Correct fitting of a product is essential in the prevention of leakage. The manufacturers fitting instructions must be followed. This will include cupping the product so it will fit around the anatomy for which it is intended, and fitting the product closely in the groin area, ensuring that the waterproof backing at the edges is not folded inwards.

Leakage of a product during use is not acceptable. An effective product means that the user can maintain dignity and social acceptability. A product, which is not appropriate for whatever reason, and leaks, may result in embarrassment and loss of self-esteem. Some products will have additional anti-leak protection built-in, and there are products with elasticised cuffs to prevent leakage in the groin area and to help contain faeces. As yet, there is no product, which will absorb faeces or faecal matter. At best, faecal loss is contained until the product is changed, ideally very soon after soiling has occurred to minimise the risk of skin damage and embarrassment to the client.

No noise

Most continence products have a waterproof backing to prevent leakage. A very small number of products do not, but I will discuss these later. As well as being waterproof to prevent urine leaking through, the backing of the product must be ‘rustle free’. No one wants to announce the fact that they are wearing a continence product from a distance therefore the backing also must be soft and quiet.

Discreet

Products must also be discreet. Whatever the degree of leakage it should be possible to be prescribed a product, which can be comfortably and effectively worn under everyday clothes without it being obvious to others. Many products now contain super absorbent polymer, or SAP, a powder, which absorbs many times its’ own weight in fluid. When this happens in a pad, it forms a gel and locks away urine. A product also contains cellulose, which is similar to cotton wool in appearance. Cellulose creates stability, and forms the base and top sandwich layers with the SAP between. This is the core of the product. Other fibres developed from cellulose may be present to maximise the effectiveness of the product. The amount of SAP in a product varies, depending on its intended absorbency and use, however the addition of SAP has enabled products to be much slimmer and discreet, often whilst increasing absorbency.

Comfort

The top layer of the product rests against the skin. This is a special non-woven material with tiny perforations to allow urine to pass through into the absorbent core of the product, keeping the skin dry. Urine will not return through the top layer due to a special coating on the underside of the non-woven material. The textile top layer should be soft and not cause chafing or discomfort when correctly fitted.

Keeping products in place

A simple fact of life for those who use continence products is, if the product is not fitted and kept in place correctly, it will leak. So wet trousers, skirts, car seats, settees and carpets, leading to odour, not to mention the horror felt by those who experience the leakage in the first place, is the result.

The healthcare professional who prescribes the product has a duty to ensure the correct use of that product and should give clear instruction on the fitting, removal, and disposal of the product in line with local policy.
 
Products with an adhesive strip

If a product has an adhesive strip on the back, then it is intended to fit inside the users own close-fitting underwear. Loose fitting underwear with the crotch mid-thigh, such as that preferred by elderly women 20 years ago, will not suffice, as the product will not be kept close enough to the body to be effective and clothing will suffer, necessitating changes following leakage, extra washing, possible damage to furniture and loss of dignity for the individual. Please encourage patients, men and women, who favour loose underwear to wear something close fitting if they need to wear pads, and explain the reason why.

Products with no adhesive strip

Generally, a body-worn product without an adhesive strip or other fastening method is intended for use with lightweight stretch knickers, of a woven net appearance. The correct size of net pants must be selected, and stretch to hold the product close to the body, as intended. These knickers are easily washed and dry very quickly.

Belted products

There is now a range of belted products available, which are secured by an integral belt fastening. This product is simple and easy to fit and may help some clients maintain independence. This type of product offers additional choice to patients, carers and professionals.

Pull-up briefs

Available in sizes to fit most individuals from children to adults, a range of pull-up briefs which can be pulled on and off like normal underwear is available from most manufacturers. Although this type of product offers discreet protection for all degrees of urinary and faecal incontinence, as these are perceived as a higher cost than other products, pull-ups tend to be reserved for use in children undergoing toilet training programmes and adults who meet specific criteria.

Products with no waterproof backing

As I mentioned earlier, there are a few products made without a waterproof backing. These are usually rectangular pads, relatively inexpensive, which may be used for faecal smearing, when the product needs to be changed frequently. In this case the product may be used inside close fitting underwear, or held in place with net knickers.

This type of product can also be used to absorb urine and may contain SAP, in which case the cost will be slightly more than those of plain cellulose. Originally used with knickers having an outside or inside waterproof-backed ‘pouch’, this product can also be used as a ‘booster’ pad inside a waterproof-backed product in extreme circumstances.

What the user brings to the product

Gender

Products to manage incontinence have traditionally been designed with women in mind. Straight products like sanitary towels were the forerunner of the anatomically shaped product revolution. Only in recent years have there been products specially designed for men, other than a penis pouch, which has been available for over a quarter of a century. This is still a very useful product for men with a dribble type of urinary loss, and a penis of sufficient size to remain within the product. For men with a greater urine loss, the choice was one of the products, which had been designed for the female gender, but now there are several products designed for men, to deal with varying degrees of leakage.   A product giving increased protection for men with slight urinary incontinence.

Size

Body sizes vary and for correct product fit, it is essential to measure for all-in-one products, belted products and adult pull-up briefs. Similarly, for those using net knickers, if too large a size is selected, the product will not fit closely enough and may leak.

 Mobility and manual dexterity

What do we treasure most in life? I guess that would be independence. To do what we want, choose when we want to do it, and how. Independence for continence product users depends very much on mobility and manual dexterity. In my opinion, if a product is available to enable an individual with restricted function in mobility or manual dexterity to be independent, they should not be denied that product.

Urine and / or faecal loss

Products are prescribed taking into consideration the volume of urine loss, and whether or not there is faecal incontinence too. It is important for product users to continue to be able to use the toilet, therefore when selecting a product this should be taken into account and a product selected, which is easily managed by the individual.

Using 2 products together

Two waterproof backed products used together do not work better than one correctly fitted product. If a product is not absorbent enough for the user, a reassessment needs to be done and a more appropriate product supplied.

Personal preference and lifestyle

Lifestyle is important to us all and to fit in with the individual, in an ideal world, the user should have some say in the choice of product, within the range suitable for their clinical need.

Disposal of the used product is equally as important as correct fitting to product users. For those without continence problems, work, going shopping and attending social events for example, are not complicated by having to consider where to change a pad and how to dispose of the used product.

Those who live in a small bed-sit, or high-rise flat, may have limited space for storing products and then removing soiled products from the living area, often to communal waste collection areas may be difficult for people with poor mobility. 

The future

So, what does the future hold for current and future users of continence products? A cash-strapped NHS looking for savings is developing programmes to streamline services and provision in many areas of health care. The supply of continence products will come under that umbrella. What that will mean to the end user is not clear, but experienced Continence Specialists who have developed top quality services, are in danger of having the heart and soul ripped out of their service, as more decisions are taken by non-clinical people on the basis of cost.

Cost savings can be delivered to the NHS without losing quality and whilst demonstrating an understanding of the many needs of those living with incontinence. A wide range of products should be available to enable patient choice, maintain dignity and quality of life.

I, like everyone else, more and more will rely on decision makers who are balancing the books, saving money when realistically there is no more to be saved, often completely detached from people living 24 hours a day with incontinence, to determine my quality of life.

I will end with the words with which I began this article:

“If ageing, frailty or disease is associated with continence problems, I want my continence problem to be cured. If that is not possible, I want the best management available, so I can continue to enjoy life to the extremes my health will allow.”

So, no different from anyone else, then......

Wendy Colley OBE
Clinical Nurse Manager
PAUL HARTMANN Limited

WC/August 2006

Article published by HARTMANN Direct - an online shopping site for incontinence and personal hygiene products. Products delivered direct to your door in discreet packaging. www.hartmanndirect.co.uk

This article is copyright protected and is not for republishing