Incontinence in the elderly is common. 30-40 % of post menopausal women have some type of bladder incontinence as do 20% of men over the age of 65. Studies have found that between 43% and 77% of nursing home residents have some level of incontinence. Despite these numbers most people do not know about treatments or the products that are available to help manage the condition.This month, Elder Voice discusses incontinence products.
Incontinence and the difficulties caused by it are significant but rarely discussed by those who experience it.This is indicative of the shame and embarrassment it may cause. These feelings may lead to people isolating themselves socially from friends and family and becoming depressed. If not properly managed, incontinence can lead to skin breakdown and infections. Skin breakdown which is not taken care of can lead to serious health issues and eventually even death. Incontinence is one of the most stressful issues for caregivers to deal with, and thus is one of the predictors of nursing home admission.
When incontinence occurs the first step is to see a doctor. There may be reversible medical causes of the incontinence and thus medical and physical treatments available which may help to control it. If it cannot be reversed,it can be managed.
Alert monitoring, good hygiene and skin cleaning as well as adequate changing of whichever product is used will help to prevent skin breakdown but it is important to use the right product for the particular individual. On a practical level, in the home you will also want to consider underpads for beds, chairs, or couches so that urine does not leak onto them, causing odor.
The goal of incontinence products is to keep someone dry, their skin intact, and enable them to go about daily life without odour or embarrassment. Dryness is achieved through different technologies, based on the brand, that absorb liquid and draw it away from the skin so that skin remains dry. The liquid is “locked in,” sometimes even transformed into a gel or other type of substance. Absorbency is achieved through the type of material used in the manufacture of the product and the amount that is used. Thus, for example, there are some pads that are “ultra thin” and others that are thicker.
Incontinence products may appear similar but in fact they vary by quality of materials, design, comfort and performance. They come in a range of sizes and and of levels of absorbency with some products drawing an amazing amount of liquid. They should fit closely to the body. Absorbent capacity is important in achieving maximum benefit. Comfort is personal; different products will feel more comfortable to different people. Specific products are designed for men and for women.There are both disposable and re-usable products available.
You will want to buy products based on how much incontinence there is, how often (times per day) it occurs, the type of incontinence, and when (day or night) it occurs. Different products are appropriate for different situations. For instance, you might want to use a pad during the day, but a highly absorbent brief at night.
It is not a good idea to use two products to achieve greater dryness as this may be counterproductive as well as also being uncomfortable. If you find one is not adequate this could indicate you should try a different brand or different type.
Many incontinent products have an odour control system built in. Again, what you choose needs to be appropriate to the type, frequency and amount of incontinence and changed at appropriate times. In addition to the products themselves there are separate products specifically designed to help control odour.
When choosing a product you will have to know the size to buy. Size is based on either hip or waist measurements. It is a good idea to know both before starting to shop.
For minimal incontinence, small and absorbent “pads” may be used. They fit within someone’s normal underwear. You can also buy undergarments which hold them in place if one’s regular underwear does not. For greater incontinence there are pull up underwear, put on and worn like normal underwear, but are made of very absorbent material. There are also briefs, which are put on and fastened like diapers. The advantage of these is someone does not have to take off shoes and pants/skirt/dress to change them. Extended wear products are briefs or or pull up pants that are made to absorb and hold a large amount of urine. These are often used at night so that the wearer can sleep through the night without impacting skin integrity.
Incontinence products can be purchased online or through home health stores. They can be purchased in bulk or smaller quantities so that you can experiment with the brand or system which works best for your situation. Online stores often have a greater selection to choose from and may carry brands which are not available in stores. If you are shopping in a home health store, ask a consultant to show you the different products and how they work. It may cause you some discomfort, but the sales people are trained to know about the products and which ones might be best for you. Most brands also have information on their websites.
For more information on incontinence, please see our Diamond Geriatrics article.