Choosing the Right Product

  Level or amount of incontinence/episode

  Patient’s weight and gender

  Patient’s mobility and activity

  Patient’s dexterity

  Patient’s cognitive ability and level of awareness

  Patient’s to do self-care

  Determinations should be based on individual patient assessment--NOT one size fits all mentality

There are several considerations to be made when selecting incontinence products. An important consideration is how best to preserve the person’s sense of dignity. It’s crucial to never refer to products as “diapers” when caring for adults. Select products are available that have a low profile and don’t make it sound or look like your clients are wearing a product.

Consider the quantity of urine loss and the timing of the incontinent episode when selecting a product for containment. Size the products accordingly. Why use a large overnight brief product for a woman who only has 1-2 episodes of stress incontinence per week and leaks approximately 2 teaspoons per episode? And remember that it is important to re-evaluate the need for specific products as continence needs change.

As a short case study, consider the following example: a patient is admitted at 9pm for an exacerbation of heart failure. IV diuretics are administered in the ER as well as on the unit.

These medications as well as nocturnal diuresis contributed to symptoms of urgency for this patient, and urinary incontinence. Due to severe shortness of breath, a commode is ordered and an overnight adult brief product used during this time. Once the heart failure has been stabilized and doses of diuretics decreased, the use of the absorbent product can be discontinued.

Since our patients come in different sizes and shapes, we should have a variety of product sizes on hand to meet their needs. We’ll discuss size in more detail a little later. There are also gender specific protective briefs and underwear that provide more absorptive material in specific anatomical locations. In long term care this feature might not matter as much, but in a home setting—or with the ambulatory patient—this feature could be very beneficial. Does the patient have the physical and cognitive abilities to get to the bathroom independently, or do they need help? Are they able to perform all or some portion of this self-care activity? Or are they non-ambulatory? Select a product that best meets their needs. Does the patient have impaired manual dexterity? A brief with refastenable sides might be very frustrating for them to use, whereas selecting a pull-on type brief could assist them in becoming more independent with toileting. Look at the person and their type of incontinence to determine the most appropriate product. A one size fits all mentality is prevalent, but it’s not what’s best for the incontinent person.

Other product considerations:

For those experiencing moderate to large amounts of urine per episode, the absorptive capability of the product is important for their dignity--and their skin integrity. Think of the client who gets up from the dining room table only to see they have left a wet chair, or that they have left “their mark” on their physical therapy mat. Having a highly absorbent nighttime product can allow patients to get much needed rest. In addition to the products worn, consider the absorptive qualities of the underpads used to protect furniture. Will one pad suffice, or should they layer them on to get the job done?

Sizing: take a look at your population. Are you, like in many care settings, seeing bigger and bigger patients and still trying to fit them into the same, older “size large” products you have always carried in stock? Or do you have a lot of frail little patients who are drowning in the smallest size you carry—which is too large--and their beds and chairs are always wet?

Rick Fields-Gardner