Urinary incontinence often presents a significant burden for
care home residents, carers and health professionals. However, these burdens can be alleviated with good continence care,
based on holistic assessment and personalised prescribing of containment products. Practical and effective ways to achieve are demonstrated in a recent service-improvement project published by the British Journal of Community Nursing, available below.
Urinary incontinence, the involuntary leakage of urine in an inappropriate location, represents a significant burden on patients and healthcare services
Urinary incontinence is very prevalent in the UK
• 14 million people
• 34% of women
• 10% of men over 65 years old
• Risk increases with age
Source: Incontinence UK, 2023; NHS England, 2018
Urinary incontinence often results in maceration and breakdown of skin integrity, known as moisture-associated skin damage (MASD), as well as associated increased risks
• Pressure ulceration
• Falls
• Secondary skin infections
• Fungal infections
Urinary incontinence can impose significant burdens on mental wellbeing and overall quality of life
• Feelings of distress
• Embarrassment
• Disturbed sleep
• Social isolation
• Dependence on carers
• Loss of productivity
Urinary incontinence is also expensive, with the NHS spending around £800 million per year on continence care. Avoidable complications are expensive for health services, especially as they mean more time is spent in high-cost hospital settings. Likewise, incontinence is a major cause of early admission to residential care, as well as being expensive to manage in a care home setting.
Source: NHS England, 2018
The burdens of incontinence can be significantly decreased with good continence care
Uncontrolled incontinence is not an inevitable part of aging
If incontinence is a symptom of underlying problems, these
can be identified and treated. If not, it can often be effectively contained to allow for social continence. A successful toileting plan may include fluid management, assistance with toilet access and pelvic floor exercises. Promoting self-management can reduce reliance on carers and promote independence.
This can be facilitated with digital tools for managing
long-term health conditions.
Incontinence can be managed with a range of containment products
• Continence products differing in absorbency levels, one-piece
or two-piece design, such as shaped pads, briefs with tabs, belted
briefs or pants
• Products are only effective if fitted and used correctly, so training
is vital
• Around £80 million is spent on continence products by the
NHS each year in the UK
People with incontinence are often prescribed a generic product
Healthcare professionals and budget holders with less experience/knowledge in continence care, may prescribe a generic product based on cost alone. However, a one-size-fits-all approach is unlikely to be cost effective or meet patient needs.
Containment products should be prescribed according to the patient’s individual needs
An appropriate prescription is likely to be more clinically effective at improving continence status and preventing avoidable complications. It can be more cost-effective, avoiding unnecessary allocation of carer time or ineffective use of medications. Therefore, personalised product choice should be part of a person-centred care plan.
Product selection can be assisted with the Continence Product Advisor website
Finding the right pad for the right patient at the right time requires a comprehensive assessment of the patient’s clinical and holistic needs
• Diet and fluid intake
• Frequency and severity of urinary incontinence
• Impact on skin integrity
• Lifestyle, including drugs, alcohol, smoking and physical activity
• Medical history, such as drugs, comorbidities and pregnancies
• Mental acuity and capacity, such as recognition of toileting need
• Personal preferences
• Physical characteristics, such as size, mobility and dexterity
• Possibility of physical abuse, including female genital mutilation
• Sex and anatomy
• Toileting ability and independence in feeding, dressing and washing
Source: NHS England, 2018
A specialist steering group came to a consensus on how to improve continence care in the NHS
The clinical and holistic needs of the patient should be the priority for pad provision across all service areas in the NHS
Source: Orme et al, 2022
Pad provision should not be based on budgets or pads per day, as this is contrary to individualised patient care
Source: Orme et al, 2022
Indirect costs (not acquisition cost alone) should always be considered when continence assessments are conducted
Source: Orme et al, 2022
A patient-related outcome measure for incontinence care designed for everyday clinical use should be developed and implemented
Source: Orme et al, 2022
Shaped pads for men should be the preferred option for dignity, mental health and ergonomic reasons
Source: Orme et al, 2022
Gait assessment must be made part of the continence product assessment and for patients where gait may be an issue
Source: Orme et al, 2022
Two-piece products should be avoided where a risk of falls is present
Source: Orme et al, 2022
A non-rinse pH-balanced wash cream should be the preferred option in patients where moisture-associated skin damage or incontinence-associated dermatitis is a risk
Source: Orme et al, 2022
Accurate patient continence assessment is vital to reduce costs to the service and provide the right product to the patient
Source: Orme et al, 2022
The advantages of individualised holistic prescribing for incontinence containment products were demonstrated in a service-improvement project covering six Lincolnshire care homes
44 care home residents
• Aged 69–99 years
• 84% female
• All dependent on
carers for toileting
Residents’ continence-related needs were not being met
• Generic product provision
• Frequent leaks
• More skin damage
• Loss of dignity
Care home staff were also impacted
• Increased laundry burden
• More moving and handling
• Negative financial impact
• More nurse visits and GP contacts
• Measurements for sizing
• Medical history
• Moving and handling requirements
• Requirement for other medical devices
• Skin condition
• Toileting and changing ability
Residents received a containment product appropriate for their needs
Undertaken May and November 2021, during the COVID-19 pandemic
Pads used with fixation pants
Pull-on pants
Light pads worn in underwear
All-in-one briefs with tabs
Belted briefs
The personalised prescriptions soon showed positive results
Generic prescription
Personalised prescription
Generic prescription
Personalised prescription
Generic prescription
Personalised prescription
Generic prescription
Personalised prescription
Measured over 5 days, 2–3 weeks before and right after intervention
Staff satisfaction scores also increased
Generic prescription
Personalised prescription
Likert scale (0–4), taken during the product review
Residents experienced fewer adverse events
Generic prescription
Personalised prescription
User feedback reflected these positive results
Produced by Mark Allen Medical Communications www.mamedcomms.com
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Staff undertook a holistic assessment of patient needs
• Bladder and bowel habit
• Cognition
• Dexterity and mobility
• Fluid intake
• Frequency of product changes
• Incontinence type
Finding the right pad for the right patient at the right time requires a comprehensive assessment of the patient’s clinical and holistic needs
• Diet and fluid intake • Frequency and severity of
urinary incontinence • Impact on skin integrity
• Lifestyle, including drugs, alcohol, smoking and
physical activity • Medical history, such as drugs,
comorbidities and pregnancies • Mental acuity and
capacity, such as recognition of toileting need
• Personal preferences
• Physical characteristics, such as size, mobility and dexterity
• Possibility of physical abuse, including female genital mutilation
• Sex and anatomy
• Toileting ability and independence in feeding, dressing and washing
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Continence assessments should be carried out by specialist nurses with sufficient time allocated to conduct these assessments properly; continence should be frequently reassessed to detect incontinence-associated dermatitis or other associated issues
Source: Orme et al, 2022
Service redesign should be considered to secure the required funding for specialists to conduct continence assessments
Source: Orme et al, 2022
Source: Orme et al, 2022
Considerations should be given to the mental health needs of the patient when making incontinence care decisions and referral processes made clear and accessible
Source: Orme et al, 2022
Education for care home staff around continence care should be improved
Source: Orme et al, 2022
A media campaign should be developed to inform public perceptions regarding pad use and design
Source: Orme et al, 2022
Continence assessments should be carried out by specialist nurses with sufficient time allocated to conduct these assessments properly; continence should be frequently reassessed to detect incontinence-associated dermatitis or other associated issues
Source: Orme et al, 2022
Service redesign should be considered to secure the required funding for specialists to conduct continence assessments
Source: Orme et al, 2022
Considerations should be given to the mental health needs of the patient when making incontinence care decisions and referral processes made clear and accessible
Education for care home staff around continence care should be improved
Source: Orme et al, 2022
Source: Orme et al, 2022
A media campaign should be developed to inform public perceptions regarding pad use and design
This supplement was supported by Essity.
Click here to access more continence training.