Technology for managing incontinence: What are the research priorities?

Incontinence and toileting difficulties can often be successfully addressed by treating their underlying causes. However, (complete) cure is not always possible and continence products to prevent or contain unresolved leakage or to facilitate toileting are in widespread use. Many people use them successfully but identifying the product(s) most likely to meet individual needs can be challenging and the recently published Seventh International Consultation on Incontinence includes a chapter which draws on the literature to provide evidence-based recommendations to help clinicians and product users to select appropriate products. This paper is based on the same evidence, but reviewed from the different perspective of those keen to identify unmet needs and develop improved products. For each of the main continence product categories it (i) outlines the design approach and key features of what is currently available; (ii) provides a generic functional design specification; (iii) reviews how well existing products meet the requirements of their main user groups; and (iv) suggests priorities for the attention of product designers. It also flags some core scientific problems which - if successfully addressed - would likely yield benefits in multiple incontinence product contexts.

An International Continence Society (ICS) report on the terminology for single-use body worn absorbent incontinence products.

AIMS: In 2016, the International Continence Society (ICS) Standardization Steering Committee appointed a working group to address the confusing plethora of synonyms currently used to describe single-use body worn absorbent incontinence products by recommending preferred terminology. METHODS: An online questionnaire was posted in 2016/17 inviting input from stakeholders internationally. The data were analyzed and conclusions progressively refined through working group discussions, an open meeting at the 2017 annual ICS conference, and a review of further iterations-including from the parent ICS Standardization Committee-until consensus was reached. Partway in, the International Organization for Standardization started a project with similar scope and the two organizations liaised to harmonize their conclusions while respecting each other's processes. RESULTS: A hundred people from 18 countries responded to the questionnaire. About a third (32.2%) of those declaring their nationality were from the UK and a further third (34.5%) from other English-speaking countries. Two-thirds (67.8%) lived in Europe; around a quarter (23%) in North America; and 9.2% in Australasia. Seven main design categories of products were identified and, while clear consensus was readily achieved in naming some of them, others required more work to determine the best term among multiple contenders. CONCLUSIONS: The working group concluded that the seven product design categories should be called: (a) pads; (b) unbacked pads; (c) male pads; (d) male pouches; (e) pull-on pads (protective underwear); (f) all-in-ones (wrap-around pads, adult briefs); and (g) belted pads (belted products), in which the bracketed terms are judged acceptable (though not preferred) alternatives.

In vivo estimation of water diffusivity in occluded human skin using terahertz reflection spectroscopy.

Water diffusion and the concentration profile within the skin significantly affect the surrounding chemical absorption and molecular synthesis. Occluding the skin causes water to accumulate in the top layer of the skin (the stratum corneum [SC]) and also affects the water diffusivity. Scar treatments such as silicone gel and silicone sheets make use of occlusion to increase skin hydration. However with existing techniques, it is not possible to quantitatively measure the diffusivity of the water during occlusion: current methods determine water diffusivity by measuring the water evaporated through the skin and thus require the skin to breathe. In this work, we use the high sensitivity of terahertz light to water to study how the water content in the SC changes upon occlusion. From our measurements, we can solve the diffusion equations in the SC to deduce the water concentration profile in occluded skin and subsequently to determine the diffusivity. To our knowledge, this is the first work showing how the diffusivity of human skin can be measured during occlusion and we envisage this paper as being used as a guide for non-invasively determining the diffusivity of occluded human skin in vivo.

An investigation of laboratory test methods for predicting the in-use leakage performance of urine-absorbing aids in nursing homes.

The absorption before leakage method for measuring the absorption capacity of urine-absorbing aids was investigated. Along with the existing international standard (ISO 11948-1:1996, the Rothwell method), it was run on 12 experimental products whose in-use leakage performance was established by 55 incontinent nursing home residents. Methods were evaluated by considering their simplicity, their repeatability within - and their reproducibility between - six laboratories, and their correlation with in-use product performance. ISO 11948-1:1996 - which measures the absorption capacity of products under simple conditions - showed good repeatability and reproducibility, and reasonable correlation with in-use data. However, it proved blind to the effects of leg cuffs that conferred measurable benefits in real use. It should, therefore, be used with caution. The absorption before leakage method - which measures how much a product will hold before leakage when it is mounted on a manikin and standard aliquots of liquid are applied - is more complex and had poorer repeatability and reproducibility. However, it had stronger correlations with in-use data and successfully detected the benefits of leg cuffs on insert products. It is concluded that it holds potential as a new international standard to replace or complement ISO 11948-1:1996, and the necessary refinement work has been ongoing since the 2007 project described here. Two other laboratory methods were run opportunistically. A rewet method (Spanish national standard UNE 153601-2:2008) - for measuring the escape of fluid from a product under pressure - showed poor repeatability and reproducibility. Finally, an acquisition method was used to measure how quickly products absorbed two successive standard aliquots of liquid. It proved robust, showing good repeatability and reproducibility. Although measurements generally correlated well with in-use leakage performance, a direct causal link is unlikely. Products with high absorption capacity tend also to absorb quickly.

An experimental study of friction between volar forearm skin and nonwoven fabrics used in disposable absorbent products for incontinence.

Incontinence-associated dermatitis is common among wearers of absorbent incontinence products and friction between product materials and skin is thought to be a contributing factor, but the details of its role are unclear. In this study, friction was measured between the dry volar forearm of 19 women (20-95 years) and five nonwovens typical of those in commercial disposable products. Euler's model/Amontons' law held to high precision for all person-fabric pairs for both static and dynamic friction, despite substantial variations in forearm size, soft tissue compliance and skin smoothness between subjects, sometimes substantial lateral contraction in fabric strips, and skin rucking beneath them. For a given subject, the highest coefficients of friction among the fabrics exceeded the lowest by ∼30% to 75%, while - for a given fabric - the highest coefficients of friction among the subjects exceeded the lowest by ∼55% to 85%. The order of coefficient of friction values across fabrics was similar for each subject, and across subjects for each fabric. There was no systematic variation with subject age. The data were well modelled by estimating the coefficients of friction for a given person-fabric combination as the product of the mean coefficient of friction across all fabrics for that person, and the mean coefficient of friction across all persons for that fabric, normalised to the mean coefficient of friction across all person-fabric combinations. Predicted values were within 10% of measured figures for ∼97% of person-fabric combinations. Stick-and-slip behaviour was observed with seven person-fabric combinations, but especially strongly for two subjects with each of two fabrics. It is not clear why and further investigation is merited. Comparison of the data with results from earlier work with the same fabrics and a skin surrogate (Lorica Soft) suggests that measurements with Lorica Soft may be helpful to screen, evaluate and compare candidate materials preparatory to human studies.

The Impact of Microclimate on Skin Health With Absorbent Incontinence Product Use: An Integrative Review.

This integrative review considers the role of skin occlusion and microclimate in incontinence-associated dermatitis (IAD), with a particular focus on disposable, body-worn, absorbent incontinence products. Although the mechanisms are not fully understood, the primary causes of IAD are well-established: occluded skin, in prolonged contact with urine and/or feces and exposed to abrasive forces, is more likely to be affected, and each of these factors can be influenced by wearing absorbent incontinence products. Studies comparing the effect of various absorbent products on skin health have been hindered by the many differences between compared products, making it difficult to clearly attribute any differences in performance to particular materials or design features. Nevertheless, the large and significant differences that have sometimes been found invite further work. Breathable back sheets can significantly reduce the temperature of occluded skin and the humidity of the adjacent air, and several treatments for nonwoven top sheet materials (used next to the skin) have been shown to impart antimicrobial properties in the laboratory, but an impact on IAD incidence or severity has yet to be demonstrated directly. Recent work to introduce sensing technology into absorbent incontinence products to reduce the exposure of skin to urine and feces, by encouraging prompt product changing, seems likely to yield measurable benefits in terms of reducing incidents of IAD as the technology develops. Published work to date suggests that there is considerable potential for products to be engineered to play a significant role in the reduction of IAD among users.

Development and psychometric evaluation of ICIQ-PadPROM: A quality of life questionnaire to assess the treatment effect of absorbent continence products.

AIM: To describe the development and evaluation of the ICIQ-PadPROM, the first self-reported quality of life questionnaire to assess the treatment effect of absorbent continence products, a new addition to the set of ICIQ modules providing international standardized assessment of lower pelvic dysfunction. METHODS: Developed in four phases, question items semi-structured interviews were conducted with pad using men (n = 19), women (n = 6), with secondary analysis undertaken on transcripts (n = 15 women) from a previous study. Validity of a draft 67 item questionnaire was tested through cognitive debriefing interviews (n = 34) and postal survey (n = 239). Reliability was evaluated by 65 users with a 3 week interval between completions. Expert opinion and factor analysis were used to reduce the final questionnaire to 17 scored and 3 unscored items. RESULTS: The questionnaire comprises four scored domains: Pad design and Physical Effects (seven items), Psychological Effects (four items), Social Effects and Pad Leakage (three items) and Burden of Pad Use (three items), plus three unscored items. Levels of missing data ranged from 0 to 7.6%, with fair-to-moderate agreement. The Cronbach's alpha coefficient for all question items was 0.91 and factor analysis was undertaken to reduce redundancy. CONCLUSION: Existing incontinence-related outcome tools measure change in symptoms and quality of life impact. The ICIQ PadPROM questionnaire is the first to measure the impact of absorbent continence products on quality of life in the absence of any change in symptoms and will help policy-makers, clinicians, industry, and researchers to evaluate different products designs and materials for different patient populations.

Quantifying the Frictional Forces between Skin and Nonwoven Fabrics.

When a compliant sheet of material is dragged over a curved surface of a body, the frictional forces generated can be many times greater than they would be for a planar interface. This phenomenon is known to contribute to the abrasion damage to skin often suffered by wearers of incontinence pads and bed/chairbound people susceptible to pressure sores. Experiments that attempt to quantify these forces often use a simple capstan-type equation to obtain a characteristic coefficient of friction. In general, the capstan approach assumes the ratio of applied tensions depends only on the arc of contact and the coefficient of friction, and ignores other geometric and physical considerations; this approach makes it straightforward to obtain explicitly a coefficient of friction from the tensions measured. In this paper, two mathematical models are presented that compute the material displacements and surface forces generated by, firstly, a membrane under tension in moving contact with a rigid obstacle and, secondly, a shell-membrane under tension in contact with a deformable substrate. The results show that, while the use of a capstan equation remains fairly robust in some cases, effects such as the curvature and flaccidness of the underlying body, and the mass density of the fabric can lead to significant variations in stresses generated in the contact region. Thus, the coefficient of friction determined by a capstan model may not be an accurate reflection of the true frictional behavior of the contact region.

Development and psychometric evaluation of the ICIQ-LTCqol: A self-report quality of life questionnaire for long-term indwelling catheter users.

AIMS: Long-term indwelling catheterisation may affect health related quality of life, but clinical assessment and monitoring of people with indwelling catheters is poorly recorded because there are no validated measures to capture these criteria. In this paper, we describe the development of the ICIQ-Long Term Catheter quality of life (ICIQ-LTCqol), one of the modules of the ICIQ series, an international project to standardise assessment of lower pelvic dysfunction: www.iciq.net. METHODS: In-depth interviews were conducted with 27 catheter-users and 4 informal carers and cognitive debriefing with a further 31 catheter-users and clinical experts to evaluate clarity and comprehensiveness. The draft 44 item questionnaire was then sent by post to 893 long-term catheter-users; the 370 completed questionnaires were used to test content validity, test re-test reliability and internal consistency (Cronbach α coefficient). Factor analysis alongside expert opinion was used to formulate the final questionnaire of 16 items. This was then sent by post to another 438 long-term catheter-users to evaluate domain scores. RESULTS: The final questionnaire consists of two scored domains: catheter function and concern (9 items) and lifestyle impact (3 items) and four standalone items, relating to pads, pain, sexual activity and bladder spasm. Levels of missing data are good (mean 3.6%) with moderate to good agreement and acceptable internal consistency (Cronbach's alpha 0.76 and 0.74 for each domain respectively), suggesting acceptability and stability of the questionnaire. CONCLUSION: The ICIQ-LTCqol is a psychometrically robust self-report questionnaire for the clinical assessment and evaluation of health related quality of life for long-term catheter users.

An Exploratory Study of Skin Problems Experienced by UK Nursing Home Residents Using Different Pad Designs.

PURPOSE: The primary aim of this study was to determine whether the severity of incontinence-associated dermatitis (IAD) among nursing home-based incontinence pad users varies between pad designs. A second aim was to examine the utility of a simple method for reporting skin health problems in which healthcare assistants were asked to record basic observational data at each pad change. STUDY DESIGN: Randomized, multiple crossover, observational, exploratory. SUBJECTS AND SETTING: Twenty-one men and 57 women using absorbent continence products to contain urinary and/or fecal incontinence were recruited from 10 nursing homes in London and the south of England. METHODS: A day-time variant and a night-time variant of each of the 4 main disposable pad designs on the market for moderate/heavy incontinence were tested: (1) insert pads with stretch pants; (2) 1-piece all-in-one diapers; (3) pull-up pants; and (4) belted/T-shape diapers. All pad variants for day-time use had an absorption capacity of 1900 mL ± 20% (measured using ISO 11948-1 International Standards Organization) while the capacity of night-time variants was 2400 mL ± 20%. Each resident used each of the 4 pad designs (day-time and night-time variants) for 2 weeks and the order of testing was randomized by nursing home. Skin health data were collected using 2 methods in parallel. Method 1 comprised visual observation by researchers (1 observation per pad design; 4 observations in total over 8 weeks). In method 2, healthcare assistants logged observational data on skin health at every pad change for the 8 weeks. The primary outcome variable was severity of the most severe skin problem noted by the researcher for each resident, and for each pad design (method 1). Descriptive data on skin care methods used in the nursing homes were also collected using short questionnaires and researcher observation. RESULTS: No significant differences in the severity or incidence of skin problems were found between observations using the 4 pad designs. However, a wide range of skin conditions was recorded that made classification difficult; the skin was often marked with creases from absorbent products, temporary marks, and pink/purple discoloration. We observed few cases of the severe erythema, rashes, and vesicles that are commonly used descriptors in previous skin tools. Nevertheless, the collected data reflect an abundance of skin problems that were difficult to categorize neatly. Researcher observations (method 1) showed that nearly all the residents (96%) had at least 1 IAD skin problem recorded over the 8-week period and 64% of residents had at least 1 problem that was rated as maximum severity. Healthcare assistants logged skin problems on 6.1% of pad changes. The discrepancy between researcher and healthcare assistant data appears to be largely due to healthcare assistants sometimes discounting low-grade IAD as normal for that population. CONCLUSION: Incontinence-associated dermatitis is common among nursing home residents who use incontinence pads, and it is often severe. No evidence was found that any design of pad was more likely than any others to be associated with skin problems. The method devised to enable healthcare assistants to record basic observational data on skin health in the diaper area at each pad change (Method 2) proved simple to use but still resulted in substantial underreporting of IAD, suggesting that further work is needed to develop a tool that more successfully encourages them to log and treat IAD problems.

Is it Feasible to Use Incontinence-Associated Dermatitis Assessment Tools in Routine Clinical Practice in the Long-term Care Setting?

PURPOSE: To investigate the feasibility of using incontinence-associated dermatitis (IAD) tools in routine clinical practice by asking nursing home staff (RNs and non-RN caregivers) and tissue viability specialty (TVS) nurses to evaluate 3 instruments and a 4-point severity scoring system for describing and grading IAD examples captured in photographs of skin underneath absorptive pads in nursing home patients. DESIGN: Feasibility study. SUBJECTS AND SETTING: Twelve female nursing home residents whose incontinence was managed with pads and who had previously been identified as experiencing IAD were recruited, along with 16 nursing home staff (6 RNs and 10 non-RNs) and 10 TVS nurses. METHODS: Weekly high-quality photographs were taken of the skin beneath absorptive pads of nursing home residents for 8 weeks yielding a library of 78 photographs. A subset of 10 representative photographs was chosen. The 16 nursing home staff and 10 TVS nurses were then asked to describe and grade the IAD in the 10 photographs using 3 IAD instruments and simple severity scoring system (SSS) developed for this study. Particular attention was paid to identifying any practical challenges staff encountered in conducting their task. RESULTS: The TVS nurses were able to use all 3 IAD instruments and the SSS and reported that they could incorporate them into their clinical practice with relative ease. Although the RNs were able to use the 3 instruments adequately with some initial assistance, they generally felt that they were too busy to complete them. By contrast, they reported that they found the SSS simple and quick enough to incorporate into their routine practice. The caregivers had difficulty with the text-based instruments, especially if English was not their first language, and they were only able to use the SSS. The caregivers' SSS scores for a given photograph varied more than TVS nurse scores, but the correlation between the mean TVS scores, which were operationally defined as the gold standard for purposes of this study, and the mean RN and caregiver scores (R = 0.811) were fairly high. CONCLUSIONS: Existing IAD instruments are too time-consuming and linguistically complex for use in routine clinical practice in nursing homes. We found that staff generally found the SSS easy to judge IAD severity based on pictures used in the study. This finding suggests that the SSS could be improved by adding reference photographs of skin illustrating each of the 4 points on the scale. Such an instrument could be designed and validated with an emphasis on integration into current clinical practice pathways.

A trial of devices for urinary incontinence after treatment for prostate cancer.

OBJECTIVE: To compare the performance of three continence management devices and absorbent pads used by men with persistent urinary incontinence (>1 year) after treatment for prostate cancer. PATIENTS AND METHODS: Randomised, controlled trial of 56 men with 1-year follow-up. Three devices were tested for 3 weeks each: sheath drainage system, body-worn urinal (BWU) and penile clamp. Device and pad performance were assessed. Quality of life (QoL) was measured at baseline and follow-up with the King's Health Questionnaire. Stated (intended use) and revealed (actual use) preference for products were assessed. Value-for-money was gathered. RESULTS: Substantial and significant differences in performance were found. The sheath was rated as 'good' for extended use (e.g. golf and travel) when pad changing is difficult; for keeping skin dry, not leaking, not smelling and convenient for storage and travel. The BWU was generally rated worse than the sheath and was mainly used for similar activities but by men who could not use a sheath (e.g. retracted penis) and was not good for seated activities. The clamp was good for short vigorous activities like swimming/exercise; it was the most secure, least likely to leak, most discreet but almost all men described it as uncomfortable or painful. The pads were good for everyday activities and best for night-time use; most easy to use, comfortable when dry but most likely to leak and most uncomfortable when wet. There was a preference for having a mixture of products to meet daytime needs; around two-thirds of men were using a combination of pads and devices after testing compared with baseline. CONCLUSIONS: This is the first trial to systematically compare different continence management devices for men. Pads and devices have different strengths, which make them particularly suited to certain circumstances and activities. Most men prefer to use pads at night but would choose a mixture of pads and devices during the day. Device limitations were important but may be overcome by better design.

Individual budgets for people with incontinence: results from a 'shopping' experiment within the British National Health Service.

BACKGROUND AND CONTEXT: Most people with urinary incontinence are given limited choice when provided with absorbent products through the British National Health Service (NHS), even though the available range is large. OBJECTIVE: To investigate users' preferences for four disposable designs (inserts, all-in-ones, belted/T-shaped and pull-ups) and towelling washable/reusable products, day and night. DESIGN: Shopping experiment. SETTING AND PARTICIPANTS: Community-dwelling women and men in England with moderate-to-heavy urinary incontinence recruited to a larger trial. INTERVENTION: Participants tested each design and selected products they would prefer with a range of different budgets. MAIN OUTCOME MEASURES: Design preferences (rankings); 'purchasing' decisions from designated budgets. Results Eighty-five participants (49 men) tested products, 75 completed the shopping experiment. Inserts, most frequently supplied by the NHS, were ranked second to pull-ups by women and lowest by men. When faced with budget constraints, up to 40% of participants opted to 'mix-and-match' designs. Over 15 different combinations of products were selected by participants in the shopping experiment. Most (91%) stated a willingness to 'top-up' assigned budgets from income to secure preferred designs. DISCUSSION: Participants displayed diverse preferences. Enabling user choice of absorbent product design through individual budgets could improve satisfaction of consumers and efficiency of allocation of limited NHS resources. CONCLUSION: Recent policy for the NHS seeks to provide consumers with more control in their care. Extension of the concept of individual budgets to continence supplies could be feasible and beneficial for patients and provide better value-for-money within the NHS. Further research is warranted.

A study of friction mechanisms between a surrogate skin (Lorica soft) and nonwoven fabrics.

Hygiene products such as incontinence pads bring nonwoven fabrics into contact with users' skin, which can cause damage in various ways, including the nonwoven abrading the skin by friction. The aim of the work described here was to develop and use methods for understanding the origin of friction between nonwoven fabrics and skin by relating measured normal and friction forces to the nature and area of the contact (fibre footprint) between them. The method development work reported here used a skin surrogate (Lorica Soft) in place of skin for reproducibility. The work was primarily experimental in nature, and involved two separate approaches. In the first, a microscope with a shallow depth of field was used to determine the length of nonwoven fibre in contact with a facing surface as a function of pressure, from which the contact area could be inferred; and, in the second, friction between chosen nonwoven fabrics and Lorica Soft was measured at a variety of anatomically relevant pressures (0.25-32.1kPa) and speeds (0.05-5mms(-1)). Both techniques were extensively validated, and showed reproducibility of about 5% in length and force, respectively. Straightforward inspection of the data for Lorica Soft against the nonwovens showed that Amontons' law (with respect to load) was obeyed to high precision (R(2)>0.999 in all cases), though there was the suggestion of sub-linearity at low loads. More detailed consideration of the friction traces suggested that two different friction mechanisms are important, and comparison with the contact data suggests tentatively that they may correspond to adhesion between two different populations of contacts, one "rough" and one "smooth". This additional insight is a good illustration of how these techniques may prove valuable in studying other, similar interfaces. In particular, they could be used to investigate interfaces between nonwovens and skin, which was the primary motivation for developing them.

Continence products: research priorities to improve the lives of people with urinary and/or fecal leakage.

Although many successful treatments for incontinence exist they are not effective or suitable for all people. Inconspicuous and dependable management with continence products and devices plays a crucial part in maintaining quality of life. We aim to briefly review what is known and not known in the field of continence products and devices and set out suggested priorities for research and development. The field of continence product research encompasses techniques and designs from basic laboratory science, through to clinical trials of products and to evaluations of service delivery models. Priorities for research include determining prevalence and costs of product use, development of patient reported outcomes, and development of methods for measuring skin health and for quantifying urine/faecal leakage. Product development priorities include better washable pads for women, absorbent products for fecal incontinence and flatus filters. Clinical trials of different product categories (e.g., devices for men) are needed, as are qualitative studies of patient experiences of product use.

Review of methods used for quantifying excess water in over-hydrated skin using evaporimetry.

BACKGROUND: Advances in diapers and skin barrier products are often aimed at reducing water penetration of the skin to prevent diaper dermatitis and evaporimetry has commonly been measured to quantify excess water in the skin. The aim of this study was to critically review the methods used to measure water vapour flux density (WVFD) using evaporimetry in order to identify a standardised methodology. METHODS: We used MEDLINE (1980-2008) and hand searching to identify published papers that used evaporimetry to measure WVFD when the skin has been exposed to water/saline/urine. We compared the papers with respect to subjects, sites, methods of hydrating the skin, the conditions of logging, timing and analysing the evaporimetry data. RESULTS: We identified 10 papers. Methods and techniques for measuring WVFD and analysing data varied considerably between studies and it was not possible to identify a standardised method. The main sources of error and variation are discussed. CONCLUSION: Little work has been carried out to establish the optimum methods and techniques needed to minimise variation in measurements of WVFD using evaporimetery. There is a need to develop more robust, standardised methods and to demonstrate their reliability for further work.

Absorbent products for moderate-heavy urinary and/or faecal incontinence in women and men.

BACKGROUND: Incontinence is a common and embarrassing problem which has a profound effect on social and psychological well-being. Many people wear absorbent products to contain urine and/or faeces and protect their clothes and dignity. Users of absorbent pads are very diverse, including younger women, particularly those who have had children, older men with prostate disease, people with neurological conditions and older people with mobility and mental impairment. Whilst small absorbent pads for light incontinence are adequate for some users with low volumes of urine loss, for others with higher volumes more absorbent products are needed. A practical definition of moderate-heavy incontinence is urine or faecal loss that requires a large absorbent pad (typically with a total absorbent capacity of 2000 g to 3000 g) for containment. OBJECTIVES: To assess the effectiveness of the different types of absorbent product designed for moderate-heavy incontinence. SEARCH STRATEGY: We searched the Cochrane Incontinence Group Specialised Register for trials carried out between 1 January 1998 and 1 January 2008 (searched 7 February 2008), and the reference lists of relevant articles. Absorbent pads are subject to frequent modification by manufacturers and trials more than 10 years old were therefore not included in this review. SELECTION CRITERIA: All randomised or quasi-randomised trials of absorbent products for moderate-heavy incontinence. DATA COLLECTION AND ANALYSIS: Two review authors assessed the methodological quality of potentially eligible studies and independently extracted data from the included trials. MAIN RESULTS: Two studies with a total of 185 participants met the selection criteria. These trials studied all the absorbent product designs included in this review. One trial took place in nursing homes, the other in people's own homes. Gender was found to be a significant variable in both trials, and accordingly the results were analysed in gender groups. Data were presented on all included outcomes, except for quality of life.The results show that there is no single best design (i.e. one design that is significantly better than all other designs and for all users). Of the disposable designs, the more expensive pull-up and T-shaped diaper designs were not better overall than the diaper for men, but the diaper was better than the insert (the cheapest), making the diaper the most cost-effective disposable design for men both day and night. For women, disposable pull-ups were better overall than the other designs (except for those living in nursing homes when disposable diapers are better when used at night), but they are expensive. Unlike men, women in the community did not favour diapers (or T-shape diapers) and insert pads are therefore the most cost-effective alternative. Washable diapers are the least expensive design but are unacceptable to most women at any time. However, some people (particularly men living at home) prefer them at night and for them they are a cost-effective design.No firm conclusions could be drawn about the performance of designs for faecal incontinence and there was no firm evidence that there are differences in skin health between designs. AUTHORS' CONCLUSIONS: Although data were available from only two eligible trials the data were sufficiently robust to make some recommendations for practice. There is evidence that different designs are better for men and women. Diapers are the most cost-effective disposable design for men. Disposable pull-ups are most preferred for women but are expensive: disposable inserts are a cheaper alternative (except in nursing homes where diapers are preferred to inserts at night). Washable diapers are the cheapest design but have limited acceptability, confined mainly to some men at night. There were not enough people in the trials to draw any conclusions about which designs are best for faecal incontinence and no particular design seemed to be better or worse for skin health. People have different preferences for absorbent product designs and using a combination (different designs for day/night, going out/staying in) may be more effective and less expensive than using one design all the time.

A noninvasive continence management system: development and evaluation of a novel toileting device for women.

PURPOSE: This paper describes a project to develop and clinically evaluate a novel toileting device for women called the Non-Invasive Continence Management System (NICMS). The NICMS device is designed to provide an alternative toileting facility that overcomes problems some women experience when using conventional female urinals. DESIGN: A single product evaluation was completed; participants used the same device with 1 or 2 interface variants. SUBJECTS AND SETTING: Eighty women from 6 countries who were either mobile or wheelchair dependent evaluated the product over a 15-month period. RESULTS: The device was found to be useful in some circumstances for women and their caregivers. CONCLUSION: Significant further development is required for it to work reliably and to provide an acceptable device in terms of reliability, size, weight, noise, and aesthetics.