Intervention Review

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

  1. Mandy Fader1,*,
  2. Alan M Cottenden2,
  3. Kathryn Getliffe3

Editorial Group: Cochrane Incontinence Group

Published Online: 8 OCT 2008

Assessed as up-to-date: 6 FEB 2008

DOI: 10.1002/14651858.CD007408


How to Cite

Fader M, Cottenden AM, Getliffe K. Absorbent products for moderate-heavy urinary and/or faecal incontinence in women and men. Cochrane Database of Systematic Reviews 2008, Issue 4. Art. No.: CD007408. DOI: 10.1002/14651858.CD007408.

Author Information

  1. 1

    School of Nursing and Midwifery, Continence and Skin Health Technology Group, Highfield, Southampton, UK

  2. 2

    Department of Medical Physics and Bioengineering, Continence and Skin Health Technology Group, London, UK

  3. 3

    University of Southampton, School of Nursing & Midwifery, Southampton, UK

*Mandy Fader, Continence and Skin Health Technology Group, School of Nursing and Midwifery, University of Southampton, University Road, Highfield, Southampton, SO17 1BJ, UK. m.fader@ucl.ac.uk.

Publication History

  1. Publication Status: Edited (no change to conclusions)
  2. Published Online: 8 OCT 2008

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Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

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 methods

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.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

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

Bladder and bowel control problems are common in women and men and many wear absorbent pads to contain urine and/or faecal leakage and to protect their clothes. In many countries people buy their own absorbent pads, but in some countries (and in institutions such as nursing homes) pads may be purchased and supplied by health services. There are four main designs of bodyworn absorbent products used for moderate-heavy incontinence (i.e. urine or faecal loss that can be contained within a large absorbent pad): disposable pads (sometimes called insert pads) worn with stretch pants, disposable diapers (like babies' nappies), disposable T-shaped diapers (like diapers with a waist-band) and pull-ups (like toddler training pants); there are also washable versions of these. In addition, disposable and washable underpads/bedpads and chairpads may be used, usually to provide 'back-up' for bodyworn pads.

This review found only two eligible clinical trials which had been carried out in the last 10 years and both were of bodyworn absorbent products. These trials included all the product designs and took place in nursing homes and in the community (i.e. involving people living in their own homes); both were carried out in the UK. There is evidence that different designs are better for men and women. Of the disposable designs diapers are the most cost-effective for men for both day and night. Women prefer disposable pull-ups, but they are expensive and disposable inserts are a cost-effective alternative (except for women at night in nursing homes where disposable diapers are better). Washable diapers are inexpensive 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 or about which particular design was better or worse for skin health. Using combinations of designs (different designs for day/night or for staying in/going out) may be more effective and less expensive than using one design all the time.

 

摘要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

背景

吸水產品對於中重度尿/大便失禁女性與男性影響

尿失禁是一種常見的尷尬問題,對於社會及心理健康有極大的影響。許多人穿著可吸收尿液或糞便的產品藉以保護他們的衣服和自尊。吸水墊的使用者十分廣泛,包括年輕婦女,特別是有孩子的女性,老年男性患有前列腺疾病的人士,有神經系統方面疾病的人和行動不便和心智障礙的老年人。雖然小吸水墊對於漏尿量小的輕度尿失禁患者已經足夠,但對於較高尿失禁量的的人來說高度吸水量的產品是必要的。實務上定義中重度尿失禁為在尿液或糞便漏失上,需要大型吸水墊(一般說來,總吸水量介於2000克到3000 克之間)來防範。

目標

評估針對中重度尿失禁所設計的不同吸水產品之效果。

搜尋策略

我們檢索了考科藍實證醫學資料庫中尿失禁專科於1998年1月1日至2008年1月1日間的試驗(搜尋日期為2008年2月7日),以及相關的參考文獻。由於吸水墊會受製造商不斷地改良因此超過 10年以上的試驗不列入審查。

選擇標準

所有隨機或半隨機試驗針對中重度失禁的吸水產品。

資料收集與分析

兩名審查員獨立評估試驗方法的品質與提取合格試驗的數據。

主要結論

兩份研究,總共185名受試者符合了遴選標準。這些試驗調查了所有納入本次評估的吸水產品。其中一個試驗於護理之家中進行,其他的試驗則在個人家中。根據性別分組的分析顯示,性別在兩項試驗中都是一個重要的因子。除了生活品質,所有可能結果皆列入分析。結果顯示沒有一個最佳的產品設計(即單一產品設計,對於所有使用者,明顯優於其他所有的設計)。在可拋棄性的設計上,更貴的訓練褲和T形尿布的設計整體並沒有優於一般男性尿布,但優於置入式(最便宜),該尿布為最具成本效益的可拋式日夜兩用男性尿布。對女性來說,可拋式訓練褲整體優於其他比其他設計(除了那些居住在護理之家,可拋式尿布在夜間使用較佳),但它們很昂貴。不像男性,女性在日常上不樂於使用尿布(或T型尿布),因此置入墊成為最具成本效益的替代品。可洗尿布是最便宜的設計,但最不為女性所接受,無論在任何狀態。不過,有些人(尤其是居住在家中的男性),他們喜歡在晚上使用可洗式尿布,其為最具有成本效益的設計。對於糞便失禁所設計的產品,目前沒有可靠的結論,而且也沒有可靠的證據顯示皮膚的健康與不同設計的關係。

作者結論

雖然數據僅從兩個合格的試驗,但證據充分有力,足以提出一些建議的做法。有證據顯示,不同的設計適用於男性和女性。對於男性,尿布是最具成本效益的可拋式設計。可拋式訓練褲是最受女性青睞,但價格昂貴:可拋式置入墊是一種較廉價的替代品(除在護理之家,傾向於夜間使用尿布)。可洗式尿布是最便宜的設計,接受程度有限,主要限於一些男人在夜間使用。關於哪些設計最適合大便失禁,目前沒有足夠的樣本在試驗中得出任何結論,也沒有何種設計對於皮膚健康有好或壞的影響。人有對於使用吸水產品有不同喜好,使用不同組合產品(因應晝/夜,外出/室內不同設計)可能會更有效,更便宜,相較於僅使用單一個設計產品。

翻譯人

本摘要由中國醫藥大學附設醫院陳祖裕翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

膀胱和腸道控制不良是女性和男性常見的問題,有許多人選擇穿戴吸水墊以避免尿液或糞便滲漏同時保護他們的衣服。在許多國家,人們購買他們自己的吸水墊,但在一些國家(和機構,如護理之家)吸水墊由健康照護單位購買和提供。針對中重度尿失禁,有四種主要的設計用於穿戴式吸水產品(即尿液或糞便滲漏,可以被吸附在一個大的吸水墊):拋棄式墊(有時稱為置入墊)與彈力褲一起穿著,拋棄式紙尿布(像嬰兒尿布),拋棄式T形尿布(像配備腰帶的尿布)和訓練褲(如幼兒訓練褲);這些均有可清洗式的樣式。此外,拋棄式/可洗式 座墊、床墊及椅墊均可配合使用,這些通常是以備不時之需。這次評估在過去10年只有兩個臨床試驗符合資格,兩者都是有關穿戴式吸水產品。這些試驗涵蓋了所有在護理之家或社區(居家使用)兩個試驗均為英國研究。有證據顯示,不同的設計適用於男性和女性。對於男性,拋棄性尿布的設計上最具成本效益,不論日夜。婦女寧願使用拋棄式訓練褲,但費用昂貴,可拋式置入墊是符合成本效益的替代方案(除了在護理之家的女性,於晚上使用紙尿布更佳)。可洗尿布價格便宜,但接受程度有限,主要限於一些男人在夜間使用。沒有足夠的樣本得出任何結論關於哪些設計最適合大便失禁,或哪些特殊的設計與皮膚健康有關。使用不同的設計產品(為晝 /夜,或戶外/室內做不同設計)可能會更有效,更便宜,相較於一直使用單一設計產品。