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.
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.
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.
To assess the effectiveness of the different types of absorbent product designed for moderate-heavy incontinence.
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.
All randomised or quasi-randomised trials of absorbent products for moderate-heavy incontinence.
Two review authors assessed the methodological quality of potentially eligible studies and independently extracted data from the included trials.
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.