Body Worn Absorbent Product Guide

INTRODUCTION

Despite recent advances in multiple areas of continence management including pharmacotherapy, surgery, physiotherapy, and neuromodulation, evidence suggests that use of incontinence products remains the most prevalent strategy among adults with urinary or fecal incontinence. To address this gap, the WOCN Society developed an evidence- and consensus-based algorithm for selection, use, and evaluation of body worn absorbent products for the management of individuals with urinary and/or fecal incontinence. This algorithm will help to fill the gap in resources available for first-line and WOC specialty practice nurses guiding optimal use of these products.

To learn more about the algorithm’s development, we invite you to read the accompanying article, “Assessment, Selection, Use, and Evaluation of Body Worn Absorbent Products for Adults With Incontinence: A WOCN Society Consensus Conference”, published in Journal of Wound, Ostomy and Continence Nursing: May/June 2018 - Volume 45 - Issue 3 - p 243–264.

Use

• Use a structured skin care regimen based on principles of cleanse, protect, restore to maintain optimal skin health.
  • Select a skin cleanser with a pH close to the acid mantle of healthy skin (pH balanced), cleanse using a soft cloth and gentle technique, consider use of a no-rinse skin cleanser.
  • Apply an ointment, cream or polymer-based skin protectant as indicated.
  • Consider application of emollient-based leave-on product to restore moisture barrier function of the skin.
• When using an ointment or cream-based skin protectant consider frequency and quantity of product application and its potential to clog and impair absorbent capacity.
• Avoid application of corn starch or talc, and shaving, which have not been found to reduce odor or optimize skin health.
• The use of unbreathable plastic outer layer or rubber pants to protect outer clothing or mattress is not recommended.

Evaluation

Categories for evaluating products

• Containment: Leakage from beneath or around the product.
• Odor: Patient's perception of odor; and others' ability to perceive odor when in immediate vicinity of user (less than 5 feet from user); versus 5 feet or greater of user.
• Perigenital skin health:
  • Presence and severity of IAD
  • Presence and severity of intertriginous dermatitis
  • Pressure injury
  • Chaffing and friction injury especially at waist and elasticated leg bands
• Ask user and caregivers about satisfaction with product: containment, odor, wet comfort, noise, discretion when worn under clothing, fit, cost

Indications for Referral

• Inability to fit a body worn absorbent product (BMI, atypical body habitus)
• Failure of two products after 7-day trial (repeated containment failure)
• Development of perigenital skin damage that does not respond to structured skin care program within 7 days or rapid deterioration of perigenital skin
• Preexisting perigenital wound or vascular access device

Indications for Referral

• Failure of two products after 7-day trial (repeated containment failure)
• Development of perigenital skin damage that does not respond to structured skin care program within 7 days or rapid deterioration of perigenital skin
• Preexisting perigenital wound or vascular access device
• Inability to fit a body worn absorbent product (BMI, atypical body habitus)

Incontinence present?

Additional Assessments

Assess Severity

Assess incontinence type

Gender

Timing

Ambulatory

Toiletable

Result

Use of body worn absorbent products is contraindicated in patients who are continent. Their use may impair continence status.

Result for Light, Fecal, Male/Female

Regardless of gender, disposable products are positioned over anus and between the buttocks.

When selecting products, consider the following:

• Consider contour, shape and other design elements to maximize effectiveness and comfort.
• If absorbent products become inadequate for containment or bothersome, consider use of pull ons.
• Comfort
• Containment effectiveness (absorbent capacity, location of absorbent surface, elastication and elastic leg gathers)
• Odor control
• Skin protection (pH, breathability/breathable side panels, pressure redistribution properties)
• Aesthetics (noise control, absence of rustling, low profile beneath clothing, and other aesthetic elements such as color, design and appearance)

Change frequency:

• Limited evidence indicates that patients and clinicians found wait times greater than 15 minutes after the fecal incontinence episode unacceptable.
• Change times should be patient centered and not based on routine and caregiver convenience.

Result for Light, Urinary, Male, Daytime

Disposable pads (guards and shields): Consider contour shape and other design elements to maintain effectiveness and comfort.

DO NOT! Disposable menstrual pads are not recommended for use in males.

When selecting products, consider the following:

• Comfort
• Containment effectiveness (absorbent capacity, location of absorbent surface, elastication and elastic leg gathers)
• Odor control
• Skin protection (pH, breathability/breathable side panels, pressure redistribution properties)
• Aesthetics (noise control, absence of rustling, low profile beneath clothing, and other aesthetic elements such as color, design, and appearance)

Change frequency:

• Optimal change time after urinary incontinence varies based on urine elimination patterns, sleep-wake patterns, absorbent product properties, and perceptions of wet comfort.
• Change times should be patient centered and not based on routine and caregiver convenience.

Result for Light, Urinary, Female, Daytime

First line recommendation: Disposable incontinence pads (up to 100 mLs per pad)

When selecting products, consider the following:

• Comfort
• Containment effectiveness (absorbent capacity, location of absorbent surface, elastication and elastic leg gathers)
• Odor control
• Skin protection (pH, breathability/breathable side panels, pressure redistribution properties)
• Aesthetics (noise control, absence of rustling, low profile beneath clothing, and other aesthetic elements such as color, design, and appearance)

Alternative recommendation: Disposable menstrual pads (up to 15 mLs per pad) based on patient preference, acceptability and cost. Not designed for urine containment.

Change frequency:

• Optimal change time after urinary incontinence varies based on urine elimination patterns, sleep-wake patterns, absorbent product properties, and perceptions of wet comfort.
• Change times should be patient centered and not based on routine and caregiver convenience.

Result for Urinary/Fecal/Dual, Moderate/Heavy, Male, Daytime, Ambulatory

First line recommendation: Disposable pull ons with superabsorbent polymer technology.

Alternative recommendation: Disposable absorbent briefs with superabsorbent polymer technology.

When briefs or pull ons provide inadequate containment, consider addition of absorbent wrap or booster pad. Booster products or absorbent wraps should not be used for staff or caregiver convenience alone.

When selecting products, consider the following:

• Comfort
• Containment effectiveness (absorbent capacity, location of absorbent surface, elastication and elastic leg gathers)
• Odor control
• Skin protection (pH, breathability/breathable side panels, pressure redistribution properties)
• Aesthetics (noise control, absence of rustling, low profile beneath clothing, and other aesthetic elements such as color, design, and appearance)

Change frequency:

• Limited evidence indicates that patients and clinicians found wait times greater than 15 minutes after the fecal incontinence episode unacceptable.
• Optimal change time after urinary incontinence varies based on urine elimination patterns, sleep-wake patterns, absorbent product properties, and perceptions of wet comfort.
• Change times should be patient centered and not based on routine and caregiver convenience.
• To minimize sleep interruption and maximize containment, booster pads or absorbent wraps may be used as an adjunct to briefs or pull ons.

Result for Urinary/Fecal/Dual, Moderate/Heavy, Female, Daytime, Ambulatory

First line recommendation: Disposable pull ons with superabsorbent polymer technology.

Alternative recommendation: Disposable shape pads with superabsorbent polymer technology worn with close-fitting underwear.

When pull ons provide inadequate containment, consider addition of booster pad. Booster products should not be used for staff or caregiver convenience alone.

When selecting products, consider the following:

• Comfort
• Containment effectiveness (absorbent capacity, location of absorbent surface, elastication and elastic leg gathers)
• Odor control
• Skin protection (pH, breathability/breathable side panels, pressure redistribution properties)
• Aesthetics (noise control, absence of rustling, low profile beneath clothing, and other aesthetic elements such as color, design, and appearance)

Change frequency:

• Limited evidence indicates that patients and clinicians found wait times greater than 15 minutes after the fecal incontinence episode unacceptable.
• Optimal change time after urinary incontinence varies based on urine elimination patterns, sleep-wake patterns, absorbent product properties, and perceptions of wet comfort.
• Change times should be patient centered and not based on routine and caregiver convenience.
• To minimize sleep interruption and maximize containment, booster pads may be used as an adjunct to pull ons.

Result for Urinary/Fecal/Dual, Moderate/Heavy, Female, Daytime, Nonambulatory, Toiletable

First line recommendation: Disposable pull ons with superabsorbent polymer technology.

Alternative recommendation: Disposable pad with close-fitting underwear.

When selecting products, consider the following:

• Comfort
• Containment effectiveness (absorbent capacity, location of absorbent surface, elastication and elastic leg gathers)
• Odor control
• Skin protection (pH, breathability/breathable side panels, pressure redistribution properties)
• Aesthetics (noise control, absence of rustling, low profile beneath clothing, and other aesthetic elements such as color, design, and appearance)

Change frequency:

• Limited evidence indicates that patients and clinicians found wait times greater than 15 minutes after the fecal incontinence episode unacceptable.
• Optimal change time after urinary incontinence varies based on urine elimination patterns, sleep-wake patterns, absorbent product properties, and perceptions of wet comfort.
• Change times should be patient centered and not based on routine and caregiver convenience.
• To minimize sleep interruption and maximize containment, booster pads may be used as an adjunct to pull ons.

Result for Urinary/Fecal/Dual, Moderate/Heavy, Female, Daytime/Nighttime, Nonambulatory, Nontoiletable

First line recommendation: Disposable briefs with superabsorbent polymer technology.

Use of absorbent products that are pulled up are not recommended in individuals who are bed-bound and non-toiletable.

When selecting products, consider the following:

• Comfort
• Containment effectiveness (absorbent capacity, location of absorbent surface, elastication and elastic leg gathers)
• Odor control
• Skin protection (pH, breathability/breathable side panels, pressure redistribution properties)
• Aesthetics (noise control, absence of rustling, low profile beneath clothing, and other aesthetic elements such as color, design, and appearance)

Change frequency:

• Limited evidence indicates that patients and clinicians found wait times greater than 15 minutes after the fecal incontinence episode unacceptable.
• Optimal change time after urinary incontinence varies based on urine elimination patterns, sleep-wake patterns, absorbent product properties, and perceptions of wet comfort.
• Change times should be patient centered and not based on routine and caregiver convenience.
• To minimize sleep interruption and maximize containment, booster pads may be used as an adjunct to briefs.

Result for Urinary/Fecal/Dual, Moderate/Heavy, Male, Daytime/Nighttime, Nonambulatory, Nontoiletable

First line recommendation: Disposable briefs with superabsorbent polymer technology.

Use of absorbent products that are pulled up are not recommended in individuals who are bed-bound and non-toiletable.

When briefs provide inadequate containment, consider addition of absorbent wrap or booster pad. Booster products or absorbent wraps should not be used for staff or caregiver convenience alone.

When selecting products, consider the following:

• Comfort
• Containment effectiveness (absorbent capacity, location of absorbent surface, elastication and elastic leg gathers)
• Odor control
• Skin protection (pH, breathability/breathable side panels, pressure redistribution properties)
• Aesthetics (noise control, absence of rustling, low profile beneath clothing, and other aesthetic elements such as color, design, and appearance)

Change frequency:

• Limited evidence indicates that patients and clinicians found wait times greater than 15 minutes after the fecal incontinence episode unacceptable.
• Optimal change time after urinary incontinence varies based on urine elimination patterns, sleep-wake patterns, absorbent product properties, and perceptions of wet comfort.
• Change times should be patient centered and not based on routine and caregiver convenience.
• To minimize sleep interruption and maximize containment, booster pads or absorbent wraps may be used as an adjunct to briefs.

Result for Urinary/Fecal/Dual, Moderate/Heavy, Male, Daytime, Nonambulatory, Toiletable

First line recommendation: Disposable briefs with superabsorbent polymer technology.

Alternative recommendation: Close-fitting underwear with integral pads (urinary only) or pull ons (all types).

When briefs or pull ons provide inadequate containment, consider addition of absorbent wrap or booster pad. Booster products or absorbent wraps should not be used for staff or caregiver convenience alone.

Disposable and reusable diapers for infants are not recommended for incontinence containment in men with urinary, fecal, or dual incontinence.

When selecting products, consider the following:

• Comfort
• Containment effectiveness (absorbent capacity, location of absorbent surface, elastication and elastic leg gathers)
• Odor control
• Skin protection (pH, breathability/breathable side panels, pressure redistribution properties)
• Aesthetics (noise control, absence of rustling, low profile beneath clothing, and other aesthetic elements such as color, design, and appearance)

Change frequency:

• Limited evidence indicates that patients and clinicians found wait times greater than 15 minutes after the fecal incontinence episode unacceptable.
• Optimal change time after urinary incontinence varies based on urine elimination patterns, sleep-wake patterns, absorbent product properties, and perceptions of wet comfort.
• Change times should be patient centered and not based on routine and caregiver convenience.
• To minimize sleep interruption and maximize containment, booster pads or absorbent wraps may be used as an adjunct to briefs or pull ons.

Result for Urinary/Fecal/Dual, Moderate/Heavy, Male, Nighttime, Ambulatory/Nonambulatory

A disposable brief with additional absorbent capacity designed for nighttime use.

When briefs provide inadequate containment, consider addition of absorbent wrap or booster pad. Booster products or absorbent wraps should not be used for staff or caregiver convenience alone.

When selecting products, consider the following:

• Comfort
• Containment effectiveness (absorbent capacity, location of absorbent surface, elastication and elastic leg gathers)
• Odor control
• Skin protection (pH, breathability/breathable side panels, pressure redistribution properties)
• Aesthetics (noise control, absence of rustling, low profile beneath clothing, and other aesthetic elements such as color, design, and appearance)

Change frequency:

• Limited evidence indicates that patients and clinicians found wait times greater than 15 minutes after the fecal incontinence episode unacceptable.
• Optimal change time after urinary incontinence varies based on urine elimination patterns, sleep-wake patterns, absorbent product properties, and perceptions of wet comfort.
• Change times should be patient centered and not based on routine and caregiver convenience.
• To minimize sleep interruption and maximize containment, booster pads or absorbent wraps may be used as an adjunct to briefs or pull ons.

Result for Urinary/Fecal/Dual, Moderate/Heavy, Female, Nighttime, Ambulatory

First line recommendation: Disposable pull ons with superabsorbent polymer technology designed for nighttime use.

Alternative recommendation: Close-fitting underwear with integral pads (urinary only), designed for nighttime use.

When selecting products, consider the following:

• Comfort
• Containment effectiveness (absorbent capacity, location of absorbent surface, elastication and elastic leg gathers)
• Odor control
• Skin protection (pH, breathability/breathable side panels, pressure redistribution properties)
• Aesthetics (noise control, absence of rustling, low profile beneath clothing, and other aesthetic elements such as color, design, and appearance)

Change frequency:

• Limited evidence indicates that patients and clinicians found wait times greater than 15 minutes after the fecal incontinence episode unacceptable.
• Optimal change time after urinary incontinence varies based on urine elimination patterns, sleep-wake patterns, absorbent product properties, and perceptions of wet comfort.
• Change times should be patient centered and not based on routine and caregiver convenience.
• To minimize sleep interruption and maximize containment, booster pads may be used as an adjunct to pull ons.

Result for Urinary/Fecal/Dual, Moderate/Heavy, Female, Nighttime, Nonambulatory

First line recommendation: Disposable briefs with additional absorbent capacity designed for nighttime use.

When briefs provide inadequate containment, consider addition of disposable booster pad. Disposable booster pads should not be used for staff or caregiver convenience alone.

When selecting products, consider the following:

• Comfort
• Containment effectiveness (absorbent capacity, location of absorbent surface, elastication and elastic leg gathers)
• Odor control
• Skin protection (pH, breathability/breathable side panels, pressure redistribution properties)
• Aesthetics (noise control, absence of rustling, low profile beneath clothing, and other aesthetic elements such as color, design, and appearance)

Change frequency:

• Limited evidence indicates that patients and clinicians found wait times greater than 15 minutes after the fecal incontinence episode unacceptable.
• Optimal change time after urinary incontinence varies based on urine elimination patterns, sleep-wake patterns, absorbent product properties, and perceptions of wet comfort.
• Change times should be patient centered and not based on routine and caregiver convenience.
• To minimize sleep interruption and maximize containment, booster pads may be used as an adjunct to briefs.

Result for Urinary/Fecal/Dual, Light, Male

Recommendations for light fecal male incontinence: Use disposable products positioned over the anus and between the buttocks.

Recommendations for light urinary male incontinence: Use disposable pads (guards and shields); consider contour shape and other design elements to maintain effectiveness and comfort.

DO NOT! Disposable menstrual pads are not recommended for use in males.

When selecting products, consider the following:

• Comfort
• Containment effectiveness (absorbent capacity, location of absorbent surface, elastication and elastic leg gathers)
• Odor control
• Skin protection (pH, breathability/breathable side panels, pressure redistribution properties)
• Aesthetics (noise control, absence of rustling, low profile beneath clothing, and other aesthetic elements such as color, design, and appearance)

Change frequency:

• Limited evidence indicates that patients and clinicians found wait times greater than 15 minutes after the fecal incontinence episode unacceptable.
• Optimal change time after urinary incontinence varies based on urine elimination patterns, sleep-wake patterns, absorbent product properties, and perceptions of wet comfort.
• Change times should be patient centered and not based on routine and caregiver convenience.
• To minimize sleep interruption and maximize containment, booster pads or absorbent wraps may be used as an adjunct to briefs or pull ons.

Result for Urinary/Fecal/Dual, Light, Female

Recommendations for light fecal female incontinence: Use disposable products positioned over the anus and between the buttocks.

First line recommendations for light urinary female incontinence: Disposable incontinence pads (up to 100 mLs per pad)

When selecting products, consider the following:

• Comfort
• Containment effectiveness (absorbent capacity, location of absorbent surface, elastication and elastic leg gathers)
• Odor control
• Skin protection (pH, breathability/breathable side panels, pressure redistribution properties)
• Aesthetics (noise control, absence of rustling, low profile beneath clothing, and other aesthetic elements such as color, design, and appearance)

Alternative recommendation for light urinary female incontinence: Disposable menstrual pads (up to 15 mLs per pad) based on patient preference, acceptability and cost. Not designed for urine containment.

Change frequency:

• Limited evidence indicates that patients and clinicians found wait times greater than 15 minutes after the fecal incontinence episode unacceptable.
• Optimal change time after urinary incontinence varies based on urine elimination patterns, sleep-wake patterns, absorbent product properties, and perceptions of wet comfort.
• Change times should be patient centered and not based on routine and caregiver convenience.
• To minimize sleep interruption and maximize containment, booster pads may be used as an adjunct to briefs or pull ons.