Prevalence of Incontinence  

This article discusses the importance of considering sustainability when selecting/recommending incontinence management solutions. It is estimated that 14 million men, women, young people and children of all ages are living with bladder problems. 1 in 10 of the population are affected by faecal incontinence. Over half a million adults suffering from faecal incontinence. Urinary and faecal incontinence are conditions affecting one in three people living in residential care. As well as, two in three nursing home residents.

Anyone of any age or with any medical condition who has a continence problem should seek healthcare professional support and advice. Often there solutions to resolve the problem or reduce the impact. However, for some, achieving continence is not possible, so effective containment is vital to quality of life, independence, dignity and self-esteem. 

We are all aware of the importance in reducing our climate footprint. How can we be more sustainable when it comes to incontinence products?

 Sustainability

Sustainable healthcare is a major goal both worldwide and for the NHS. Single-use products are a key contributor to plastic waste (Sustainable Development Unit, 2020). Incontinence management is heavily dependent on single-use products; many of which contain non-biodegradable materials including plastics. These include urinary drainage sheaths and catheters as well as containment products. NHS Inform (2020) estimates that three million to six million people in the UK experience urinary incontinence and that demand for containment products is likely to rise because risk factors for incontinence are increasing. These include advancing age, lifestyle factors, dementia, neurological conditions, complex comorbidities and obesity.

A more sustainable approach to containment product provision currently depends on a reduction in use of single-use products and their substitution with reusable alternatives. There are advantages and disadvantages to both washable (reusable) and single-use products. A ‘mix and match’ approach is key.

For many people, the introduction of washable products may be acceptable. However, some will only be able to manage these in combination with other single-use versions for specific times of the day. Working towards strategies for sustainability in continence care; such as reduce, reuse, recycle – requires a thorough understanding of the lifecycle of products and associated processes. This is the responsibility of us all. This includes product manufacturers, policymakers, purchasing agencies, prescribers, researchers, health professionals and end users.

Environmental sustainability

Both cloth and disposable containment products have environmental impacts. Some of these include: the consumption of natural resources, energy usage, health issues, air and water pollution and waste disposal. However, the damaging impact from cloth containment products is less than that of disposable containment products.

Disposable containment products are usually made with wood pulp, oil and plastics. Cloth products are often made of cotton or other natural fibres. Choosing cloth instead of disposable containment products represents a significant way to reduce oil and tree consumption.

Billions of containment products end up in landfills and an estimated three billion disposable containment products are thrown away every year in the UK. This accounts for 2-3% of all household waste, according to recycling charity WRAP. Methane is released into the air during the decomposition of disposable containment products. This contributes significantly to global warming. Disposable containment products have a negligible recycling rate. The absorbent gels and plastic components found in disposal containment products take up to 500 years to decompose.

For the millions of people who are affected by incontinence, management products are an important part of their lives and ensure dignity, self-esteem and allow them to continue with their usual activities

Introducing Washables Incontinence Underwear

Washable incontinence underwear is largely produced from natural materials such as cotton or bamboo, biodegradable and renewable resources. A pack of seven washables can be used up to 250 times per pair – lasting about two years at very low cost. Therefore, healthcare providers can save significant amounts of money each year and increase sustainability by sensibly switching to washables for the right patients according to a good clinical care pathway.

Washable pants may provide adequate absorbency during the day for some patients who have light to moderate bladder leakage, or those who experience only occasional light leakage (perhaps just after urinating) and want some form of protection “just in case”. They are very good at staying in place and are relatively discreet. They may be the best solution for those who are physically active. Overnight use of washable containment products may be better suited for men and women who sleep on their backs with light leakage. When selecting washable containment products, it is important to consider whether they are the right size, the right absorbency, and whether the patient and/or their carers/relatives can manage them.

Most washable containment underwear for adults is adapted to fit either male or female anatomy. With more padding at the front for men and more padding in the middle for women. There are a diverse range of styles available, ranging from classic briefs to boxers for men and full cut pants through high leg, lace and mid-rise to bikini styles for women. Similarly, for children there are pant and boxer styles available.  

Initial Preparation & Washing:

The garment should be washed once before using. Underwear can be washed in a normal wash cycle without bleach or fabric softener. The garment must be fully dry before it is worn.

In a care home setting, it can be useful to label underwear with indelible ink. It may also be helpful to put the used product into the washing machine in a net bag to ensure easy identification.

To conclude, sustainability is vitally important to us all. The NHS is the first health service in the world to commit to reaching carbon net zero. This is in hopes to address the increasing threat to human health of climate change.  All those with an interest in continence care should be adopting solutions that maintain the dignity, independence and quality of life of patients while reducing the reliance on disposable single-use containment products.

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Definition of sustainability: using resources responsibly so they are available for future generations, while doing as little harm to the environment as possible.

Urinary incontinence is a common problem, thought by the NHS to affect millions of people. If you or someone you care for has a continence problem, it’s important to see a medical professional as there are lots of options which can improve or eliminate the problem. However, this isn’t always possible, so whether we’re talking about the short or long term, using the correct products for incontinence management is vital for physical health, independence, and quality of life. 

So how can we combine greater awareness of sustainability with proper management of the condition?

Disposable products are the norm

‘Sustainable healthcare is a major goal both worldwide and for the NHS, where single-use products are a key contributor to plastic waste.”

Sustainable Development Unit, 2020 (UK Government Body)

Making incontinence products more sustainable

A more sustainable approach to incontinence management includes reducing the amount of single-use products, recycling, and finding longer lasting, multi-use alternatives.  Thankfully, there is innovation happening within this area.

Multi-use options include: 

•  Washable incontinence underwear: these can be washed and re-worn multiple times. 
•  Female bladder support devices: they are inserted into the vagina to support the bladder neck and can reused.  
•  Male urethral control devices: these are wrapped around the penile shaft to restrict urine flow.  
•  Male body worn urinal: they have an inner receptacle lining that drains urine from the penis and direct-connect leg collection bag. 

These options are more sustainable because they result in fewer products being thrown away and fewer products being produced in the first place. They can also be more cost-effective than the disposable products.  

Hygiene, comfort, and quality of life 

For people with continence difficulties, hygiene, comfort and quality of life are the priorities.

Appropriate use of the right product for the right person reduces the likelihood of skin irritation, dermatitis, rashes, skin infections and moisture lesions. It is also important to consider effective containment, lifestyle, maximising independence and personal preference.

Pros & cons of disposable pads 

• Disposable, single-use pads usually need to be changed several times during the day, when the pad reaches its absorbency capacity (some have a wetness indicator to guide changing), or is soiled.  This has a time and cost implication.  

• Disposable pads are often designed to reduce odour and lock urine and moisture away from the skin. Some new generation products have devices that alert an app when the product needs to be changed.  

• They come in many sizes and designs, meaning that there should be a product available for all levels of incontinence and different body shapes.  

• They are widely available.

• They are non-recyclable for hygiene reasons and are often made with non-biodegradable materials. 

Pros & cons of washable products  

• Washable products usually require a larger initial financial outlay.   

• They require individuals to have access to a washing machine, and appropriate facilities to dry them, such as a tumble drier, well-ventilated house, or access to outside drying.  This can be time consuming for the individual or their carers. 

• They have a reduced carbon footprint thanks to their multi-use nature: less production, and less waste. 

• New innovation means that a wider range of washable products are available. Like disposables they come in a range of sizes, designs and absorbencies which are discrete and effective.

• Washable products may be worn throughout the day and night, like disposable products. 

Most washable products are made from soft natural fibres, so are comfortable. 

Support to make the right decision

For the millions of people who are affected by incontinence, management products are an important part of their lives and ensure dignity, self-esteem and allow them to continue with their usual activities. 

There are lots of things to consider when deciding on the best option for anyone managing a continence issue. It is important to be aware that treatment is possible for many conditions.  Where this is not an option, or is not immediately possible, it is helpful to know that there are other products than just the disposable pad that has been available for many years. Happily, research and development continues to explore innovative and increasingly sustainable alternatives. 

Your healthcare professional can provide more advice, information and support

This article is part of the Education Spotlight on Urinary Incontinence, supported by iMedicare. You can also read more about constipation in our information library here.

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