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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.

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.

Storage LUTS are highly influenced by behavioural traits, and correcting these is absolutely vital—all subsequent attempts at therapy may well fail if the basics are not properly addressed. The medications available are two main classes, the antimuscarinic drugs and a beta-3 adrenergic agonist. Antimuscarinics are well established and understood, but have significant side effects and limited efficacy which means most people stop taking them in a comparatively short time-frame. The beta-3 agonist is of comparable efficacy but generally has fewer side effects. Both drug classes have some specific contraindications. They can safely be used in combination for greater efficacy, and with no substantial increase in adverse effects. Refractory symptoms of overactive bladder may be treated with botulinum bladder injections if the patient has the aptitude and attitude to accept self-catheterization, which is needed in a minority. Sacral or tibial nerve stimulation are two established techniques which have rather differing profiles. For stress incontinence, surgical intervention is the main approach once conservative measures have properly been put in place. The operations for women are colposuspension, autologous sling and midurethral tape, but a major challenge is emerging for the latter as a result of problems from using mesh in vaginal surgery. For men, the interventions are artificial urinary sphincter or male sling. Major surgery is the only option if people still remain substantially symptomatic.

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.

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.

The 6th International Consultation on Incontinence met between September 13-15th 2016 in Tokyo and was organised by the International Consultation on Urological Diseases and the International Continence Society (ICS), in order to develop consensus statements and recommendations for the diagnosis, evaluation and treatment of urinary incontinence, faecal incontinence, pelvic organ prolapse and bladder pain syndrome.The consensus statements are evidence based following a thorough review of the available literature and the global subjective opinion of recognised experts serving on focused committees. The individual committee reports were developed and peer reviewed by open presentation and comment. The Scientific Committee, consisting of the Chairs of all the committees then refined the final consensus statements. These consensus statements published in 2017 will be periodically reevaluated in the light of clinical experience, technological progressand research.

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 2 scored domains: catheter function and concern (9 items) and lifestyle impact (3 items) and 4 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.

© 2018 Wiley Periodicals, Inc. 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.

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.

Aims This two phase study aimed to explore health care professionals' teaching and prescribing practice related to intermittent catheterisation and to identify their perceptions about the possible implementation of a mixed (single and multi-use) package for intermittent catheterization. Introduction Single-use intermittent catheters are the norm in the UK although multi-use is common in some other countries. A recent Cochrane review found no difference in complications, including urinary tract infection rates, between those using single or multi-use catheters. A flexible option of both multi-use and single use intermittent catheters could provide users with more flexible choices in self-care. However, understanding health care professionals' perspectives is one of the keys to developing a multi-use intervention. Design A qualitative research framework using in-depth interviews to inform an on line survey. Method In-depth interviews were conducted with health care professionals based in the UK who prescribe catheters, teach intermittent catheterisation or manage an intermittent catheterisation service. The interviewees were selected to represent a range of clinical areas, experience and professions − continence advisors, urology, multiple sclerosis (MS) and spinal cord injury specialist nurses, and General Practitioners. Following framework analysis the themes and factors identified were used to develop an on-line survey which was disseminated through health care professional networks whose members saw patients who use intermittent catheters. Results Nineteen health care professionals participated in the telephone interviews; 206 completed the survey. A wide range of professionals in terms of experience and specialty afforded rich information regarding the contextual issues around the teaching and prescribing of intermittent catheters. The primary finding was that health care professionals were concerned about ‘minimising health risk' and maximising ‘normalcy' for those using intermittent self-catheterisation. Health care professionals who worked in the acute setting or had no experience of re-use were most resistant to the re-use of catheters. Professionals requested evidence that a multi-use package would not increase the risk of developing a urinary tract infection or increase the burden of use to a patient before a mixed package would be considered. Conclusions For multi-use to be acceptable, evidence based guidelines must be available for healthcare professionals and cleaning methods must be acceptable and safe for intermittent catheter users. Further evidence may be required to establish that a mixed catheter package is equivalent to single use only, particularly for outcomes such as urinary tract infection, urethral injury and quality of life. Relevance to clinical practice This paper highlights that if multi-use catheters are to be successfully introduced into clinical practice, the ease of use, safety and effectiveness of the cleaning technique will need to be convincingly demonstrated by a range of well-defined users.

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. © 2012 John Wiley & Sons Ltd.

Although evaporimetry (the measurement of water vapour flux density from the skin) has often been used to study the impact on skin hydration of using products such as baby diapers and incontinence pads, it is difficult to interpret results and to compare data from different studies because of the diversity of unvalidated methodologies used. The aim of this work was to develop a robust methodology for measuring the excess water in over-hydrated skin and test it on volar forearm and hip skin which had been occluded with saline soaked patches. Three repeat measurements were made on the volar forearm and the hip of five young (31-44 years) and six older (67-85 years) women and moderately good within-subject repeatability was found for both skin sites for both subject groups. Measurements taken from the hip were significantly higher (P = 0.001) than those from the arm and had larger coefficients of variation (3.5-22.1%) compared to arms (3.0-14.0%). There were no significant differences between young and older skin, implying that women for future studies could be recruited without regard to age. This is the first time that a robust evaporimetric methodology for quantifying excess water in over-hydrated skin has been described and validated, and it will form a solid basis for future work.

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) 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 stratum corneum changes upon occlusion. From our measurements, we can solve the diffusion equations in the stratum corneum 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.

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. Neurourol. Urodynam

A new method for measuring the coefficient of friction between nonwoven materials and the curved surface of the volar forearm has been developed and validated. The method was used to measure the coefficient of static friction for three different nonwoven materials on the normal (dry) and over-hydrated volar forearms of five female volunteers (ages 18–44). The method proved simple to run and had good repeatability: the coefficient of variation (standard deviation expressed as a percentage of the mean) for triplets of repeat measurements was usually (80 per cent of the time) less than 10 per cent. Measurements involving the geometrically simpler configuration of pulling a weighted fabric sample horizontally across a quasi-planar area of volar forearm skin proved experimentally more difficult and had poorer repeatability. However, correlations between values of coefficient of static friction derived using the two methods were good ( R = 0.81 for normal (dry) skin, and 0.91 for over-hydrated skin). Measurements of the coefficient of static friction for the three nonwovens for normal (dry) and for over-hydrated skin varied in the ranges of about 0.3–0.5 and 0.9–1.3, respectively. In agreement with Amontons' law, coefficients of friction were invariant with normal pressure over the entire experimental range (0.1–8.2 kPa).

PURPOSE: This paper describes a project to develop and clinically evaluate a novel toileting device for women called the Noninvasive Continence Management System (NICMS). The NlCMS 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.

Aim: This study aimed to determine how the use and characteristics of absorbent products for incontinence impact on women's quality of life, and to examine the concept of ‘treatment effects’ in the context of pad use. Method: Key pad performance characteristics were identified from the literature and focus group work. Semi-structured interviews with 99 women with light incontinence were used to investigate the impact of pad use on women's quality of life, including both positive and negative ‘treatment effects’, and to rank pad characteristics by their importance. Results: Achieving effective and discrete containment of urine was the dominant factor impacting on women's lives. Sub-themes embraced physical effects, psychological impact and social functioning. The five pad characteristics ranked most important for day time use were: ‘to hold urine, to contain smell, to stay in place, discreteness, and comfort when wet. For night use discreteness was replaced by to keep skin dry’. High levels of reported anxiety were associated with perceived risk of poor pad performance, lack of discreteness and need for complex regimes for pad management. Conclusion: Insufficient attention has been paid to the balance between the beneficial and negative treatment effects of absorbent pads to date. Existing continence-related quality of life measures are not designed for conditions where change in symptoms is not an outcome measure. The study findings provide the basis for developing a more sensitive, patient-oriented, quality of life measure for pad-users which can aid product selection, new product development and inform future evaluative comparisons between products/products and treatments. Relevance to clinical practice. This paper illustrates the complex influence on quality of life caused by using absorbent pads to contain incontinence. It raises awareness of the importance of careful selection of the most appropriate pad for each individual to minimize unfavourable side effects, and the need for a new quality of life measure designed for pad-users.

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.

In fibre-optic evanescent wave absorption in spectroscopy and sensors, both meridional and leaky skew rays contribute to absorption of the evanescent wave. This paper presents a whole view of the absorption of evanescent wave in fibre-optic evanescent wave absorption spectroscopy and sensors. Results of this study show that previous models of evanescent wave absorption based only on meridional rays overestimates the absorption of fibre-optic evanescent wave absorption spectroscopy and sensors.

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.

Optical surface plasmon resonance (SPR) excitation can be theoretically depicted and discussed using Fresnel’s equations. However, Fresnel’s equations cannot explicitly give expressions to reflect the characteristics of SPR systems, especially in SPR optical waveguide and fibre-optic sensors. In this paper a mathematical model based on the approximation proposed by Kretschmann in bulk optics is presented to describe the characteristics of SPR optical waveguide and fibre-optic sensors. The results show that the model keeps high accuracy when used in the area close to the minimum reflection, at which the resonance condition is achieved. This model can be used to analytically estimate the performance of SPR optical waveguide sensors, and SPR fibre-optic sensors in meridional rays approximation.

The flow from line and point sources through an inclined fibrous sheet is studied experimentally and theoretically for wicking from a saturated region and flow from a constant-flux source. Wicking from a saturated line generates a wetted region whose length grows diffusively, linearly or tends to a constant, depending on whether the sheet is horizontal or inclined downwards or upwards. A constant-flux line source generates a wetted region which ultimately grows linearly with time, and is characterized by a capillary fringe whose thickness depends on the relative strength of the source, gravitational and capillary forces. Good quantitative agreement is observed between experiments and similarity solutions.Capillary-driven and constant-flux source flows issuing from a point on a horizontal sheet generate a wetted patch whose radius grows diffusively in time. The flow is characterized by the relative strength of the source and spreading induced by the action of capillary forces, gamma. As gamma increases, the fraction of the wetted region which is saturated increases. Wicking from a saturated point corresponds to gamma = gamma(c), and spreads at a slower rate than from a line source. For gamma < gamma(c), the flow is partially saturated everywhere. Good agreement is observed between measured moisture profiles, rates of spreading, and similarity solutions.Numerical solutions are developed for point sources on inclined sheets. The moisture profile is characterized by a steady region circumscribed by a narrow boundary layer across which the moisture content rapidly changes. An approximate analytical solution describes the increase in the size of the wetted region with time and source strength; these conclusions are confirmed by numerical calculations. Experimental measurements of the downslope length are observed to be slightly in excess of theoretical predictions, though the dependence on time, inclination and flow rate obtained theoretically is confirmed. Experimental measurements of cross-slope width are in agreement with numerical results and solutions for short and long times. The affect of a percolation threshold is observed to ultimately arrest cross-slope transport, placing a limitation on the long-time analysis.

Aim. The aim of this paper is to report a study to determine the effects of absorbent pads on the pressure-relieving properties of 'standard' and pressure management mattresses. Background. Pressure ulcers and incontinence often co-exist. There is a strong association between poor mobility and continence problems and patients using pressure management products are therefore also likely to be using absorbent pads. Methods. An instrumented articulated anthropometric phantom with simulated soft body 'tissues' in the gluteal and sacral areas was used as the 'subject'. The phantom was raised and lowered on to three mattresses (standard foam, visco-elastic foam and surface-cut foam) in three states: naked, wearing a dry pad (Tena Super, SCA Hygiene AB) and wearing a wet pad. The pressure mapping device Xsensor was used to record the distribution of pressure over the sacral and ischial areas of the phantom. Peak pressure was used as the primary outcome variable and 10 repeats were made on each mattress under each condition. Results. There were substantial and significant differences for all three mattresses in recorded peak pressures between the naked buttocks and the buttocks wearing a dry pad. There were no significant differences between measurements made using the dry vs. wet pad. Peak pressures frequently occurred over areas of pad folds. Additional testing showed that pads that were 'smoothed' by hand had significantly lower peak pressures than 'unsmoothed' pads. Conclusions. Absorbent pads have a substantial adverse effect on the pressure redistribution properties of mattresses. Pad folds appear to contribute to this effect, which can be ameliorated slightly by smoothing. Absorbent pad manufacturers should consider engineering pads that minimize disruption to pressure management. Further examination of continence and pressure management products is necessary to establish optimum combinations for nursing care.

Objective: The purpose of this pilot study was to evaluate the performance of reusable absorbent body-worn products for adults with moderate/heavy urinary incontinence, compare their performance with a group of equivalent disposable products, and establish the need for a larger statistically robust study. Setting and Subjects: Ten men and 4 women living in the community were recruited from locations throughout the United Kingdom. Methods: A randomized multiple crossover design was used in which all subjects were given the opportunity to test each product. All the products were available on the UK market in January 2001. The following tools were used in the evaluation: a product performance questionnaire and a pad leakage diary. Overall opinion was used as the primary outcome indicator. Results: The reusable Paddy T was the best performing product overall, outperforming the disposable products. For low leakage and good absorbency (the most important product attributes identified by the subjects), the disposable all-in-one product performed best during the day. However, the Paddy T performed best for night use. The remaining reusable products performed poorly overall. Conclusions: Reusable products for moderate/heavy incontinence remain unpopular for use in isolation. Surprisingly, a product manufactured from terry toweling, a traditional material, performed relatively well. Reusables may provide a useful alternative to disposable products in certain circumstances. The results from this study do not support a more comprehensive costly study.

OBJECTIVE: To evaluate all disposable pull-up-style pads (pull-ups) designed for children with learning and or physical disabilities and compare these with a representative sample of disposable diapers (diapers). DESIGN: A multicenter randomized crossover trial where all children evaluated each product. SETTING AND CHILDREN: A total of 61 community dwelling children with disabilities were recruited from 5 areas throughout the United Kingdom. Families were invited by letter to participate through their local clinical nurse specialist for continence care. INSTRUMENTS: Instruments used included a range of questionnaires (product performance, design performance, and design preference questionnaires) and pad weight and leakage diaries. METHODS: The children tested 10 products (5 pull-ups and 5 diapers) for up to 1 week per product both at home and at school. Caregivers (parents and guardians) completed the questionnaires after evaluation of individual products and design groups had been completed. They recorded wet product weights and scored pad leakage at each pad change. School staff completed an abbreviated product performance questionnaire for each product. RESULTS: There was little difference in the overall performance of the pull-ups compared with the diapers. In the pull-up group, one product performed significantly worse than the others for some performance aspects. Pull-ups worked particularly well for children able to assist with toileting and pad changes. Diapers were liked for ease of changing if the child used calipers, adapted footwear, or trousers. Diapers were more popular than pull-ups for night use, when greater absorbency was required. Neither design performed differently for school or home use. Most caregivers expressed a preference for diapers or pull-ups based on a range of individual needs, for example, level of independence in toileting, discreteness in pad change, fit, and product appearance. CONCLUSIONS: Diapers and pull-ups have different strengths and limitations, and both meet the specific needs of individual children. Although pull-ups are more expensive than diapers, their use is justified if based on a thorough assessment of individual need.

The use of validated computational models to predict liquid spreading in fibrous materials is an important tool for understanding and optimising the function of absorbent products. The aim of this paper is to review these modelling strategies and their limitations. Experimental methods to find the closure relationships required as an input into Richards' equation (which describes the fluid transport in porous materials) are discussed. The computational models are validated against the detailed laboratory experiments of the flow of fluid from sources on inclined or horizontal homogeneous fibrous sheets, and are extended to inhomogeneous layered structures. Recent progress towards modelling simple incontinence products is described.

The paper considers comparative studies in which subjects use more than one product or receive more than one treatment. The paper is focused mainly on the comparison of products, including the possibility of a large number of products. The data to be analysed are on a binary variable that is observed by each subject for each product used. The calculation of the number of subjects or sample size is illustrated for a variety of basic study designs, assuming that the data may be correlated and the analysis of the data uses generalized estimating equations methodology. The sample sizes use asymptotic theory developed by Liu and Liang. A simulation study that evaluates some of the resulting sample sizes suggests that these need to be increased slightly to achieve the nominal power.

The use of nuclear magnetic resonance to make quantitative measurements of the absorption processes occurring in the constituent materials of disposable incontinence pads was investigated. Modern incontinence pads often have a layered structure with the absorbent layer principally consisting of superabsorbent polymer (SAP) grains distributed in fluffed wood pulp. T 2-weighted and magnetisation transfer contrast (MTC) measurements were made using samples of SAP, fluffed wood pulp, and a mixture of 50% SAP and 50% fluffed wood pulp following the addition of water and NaCl solutions. The T 2-weighted signal always decreased on mixing the liquid and material samples, with SAP showing the smallest magnitude of signal decline. The MTC change was minimal for SAP, but increased for the other samples. The small changes in the T 2-weighted signals and the MTC observed when adding water to SAP indicate that water is not principally being tightly bound by the polymer. The absorption time-course was further evaluated by acquiring proton-density-weighted 1D profiles after the addition of water to the samples. In SAP, the fitted time constant was comparable to the activation energy measured by other methods. The relaxation times both declined on mixing the liquids with samples of SAP and fluffed wood pulp. The reduction in spin–spin relaxation is sufficient to account for the T 2-weighted signal changes.

The ability of ISO 11948-1 (the Rothwell method) to predict the leakage performance of disposable bodyworn pads for heavy urinary incontinence was investigated by measuring correlations between models based on clinical evaluations of 138 diapers and inserts (the two major design categories), and technical models based on their Rothwell absorption capacities and design features. Correlations were poorer than in the original 1993 study for the standard (r less than or equal to 0.87 compared with r less than or equal to 0.95), but still strong enough to help with purchasing choices.For a given Rothwell capacity, the leakage performance of diapers was far superior to inserts; for example, diapers containing 450 and 300 g of urine performed, as well as inserts containing 300 and 100 g, respectively. No evidence was found for any other design feature having a significant impact on leakage performance. The coefficient of variation for Rothwell capacity (a measure of product consistency) had significant impact on the leakage performance of diapers, but not inserts. The probability of diapers with the poorest consistency leaking exceeded that for the best by about 10 percentage points. Similarly, diapers were about 10 percentage points more likely to leak when used at night than during the day. Differences between day-time and night-time use of inserts were not studied. (C) 2003 IPEM. Published by Elsevier Science Ltd. All rights reserved.

Objective: To evaluate the current range of hydrophilic-coated catheters for intermittent self-catheterization, focusing on the adherence of the catheter to the urethral mucosa at the end of catheterization. Subjects and methods: In a prospective randomized study, 61 community-based men tested each of four different hydrophilic-coated catheters available in the UK at the time. Subjects used each of the four test catheters for 1 week in a random order, and were provided with the number and size of catheter they normally used. To assess the products, the subjects: (i) timed seven catheterizations using a stop-watch to determine the time taken from extracting the catheter from the water-filled package, to removing the catheter from the penis, having emptied the bladder; (ii) recorded the severity of 'sticking' on catheter removal on a three-point scale (not at all, a little, a lot); and (iii) completed a product-performance questionnaire. Results: There were no significant differences in ratings of 'sticking' between the 'Easicath' and 'Lofric' (P > 0.05), but there were significant differences between these two products and the 'Aquacath' and the 'Silky', which were found to 'stick' more (P Conclusions: Adherence to the urethral mucosa on catheter removal was a common problem, occurring with all catheters, but two products were significantly more likely to stick than the other two. The clinical importance of 'sticking' and the long-term implications are currently unknown. The relative 'sticking' of uncoated catheters has also not been established.

Objective: To evaluate the full range of self-adhesive continence sheaths for men available in the UK and thus provide clinicians and consumers with a basis for product selection. Subjects and methods: Fifty-eight volunteers (aged 30–89 years) tested each of six different self-adhesive sheaths available in the UK in September 1998 for 1 week each. Thirty subjects applied the sheaths themselves and 28 subjects relied on a carer to do so. During each week subjects completed a diary recording sheath changes and the result of skin inspection, to note any unscheduled sheath changes (because of sheath detachment) and any skin problems. At the end of each week an 11-item questionnaire was completed using a three-point rating scale ('good', 'acceptable', 'unacceptable') to assess the key aspects of product performance. Results: A significantly higher proportion of subjects scored the 'Aquadry Clear Advantage' sheath as 'good' than four of the other sheaths (P Conclusions: There were substantial differences between products in their general performance and ergonomics, and for the frequency of detachment as recorded in the diary. The 'Aquadry Clear Advantage' was particularly successful and the 'Incare' particularly unsuccessful when compared with the other sheaths. Sheaths with no applicators were preferred to those with applicators. Applicators are mainly designed to make sheaths easier to put on, especially for carers, but there was no evidence that carers preferred applicators. This may have implications for manufacturers.

Selecting continence products for an individual patient or hospital contract is often a daunting task. This article describes the evaluation process developed for a program of government-funded multicenter evaluations of continence products established in the United Kingdom to provide an evidence base for product selection. The essential requirements of an evaluation are discussed, together with the methodologic and statistical issues that such evaluations present. The strengths and limitations of multicenter trials are examined and suggestions are made regarding other areas of nursing in which this approach could be usefully adopted.

The relationship between the wet comfort of small disposable incontinence pads and their absorption capacity and rewet properties is studied by asking twenty lightly in continent women to test a range of experimental pads. In Experiment 1, testers use a random mix of three pad variants, log the time at which they put on and take off each pad, and score it for leakage performance, wet comfort, and absorbence using a three point scale ( Good, OK, Poor). Used pads are weighed and pad performance is studied as a function of urine weight, wear time, and put-on time. In Experiment 2, testers are asked to compare the overall performance and leakage performance of different pairs of pad variants, having used each for a week. As expected, pads with high absorption capacity and low rewet work best, but differences are smaller than conventional wisdom would have predicted and often fail to reach statistical significance.

Purpose: The wet comfort of small, disposable incontinence pads has been found to correlate strongly with overall acceptability. This study examined the relationship between pad properties (absorption capacity, strike-through, and wetback) and wet comfort. Design: A group of women with light incontinence were asked to report on the wet comfort of a series of experimental pads made up to the same design geometry but in different combinations of materials. Methods: Three different pad variants were selected, and two experiments were conducted. Experiment 1 used a single-blind design in which 20 testers were supplied with a random mix of the three unlabeled pad variants. All pads were saved for weighing and scored for overall performance, wet comfort, and absorbency. In experiment 2, subjects used each pad variant in turn for 1 week and at the end of each week compared that pad with the one used the previous week. Main Outcome Measures: Absorption capacity, wetback, and strike-through properties for each pad variant were measured in the laboratory setting, and wet comfort was measured by a written tool completed by participants during clinical trials. Results: Data analysis from experiment 1 revealed statistically significant differences among pad variants, particularly when assessed for absorbency. Differences for wet comfort were less marked and only achieved significance when those with ratings of good or OK for wet comfort were compared with those with a score of poor. In experiment 2, no statistically significant differences were found for wet comfort. Conclusions: Overall, the improvement in wet comfort achieved by a substantial increase in absorption capacity and reduction in wetback were disappointing. The relatively small sample and the design specifications of the pad may have masked differences. Cost considerations mean that more evidence is needed to justify the inclusion of more expensive materials and production stages in the manufacture of small pads.

Catheter valves are an alternative to lee balls for urine drainage, but no studies have yet been published which have compared the performance of different valves. This study was undertaken to evaluate the performance of the seven catheter valves available on the UK market in April 1996. The study was carried out by the Continence Products Evaluation (CPE) Network funded by the Medical Devices Agency (Department of Health). Each valve type was tested for 1 week by 19–36 cognitively unimpaired and manually dextrous subjects recruited from 11 test centres. At the end of each week, subjects completed an evaluation form (based on a three-point rating scale) to record product performance. The same catheter valves were also tested for ease of opening/closing by 33 subjects (mostly catheter users) who had some manual impalnnent. Performance scores varied widely between products. It was found that, to be successful, a valve needs to be easy to manipulate, leak-free, comfortable and inconspicuous. Prescribers need to be aware of the strengths and limitations of different valves for appropriate product selection.

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 (R2>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.

Incontinence pad wearers often suffer from sore skin, and a better understanding of friction between pads and skin is needed to inform the development of less damaging materials. This work investigated friction between a skin surrogate (Lorica Soft) and 13 nonwoven fabrics representing those currently used against the skin in commercial pads. All fabrics were found to behave consistently with Amontons' law: coefficients of friction did not differ systematically when measured under two different loads. Although the 13 fabrics varied considerably in composition and structure, their coefficients of friction (static and dynamic) against Lorica Soft were remarkably similar, especially for the ten fabrics comprising just polypropylene (PP) fibres. The coefficients of friction for one PP fabric never differed by more than 15.7% from those of any other, suggesting that the ranges of fibre decitex (2.0–6.5), fabric area density (13–30 g m−2) and bonding area (11%–25%) they exhibited had only limited impact on their friction properties. It is likely that differences were largely attributable to variability in properties between multiple samples of a given fabric. Of the remaining fabrics, the one comprising polyester fibres had significantly higher coefficients of friction than the highest friction PP fabric (p < 0.005), while the one comprising PP fibres with a polyethylene sheath had significantly lower coefficients of friction than the lowest friction PP fabric (p < 10−8). However, fabrics differed in too many other ways to confidently attribute these differences in friction properties just to the choice of base polymer.

This chapter focuses on the current place of washable, textile-based absorbent products in the management of urinary incontinence. It opens by describing the principal categories of products available, summarises the functional requirements of users, and reviews the clinical literature to establish how well existing products meet current needs. It then reviews the very limited work that has been published to characterise the fluid-handling properties of such products in the laboratory and relates the results to clinical data. It concludes by focusing on future trends, suggesting where improved products are needed.

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.

Background: ncontinence 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

To compare the performance and cost-effectiveness of the key absorbent product designs to provide a more solid basis for guiding selection and purchase. Also to carry out the first stage in the development of a quality of life (QoL) instrument for measuring the impact of absorbent product use on users' lives.Three clinical trials focused on the three biggest market sectors. Each trial had a similar crossover design in which each participant tested all products within their group in random order. SETTING, PARTICIPANTS AND INTERVENTIONS: In Trial 1, 85 women with light urinary incontinence living in the community tested three products from each of the four design categories available (total of 12 test products): disposable inserts (pads); menstrual pads; washable pants with integral pad; and washable inserts. In Trial 2a, 85 moderate/heavily incontinent adults (urinary or urinary/faecal) living in the community (49 men and 36 women) tested three (or two) products from each of the five design categories available (total of 14 test products): disposable inserts (with mesh pants); disposable diapers (nappies); disposable pull-ups (similar to toddlers' trainer pants); disposable T-shaped diapers (nappies with waist-band); and washable diapers. All products were provided in a daytime and a (mostly more absorbent) night-time variant. In these first two trials, the test products were selected on the basis of data from pilot studies. In Trial 2b, 100 moderate/heavily incontinent adults (urinary or urinary/faecal) living in 10 nursing homes (27 men and 73 women) evaluated one product from each of the four disposable design categories from Trial 2a. Products were selected on the basis of product performance in Trial 2a and, again, day time and night-time variants were provided. The first phase of developing a QoL tool for measuring the impact of using different pad designs was carried out by interviewing participants from Trials 1 and 2a.Product performance (e.g. comfort, discreetness) was characterised using a weekly validated questionnaire. A daily pad change and leakage diary was used to record severity of leakage, numbers of laundry items and pads. Skin health changes were recorded weekly. At a final interview preferences were ranked, acceptability of each design recorded, and overall opinion marked on a visual analogue scale (VAS) of 0-100 points. This VAS score was used to estimate cost-effectiveness. In addition, a timed pad changing exercise was conducted with 10 women from Trial 2b to determine any differences between product designs.Disposable inserts are currently the mainstay of management for lightly incontinent women (Trial 1) and they were better for leakage and other variables (but not discreetness) and better overall than the other three designs. However, some women preferred menstrual pads (6/85) or washable pants (13/85), both of which are cheaper to use. Washable inserts were worse both overall and for leakage than the other three designs (72/85 found them unacceptable). For disposable inserts and disposable diapers, findings from the community (Trial 2a) and nursing home trials (Trial 2b) were broadly similar. Leakage performance of disposable inserts was worse than that of the other designs for day and night. Pull-ups were preferred over inserts for the daytime. The new T-shaped diaper was not better overall than the traditional disposable one. However, there were important differences in performance and preference findings for men and women from both trials. Pull-ups (the most expensive) were better overall than the other designs for women during the day and for community-dwelling women during the night. Although disposable diapers were better for leakage than disposable inserts (the cheapest), women did not prefer them (except in nursing homes at night), but for men the diapers were better both overall and for leakage and were the most cost-effective design. No firm conclusions could be drawn about the performance of designs for faecal incontinence. Nursing home carers found pull-ups and inserts easier to apply (in the standing position) and quicker (in the pad change experiment) than the diaper designs; the ability to stand was associated with preference for pull-ups or inserts. The T-shaped diaper was not easier or quicker to change than the diaper. The washable products (Trial 2a) gave diverse results: they were better for leakage at night, but were worse overall for daytime than the other designs. Three-quarters of the women (27/36) found them unacceptable, but nearly two-thirds of men (31/49) found them highly acceptable at night. Findings from the two community trials (Trials 1 and 2a) showed that there were many practical problems in dealing with washable products but, together with the less effective and less expensive products, such as menstrual pads, they were more acceptable at home (and, in the case of washables, at night). This suggests that cost-effective management may involve combining products by using more effective (for a given user) but more expensive designs (e.g. pull-ups) when out and less effective but less expensive designs when at home. The interviews examining the impact of pad use on QoL provided themes and domains that can be further developed into a tool for further evaluation of absorbent products.This study showed that there were significant and substantial differences between the designs of absorbent products and for moderate/heavy incontinence some designs are better for men/women than others. There was considerable individual variability in preferences and cost-effective management may best be achieved by allowing users to choose combinations of designs for different circumstances within a budget. Further research is needed into the feasibility of providing choice and combinations of designs to users, as well as into the development of more effective washables and of specifically male disposable products. QoL measurement tools are needed for users of absorbent products, as are clinical trials of designs for community-dwelling carer-dependent men and women with moderate/heavy incontinence.

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 leakage and protect their clothes. It can be difficult to define light urinary incontinence because urine volumes, flow and frequency rates may vary substantially whilst still being considered 'light'. Light incontinence may encompass occasional (monthly) leaks of very small amounts (e.g. 1 g to 2 g) up to frequent leaks (several times per day) of larger amounts (e.g. 20 g to 50 g). A practical definition is urine loss that can be contained within a small absorbent pad (typically 50 g to 500 g; ISO 1996). OBJECTIVES: To assess the effectiveness of different types of absorbent product designs for women with light urinary incontinence. SEARCH METHODS: We searched the Cochrane Incontinence Group Specialised Trials Register (searched 2 April 2009) and the reference lists of relevant articles were perused. SELECTION CRITERIA: Types of studies All randomised or quasi‐randomised trials of absorbent products for women with light urinary incontinence. Types of participants Women with light urinary incontinence. Types of intervention Absorbent products (disposable insert pads, menstrual pads, washable pants with integral pad, washable insert pads) suitable for light incontinence. DATA COLLECTION AND ANALYSIS: Two review authors assessed the methodological quality of potentially eligible studies and independently extracted data from the included trial. MAIN RESULTS: One study with 85 participants met the selection criteria. This trial studied all the absorbent product designs included in this review. Data were presented on all included outcomes. For preventing leakage, for preference and for overall acceptability disposable insert pads are better than disposable menstrual pads which are better than washable pants with integral pad which are better than washable insert pads. There is no strong evidence that either disposables or washables are better for skin health. The disposable insert is the most expensive design and there is no dominant design for cost‐effectiveness. There is evidence that some women will prefer alternative designs which are all cheaper than disposable inserts. AUTHORS' CONCLUSIONS: Although data were available from only one eligible trial the data were sufficiently robust to make recommendations for practice. Disposable insert pads are typically more effective than the other designs considered. However, because they are the most expensive, providing choice of designs (or combinations of designs for different circumstances) is likely to be cost‐effective.

Margaret Macaulay and colleagues describe the range of female urinals currently available, provide guidance on product selection and introduce a novel device designed to overcome some of the limitations of conventional urinals.

Aims This study compared the performance of the four main designs of absorbents for men with light incontinence: pouches (shields), leafs (guards), washable pant with integral pad (pantegral), and small disposable pad. Materials and Methods We did a multiple crossover trial. Men with light urinary incontinence were recruited. All pouches and leafs available in the UK were identified for inclusion. A single pantegral and small pad were selected based on previous evaluations for design comparison. Products were tested in random order for up to 1 week. Performance criteria (e.g., leakage and comfort) were rated using a validated product performance questionnaire. Wet product weights and amount of leakage were recorded in pad leakage diaries. Overall opinion for design performance was used as the primary outcome indicator. Results Seventy-four men tested six leafs, six pouches, one pantegral, and one small pad. Leakage data was taken from 3,386 wet pads. The pouches generally performed poorly with few significant differences between products. The leafs were more variable with large and significant differences in ratings. Overall the leaf, pantegral, and small pad designs performed significantly better than the pouch (P ? 0.01) and the pantegral design performed significantly worse than the leaf (P = 0.01). One leaf product was outstanding and performed significantly better than all other designs (P ? 0.001). Neurourol. Urodynam. 25:689-695, 2006. © British Crown Copyright 2006/DERA - Published with the Permission of the Controller of Her Majesty's Stationery Office. Conclusion This is the first published trial of absorbent products specifically designed for men. Results show that one particular leaf product works best, the pantegral is most suitable only for very light incontinence and the pouches are least successful.

A computerised real-time measurement system has been developed and tested for locating the position of the urine stream into a handheld urinal and onto a body-worn pad using arrays of resistive or optical sensors. Experimental data indicates that urine streams were usually scattered over quite a large cross-sectional area (typically 30 mm in the anterior/posterior direction) at the point of entry into handheld urinals. However, a correctly placed aperture of length 90 mm would have successfully received all the urine from the total of 36 clinical experiments run with seven women. Similarly, experiments to determine the initial position of the urine stream onto body-worn pads indicated that a target area of length 120 mm would have received the initial stream of urine from all 54 clinical experiments with 18 women. These data have been used to help with the design of a handheld urinal and a body-worn urine collection interface (the latter using the body-worn pad data) to be used in two variants of a new urine collection device for women (NICMS). Although both resistive and optical sensors provided useful data, the reliability of optical sensors was often compromised by droplets of urine splashing onto light sources or detectors. Future work should focus on protecting them from splashing.

ISO 11948-2--an international standard laboratory method developed to predict the leakage performance of small disposable pads for lightly incontinent women--was investigated. The repeatability and reproducibility (precision within and between laboratories, respectively) of two variants on the method were found to be poor. The coefficient of variation for each method variant in each laboratory (two laboratories ran each variant) was higher than 40% for about half the 12 products evaluated. Results differed by up to 94% between laboratories for a given product. The ability of the method to predict the leakage performance of pads was investigated by measuring correlations between the clinical evaluations of the 12 products, and technical evaluations using ISO 11948-2. Correlations were very weak (r < or= 0.487). Accordingly, it is recommended that 11948-2 is withdrawn. A second international standard method (ISO 11948-1)--developed for evaluating large pads, but sometimes used on small ones--was also investigated. Correlations between the clinical evaluations of the 12 products and technical evaluations using ISO 11948-1 were weak (r < or = 0.560). Accordingly, it is recommended that ISO 11948-1 is not used for evaluating small disposable bodyworn pads for women.