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Incontinence - urinary, in women - Management
Should I recommend the use of absorbent pads or containment devices?
- Reserve the use of absorbent products for the following circumstances:
- To cope with urinary leakage whilst awaiting assessment and treatment.
- To contain leakage whilst awaiting response to ongoing treatment.
- For women with severe cognitive or mobility impairment that precludes further assessment or treatment.
- For long-term management only after all treatment options have been explored.
- If appropriate refer to a continence adviser or the district nursing service to enable provision of the most suitable daytime and night-time protection (such as pads).
- If the woman is keen to purchase an intravaginal or intraurethral device, advise that they may only be used occasionally to prevent incontinence (such as during physical exercise).
- Do not recommend the use of menstrual tampons for incontinence.
- Ring pessaries are not recommended.
Basis for recommendation
Absorbent pads
- The emphasis should always be on appropriate treatment [NPC, 1999]. Offering disposable pads prematurely can lead to psychological dependence on them and reluctance to accept active treatment [SIGN, 2004]. The National Institute for Health and Clinical Excellence (NICE) recognized that absorbent products, hand-held urinals, and toileting aids are options in women who do not wish to pursue active management but stressed that women must be fully aware of all the treatment options available in order to make a fully informed decision. NICE recommended that pads should be considered in women awaiting treatment [National Collaborating Centre for Women's and Children's Health, 2006].
- A Cochrane systematic review and a Health Technology Assessment found evidence that pads, particularly disposable insert pads, are effective in containing urinary leakage.
Referral for incontinence pads
Use of containment devices
- There is limited evidence of efficacy for the use of mechanical devices to prevent incontinence. NICE found limited evidence of efficacy for Contrelle® Activgard (formerly known as the Continence Guard or Conveen® Contiguard) and FemSoft® in the management of incontinence. Adverse effects, particularly urinary tract infection, are very common with the intraurethral device.
- Menstrual tampons used intravaginally may support the bladder neck and therefore prevent incontinence; however, there is no evidence to support their use. The manufacturers of these products state that they should be used only during menstruation.
Ring pessaries
- These are not recommended by NICE, as limited evidence does not support their use regardless of whether prolapse is present. However, some experts believe that ring pessaries are of benefit to some women and continue to fit or recommend them.
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