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A Journal on Physical Medicine and Rehabilitation after Pathological Events

Official Journal of the Italian Society of Physical and Rehabilitation Medicine (SIMFER), European Society of Physical and Rehabilitation Medicine (ESPRM), European Union of Medical Specialists - Physical and Rehabilitation Medicine Section (UEMS-PRM), Mediterranean Forum of Physical and Rehabilitation Medicine (MFPRM), Hellenic Society of Physical and Rehabilitation Medicine (EEFIAP)
In association with International Society of Physical and Rehabilitation Medicine (ISPRM)
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Europa Medicophysica 2003 June;39(2):101-10

language: English

Criteria for prescribing aids for the management of urinary incontinence

Benvenuti F. 1, Banfi R. 2, d’Ippolito P. 3, Cottenden A. 4, Mencarelli M. A. 1, Di Benedetto P. 5

1 Department of Geriatrics, INR­CA “I Fraticini”, Florence, Italy
2 Pharmaceutical Service, Azienda Sanitaria di Firenze, Florence, Italy
3 Institute of Gerontology ­and Geriatrics University of Florence, Florence, Italy
4 Departments of Medical Physics and Bioengineering/Medicine Continence Technology Group University College London, London, England
5 hysical Medicine ­and Rehabilitation Institute Medicine Department, Udine, Italy


The ­term “social ­continence” is ­used to ­describe ­the con­di­tion in ­which ­urine loss­es ­are con­tained, to ­ensure ­the dig­nity ­and ­hygiene of ­the ­patient ­and ­the liv­ing envi­ron­ment, by ­using ­aids ­applied to ­the indi­vid­u­al. The devic­es ­used ­may be exter­nal (absor­bent prod­ucts, exter­nal cath­e­ters) or inter­nal (Foley ­type cath­e­ters). An ­ideal ­anti-incon­ti­nence ­aid ­must be ­capable of sep­ar­at­ing ­the ­patient ­from ­his or ­her excre­ments with­out col­lat­er­al ­effects. However, no ­device ­exists ­that ­can ­offer ­these char­ac­ter­is­tics. All ­the prod­ucts ­used ­have ­both advan­tag­es ­and dis­ad­van­tag­es. The devic­es ­that ­ensure ­social con­ti­nence dis­guise but do ­not cure ­the prob­lem. Consequently, ­their inap­pro­pri­ate ­use ­tends to ­turn con­di­tions ­that ­would oth­er­wise be rever­sible if treat­ed, ­into chron­ic ­forms. This has heavy consequences both in terms of quality of life for the patients and of economic costs (for the National Health Service and families). We emphasize the importance of a targeted clinical assessment in patients wearing incontinence aids without having previously undergone an adequate evaluation. The clin­i­cal assess­ment is ­also essen­tial for choos­ing ­the ­type ­and the char­ac­ter­is­tics of ­the appro­pri­ate ­aid. This ­depends on a num­ber of fac­tors ­which ­must be care­ful­ly eval­u­at­ed: ­post-void residual volume, fre­quen­cy, severity ­and dai­ly ­rhythm of ­urine ­loss, co-exis­tence of ­fecal incon­ti­nence, capac­ity to ­use the toi­let ­and/or ­its sub­sti­tutes ­and/or ­the ­aid independently (this ­depends exten­sive­ly on ­the cog­ni­tive ­state, loco­mo­tion ­and man­u­al dex­ter­ity), life­style, moti­va­tion ­and col­lab­o­ra­tion, ­social sup­port, asso­ciat­ed pathol­o­gies ­and prog­no­sis, ­cost ­and pos­sibil­ity of pre­scrip­tion ­from The National Health Ser­vice. The ­aim of ­this arti­cle ­was to out­line ­the cri­te­ria ­for pre­scrip­tion on ­the ­basis of ­the evi­dence pre­sent­ed.

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