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Europa Medicophysica 2003 June;39(2):101-10

Copyright © 2003 EDIZIONI MINERVA MEDICA

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.