How to choose and fit pads, protective underwear and briefs for best results
by Ken Edmunds

Six billion miles—this is one estimate on how many miles home health caregivers travel each year to see Americans over 65 who need assistance in their homes.

Approximately 70 percent of Americans are over 65, and upwards of 40 percent of this group live with incontinence. I was never very good at story problems in math class, but I bet this equates to incontinence care spinning the caregiver’s odometer upwards at roughly the speed of light.

There are many ways to overcome or at least mitigate incontinence. Here’s a quick guide; we’ll refer to the person receiving care as the client.

Selecting the Type of Incontinence Product

Below are the three basic types of disposable incontinence product choices appropriate for either permanent or transient (temporary) incontinence.

1. Briefs: This is a body-worn product featuring some type of tab as the closure system. Often still referred to as diapers (although the term briefs is more widely embraced by clients), this product option tends to be for the more severe levels of incontinence and is appropriate for either bladder or bowel incontinence. Look for different absorbency levels along the lines of a “good–better–best” array.

2. Disposable protective underwear: This is also a body-worn product featuring an elastic waistband as the closure system/means of staying in place. Often called pull-ups, this product option tends to be for the more ambulatory client generally not experiencing daily episodes of bowel incontinence. This product is appropriate in bladder incontinence or intermittent bowel incontinence. Again, look for different absorbency levels.

3. Pads/Liners: This product is held in place by either the client’s own underwear, a “fixation” pant (spandex-like shorts made for the specific purpose of holding a liner in place), or a body-worn incontinence product. This product is appropriate for light bladder incontinence, but many of the larger style pads/liners can be used to address more severe bladder leakage or bowel incontinence. Different absorbency levels are usually defined by dimensions (larger=more absorbent).

There are other types of disposable incontinence products, but these three basic categories tend to be the most widely used.

Selecting the Size of the Incontinence Product

Improper sizing ranks among the top three reasons that body-worn products leak. A waist range is published on the packaging so that the client or their caregiver can measure the waist and make the appropriate size selection.

Choosing the right size is not always as simple as taking measurements. Each person has a unique body style that does not necessarily follow perfect height/weight proportions. For example, men tend to get a larger tummy as they age. At the same time, the upper thigh seems to shrink past middle age. A male client might measure as a size large around the waist and a size medium around the upper thigh area. The best strategy is to accept the waist measurement as a key indicator of proper sizing, but remember that it is not the only clue.

If your client’s condition is appropriate for using a pad, and they are comfortable with it, you can determine the appropriate size of the pad by the amount of leakage escaping the bladder. In general, the larger the pad, the more leakage the pad can handle.

For Best Results

Pads are generally the easiest to use and when applied without assistance help satisfy a client’s need to maintain as much independence as possible.

Protective underwear application is slightly more difficult. A common mistake is putting the product on backward. Protective underwear designates the front and back (the back a little higher than the front). Other visual cues and the dimension tell are used. Look for a printed indicator or a color-coded approach.

With briefs, sizing is truly critical. Because the brief is not an elastic, stretchable product, there is less forgiveness on sizing. In terms of application, the brief has three options and corresponding instructions:

  • Brief applied while client is seated
  • Brief applied while client is standing
  • Brief applied while client is lying down

Brief application options are largely determined by:

  • Degree of ambulation of client
  • Degree of acuity of client
  • Degree of cooperation of client

General tips for using incontinence products:

  • Always check to make sure the wetness indicator is aligned with the client’s spine.
  • Always angle the tabs downward when applying to the backsheet.
  • Pull looser skin in the inner/upper thigh area out of the product so it is not bunched up underneath the product.
  • A snug but comfortable fit is the goal around the waist.
  • A snug and secure fit is the goal around the legs (where leakage is most likely to occur).

Don’t forget skin care. The perineal area and entire area covered by the product are most at risk. Most of the time, red and irritated skin is a consequence of friction (usually poor fit/sizing) or urine against the skin (inadequate absorption and/or poor fit).

During changes, use a gentle and disposable wet wipe as opposed to warm water and a washcloth (these can become abrasive after a few washes). Always wipe from front to back—away from the genitals. Barrier creams and sprays are effective; apply in a moderately thin coat.

Coping with bladder and/or bowel incontinence can be a challenge for both clients and caregivers. Educating yourself about incontinence products is a good first step toward using the products effectively to meet your patient's needs.