This article discusses the importance of considering sustainability when selecting/recommending incontinence management solutions. It is estimated that 14 million men, women, young people and children of all ages are living with bladder problems. 1 in 10 of the population are affected by faecal incontinence. Over half a million adults suffering from faecal incontinence. Urinary and faecal incontinence are conditions affecting one in three people living in residential care. As well as, two in three nursing home residents.

Anyone of any age or with any medical condition who has a continence problem should seek healthcare professional support and advice. Often there solutions to resolve the problem or reduce the impact. However, for some, achieving continence is not possible, so effective containment is vital to quality of life, independence, dignity and self-esteem. 

We are all aware of the importance in reducing our climate footprint. How can we be more sustainable when it comes to incontinence products?

Sustainable healthcare is a major goal both worldwide and for the NHS. Single-use products are a key contributor to plastic waste (Sustainable Development Unit, 2020). Incontinence management is heavily dependent on single-use products; many of which contain non-biodegradable materials including plastics. These include urinary drainage sheaths and catheters as well as containment products. NHS Inform (2020) estimates that three million to six million people in the UK experience urinary incontinence and that demand for containment products is likely to rise because risk factors for incontinence are increasing. These include advancing age, lifestyle factors, dementia, neurological conditions, complex comorbidities and obesity.

A more sustainable approach to containment product provision currently depends on a reduction in use of single-use products and their substitution with reusable alternatives. There are advantages and disadvantages to both washable (reusable) and single-use products. A ‘mix and match’ approach is key.

For many people, the introduction of washable products may be acceptable. However, some will only be able to manage these in combination with other single-use versions for specific times of the day. Working towards strategies for sustainability in continence care; such as reduce, reuse, recycle – requires a thorough understanding of the lifecycle of products and associated processes. This is the responsibility of us all. This includes product manufacturers, policymakers, purchasing agencies, prescribers, researchers, health professionals and end users.

Both cloth and disposable containment products have environmental impacts. Some of these include: the consumption of natural resources, energy usage, health issues, air and water pollution and waste disposal. However, the damaging impact from cloth containment products is less than that of disposable containment products.

Disposable containment products are usually made with wood pulp, oil and plastics. Cloth products are often made of cotton or other natural fibres. Choosing cloth instead of disposable containment products represents a significant way to reduce oil and tree consumption.

Billions of containment products end up in landfills and an estimated three billion disposable containment products are thrown away every year in the UK. This accounts for 2-3% of all household waste, according to recycling charity WRAP. Methane is released into the air during the decomposition of disposable containment products. This contributes significantly to global warming. Disposable containment products have a negligible recycling rate. The absorbent gels and plastic components found in disposal containment products take up to 500 years to decompose.

For the millions of people who are affected by incontinence, management products are an important part of their lives and ensure dignity, self-esteem and allow them to continue with their usual activities

Washable incontinence underwear is largely produced from natural materials such as cotton or bamboo, biodegradable and renewable resources. A pack of seven washables can be used up to 250 times per pair – lasting about two years at very low cost. Therefore, healthcare providers can save significant amounts of money each year and increase sustainability by sensibly switching to washables for the right patients according to a good clinical care pathway.

Washable pants may provide adequate absorbency during the day for some patients who have light to moderate bladder leakage, or those who experience only occasional light leakage (perhaps just after urinating) and want some form of protection “just in case”. They are very good at staying in place and are relatively discreet. They may be the best solution for those who are physically active. Overnight use of washable containment products may be better suited for men and women who sleep on their backs with light leakage. When selecting washable containment products, it is important to consider whether they are the right size, the right absorbency, and whether the patient and/or their carers/relatives can manage them.

Most washable containment underwear for adults is adapted to fit either male or female anatomy. With more padding at the front for men and more padding in the middle for women. There are a diverse range of styles available, ranging from classic briefs to boxers for men and full cut pants through high leg, lace and mid-rise to bikini styles for women. Similarly, for children there are pant and boxer styles available.  

The garment should be washed once before using. Underwear can be washed in a normal wash cycle without bleach or fabric softener. The garment must be fully dry before it is worn.

In a care home setting, it can be useful to label underwear with indelible ink. It may also be helpful to put the used product into the washing machine in a net bag to ensure easy identification.

To conclude, sustainability is vitally important to us all. The NHS is the first health service in the world to commit to reaching carbon net zero. This is in hopes to address the increasing threat to human health of climate change.  All those with an interest in continence care should be adopting solutions that maintain the dignity, independence and quality of life of patients while reducing the reliance on disposable single-use containment products.


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