Back in 1987 when I first started using disposable adult incontinence products on a regular basis, it was very rare to be able to go more than 4-6 hours before needing a change, Leaks during the night were common and while better than sleeping without the incontinence products, linen changes while reduced were still often needed and plastic sheets or pads required. During the day the padding was quick to clump up and break apart offering little protection and many products at the time were a giant waste of time, money and a great source of stress, anxiety and sadly some very embarrassing moments. Often the best and only thing to do was to double up on the product to get more time between changes. However, even though doubling up on the product was often able to increase the time between changes two factors really made it hard to be able to go over 6 hours anyway and that was odor and skin breakdown! The products offered at the time had zero protection from the odor issue, PH balancing and other modern tricks did not exist so even if my protection was able to keep me “dry” odor sometimes gave my “condition” away. *If odor was not an issue for a particular day many products of the time did not do a great job of keeping moisture locked into the inner core of the products and away from the skin, which could lead to painful diaper rashes if worn for extended times.
It was not until early 2000’s that I found products that were capable of 8 hrs or longer use and much better at keeping moisture away from the skin these products were far from perfect they tended to clump up with movement and odor was still a real issue but still much better than many other products, but the costs of these products and availability for me often meant I was still needing to wear lesser products and “doubling-up” to get thru a day.
Fast forward to today.
Now, there are many products on the market that can easily absorb enough fluid technically to be worn over 24hrs! Many manufacturers claim 4,000 and even 6,000ml of absorptive capabilities and based on human fluid output averages and perfectly balanced hydration levels these products should be amazing! And often Are BUT,
Can you or should you wear a product so long? How often should they be changed?
There are a few things to take into consideration when deciding how often a product should be changed. The user, odor, skin health, and the products themselves.
The User:
Bodily functions vary day-to-day and person-to-person; a diary can help determine when and how often these functions occur. What the individual eats and drinks and the overall health will often likely play a role. Does the wearer have a food allergy that may cause diarrhea? Many foods can cause a strong odor; dehydration can affect both the frequency of urination as well as having a strong odor!
Knowing the individual’s incontinence levels and how much fluid on a typical wetting will help greatly in finding the proper product and how often you may need to change a product.
Odor:
Many things must be taken into account when dealing with odor and incontinence.
Generally, fresh urine does not have a strong odor however many things can affect odor,
Dehydration:
Dehydration concentrates the waste products in urine and tends to produce a strong Ammonia scent; the concentrated urine also irritates the bladder and can increase the number of accidents! Drinking water dilutes the irritants and reduces the odor!
Urinary tract infection:
Infections in the urinary tract can have a strong and foul odor, the bacteria can make urine smell unpleasant and cause it to be cloudy or bloody.
If your urine smells bad make sure to see a doctor to test for an infection!
Foods and drinks:
Many foods and drinks can make urine and stool smell bad, coffee, garlic, onion, asparagus, cabbage, lactose intolerance and many, many more are common causes for strong odors in urine and stools. But these are often on an individual basis; by doing a process of elimination you may discover foods that are safe for the user and reduce foul odors!
Diabetes can also have an effect on odor. Sweet or fruity odor is often associated with those with diabetes if the wearer was not diagnosed with diabetes but you notice a sweet or fruity odor you should check for diabetes!
When it comes to incontinence oftentimes the strongest and most unpleasant odor is the “stale urine smell” this comes when natural bacteria begin breaking down urea found in urine which produces ammonia, while this process can begin in the urinary tract it usually begins to become very strong within a few hours after contact with the air. Once the bacteria start this process the odor can become very strong. Changing wet absorbent pads is very important to reduce this odor however good Hydration is also key as the more diluted the urea in the urine is the less the bacteria have to breakdown!
Skin Health:
The health of the wearer's skin can play a big role how often an incontinence product should be changed, Contact to stool and moisture changes the PH of the skin and it begins to breakdown after the skin becomes irritated rashes and skin ulcers can begin to form.
Elderly, young children and several health conditions may cause the skin to be more sensitive and breakdown more easily.
Timely product changes, barrier creams, and skin conditioners are great tools to prevent skin breakdown.
Incontinence products:
Most disposable products have similar ways to absorb and lock in fluid but not all incontinence products are the same! Just because a product is able to absorb a great deal of fluid does not mean it is safe to wear for extended times!
The very most important item to check if a product is safe to wear for extended times is its top sheet! How quickly does it allow fluid to absorb into the padding?
How well does it keep moisture away from the skin?
We know that contact to moisture is bad for the skin so a dry top-sheet is critical.
We test products for this in our lab with a dry pad during our press-out test. We apply a dry pad to the top sheet after a 20-minute delay after each wetting to see how moist it becomes, the dryer the pad the better for the skin!
The Second most important piece is the ability to contain fluid and solids, features such as “Standing leak guards”, and “leg gathers” are critical in containing fluid and solids in the product and allow it to be absorbed into the core, but how well the absorbent material used to “Lock in” the fluid into the core varies from product to product.
Most disposable absorbent products use a combination of SAP (super absorbent polymer) and fiber material to lock moisture in. We test how well the products do in our lab with our press-out test by wetting a product and giving it a fair amount of time to absorb the fluid then apply pressure to find how well the fluid is locked into the “Core”.
Many products attempt to help contain odor by using the SAP and various chemical agents to change the PH of urine as well as other tricks known to them.
This works for many people but there are many factors involved with odor so they may or may not work for you. The simple fix is to change before the odor becomes strong.
What are our recommendations?
Based on my life experiences and lessons learned in our lab and in the world how often a product should be changed is very much an individual thing based on the things we wrote about earlier but I am able to lay down a few basic “rules” to go by.
Rule #1
A product should be changed as swiftly as possible after a bowel movement, Stool is very rough on the skin and most products cannot contain the odor. Even if using barrier creams, the quicker the removal of a soiled product the better for the wearer.
Rule #2
A product should only be worn as long as it can both absorb the wearer’s fluid output AND be able to keep the skin dry.
Rule #3
Typically urine does not have a strong odor, but once exposed to the air it can become strong after 4-6 hours, so it is safest to change wet products in this time frame, BUT if the odor is not an issue wearing a product for extended times is ok ONLY if it can pass rule #2
Rule #4
Only use a product that you trust and have tested capable of working for the wearer and know how long that product will work for them! Always try a new product at home for a few days before going out in public!
What about me?
After 32 years of wearing incontinence products, I mostly use “premium” products that CAN be used for up to 12 hours, but when I am out I always change in the morning, at lunch, sometimes after work and always before bed, basically every 6-8 hrs.
I change this often not because the products usually NEED to be changed but it is a safe way to avoid odor issues. However, on the weekends or at home I tend to change less often maybe every 8-10 hrs this helps me save a few pennies.
Why do I choose to use the products capable of 12hrs? Because life tends to throw things at us sometimes I don’t have the opportunity to change at lunch and wearing a product I personally trust that can keep me dry for much longer periods is a safety net!
And when it comes to living an active life with incontinence a good safety net is a good thing!
*edit we added a mention of skin issues to the opening of the blog.