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How much fluid does an incontinence pad hold?

Open Door - November 2006 pages 8-9

coffee cup in puddle of spilt coffee

We have all laughed with people in much loved sitcoms - for example Godfrey, from Dads' Army, needing "to be excused" at inappropriate moments, or Martin Crane, the father of Frasier, who admits to getting up in the night five or six times. "Hey", he says, "I'll have a coffee. Why shouldn't I have some fun too!" Comedy appropriately pitched - sensitively portrayed.

But what do we really think about hapless Mrs Emery, who wets herself in public places, as brought to our TV screens by Little Britain? Is this appropriate or sensitive? Sometimes its hard to see the funny side. But it's good to have a sense of humour.

When I was asked to contribute my thoughts to Open Door about my own experience of coming to terms with and then finding the solution to that almost taboo subject of urinary incontinence, I refused. Too embarrassing. Not funny, not really. Although as you will find out if you read on, laughter can be a more helpful response to what feels like a lack of compassion than say, getting angry or bursting into tears.

Owning up to the problem was the first step. Great! Professional and sensitive help on the way. Enter the incontinence nurse - oops, I mean continence adviser.

Initially all went well.

Some of you may know the routine:

  • filling in umpteen intake and output
  • fluid charts
  • drinking enough fluids to avoid getting infections but not so much that you need to go to the loo too frequently, drinking more in the earlier part of the day, cutting down fluid intake in the evening, you know the sort of thing
  • managing bowels to avoid both constipation and its opposite
  • ultrasound scan to determine how much residual urine there is after spending a penny - then learning how to empty the bladder properly. If larger amounts (more than 150 mls) remain, then intermittent self catheterisation (ISC) is recommended.
  • urodynamic tests
  • medications for treating an overactive bladder
  • occasional use of the hormone desmopressin that switches off urine production for up to 8 hours, via a nasal spray (very useful when travelling)

In short, you get a snapshot in time of your bladder function. Understanding the problem helps to manage it.

However, we all know that MS symptoms are continually changing. They may fluctuate from day to day or deteriorate gradually or both. So the snapshot doesn't necessarily help with making day to day adjustments or explain why it is that on some days more than others urine seems to appear out of nowhere. It seems to me that muscle spasms affect the bladder in the same way as they affect muscles in other parts of the body. This means that some days I need fewer pads than others. In any case, the downside of occasionally using desmopressin, is the need to void urine more frequently when its effects have worn off. Not to mention other reasons for needing to change a pad (such as menstruation). Unfortunately our bladders were not designed to be visible. Until we have transparent skin and muscle to be able to see through, we shall never know from day to day exactly what our bladders are doing. It's a perverse thing, the MS bladder.

Time passed by. I did all the things as advised - although it took me ages to conquer self catheterisation, and that despite having been a nurse. I had more or less given up drinking tea and coffee as well. But then my bladder became more unpredictable. When I could no longer get by with the management strategies I had learned to use and the pads you can buy in the local chemist or supermarket, I realised I needed more help. It was time to call in the expert - again.

It was a shock to discover that the continence adviser (I believe that some call this person the 'wet knickers nurse' too, although the 'puddles on the floor nurse' could be more apt) is ruled by the financial budget allocated for the purpose. One estimate suggests that pads account for 1/120th of the total cost of the NHS1. Money available versus professional judgement and patient comfort is not an uncommon issue within health and social care. It's also called prioritising. How tragic it seems to be so in the area of continence care, which is such a basic need.

I guess I was naïve. It seems that taking a pride in my appearance is not the issue. I was told I could have up to five pads of the correct size each day. The fact that I often used more was irrelevant. It seems that although pads are designed to absorb urine and present a 'feel-dry' surface to the skin, wet or soiled pads are best changed before they become saturated, to minimise leaks and the risk of skin damage2. Financial restraints dictate otherwise. According to the adviser's assessment, I was using the wrong size for my needs. Silly me, no wonder I kept running out of pads! I was not amused when the continence adviser asked me to save pads I had used so she could weigh them to estimate the amount of urine I was passing. I didn't laugh when she asked to borrow my kitchen scales. Well, not at the time. We reached a compromise - I could purchase the excess pads myself from the manufacturers who deliver them every eight weeks.

I am blushing as I write. I just hope that somebody in a position of authority is reading this. Somebody who could make a difference by banning thoughtless and insensitive policies, who could be an advocate for people who need to use pads. Perhaps a scriptwriter or comedian might see it and join the campaign to provide such basic items as incontinence pads alongside disease modifying drugs and other treatments. After all, life is much more fun when you can use discreet pads, and still fit in to your size 14 clothes.

References

  1. Continence Foundation
    Making the case for investment in an integrated continence service.
    London:Continence Foundation;2000.
  2. Continence Foundation
    Protecting Yourself and Your Clothes.

* The work of the Continence Foundation has now been taken over by a new charity called the Bladder & Bowel Foundation.

Incontinence pads and beyond
A response to this article published in the February 2007 issue of Open Door

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