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327
Box 14.4 (continued)
Follow-Up
• Review the turning schedule with the nursing staff; check that the head of
his bed is at 30
o
, and his time up in the wheelchair is not more than 45min
at a time.
• Assess the pressure redistribution products.
• Assess progress on his bowel program, diarrhea, and stool frequency and
consistency.
• Order blood glucose to be drawn.
Box 14.5: Case Study 2
Mrs. Somner is a 70-year-old woman with a hip fracture. She has been admit-
ted to the hospital for surgical repair. She has been sitting in the wheelchair
4h, twice per day. She ambulates with a front wheel walker up to 25feet. She
has difculty transferring to the commode or toilet and requires assistance of
one person. She slides down in bed regularly. She requires assistance with bed
mobility of 2 to 4 people due to pain. She is alert and oriented, but incontinent
of urine twice each night and occasionally during the day. She has had consti-
pation but complains of itching of her “bottom.” She has a poor appetite, eat-
ing only a few bites of each meal and drinks a small amount of a liquid feeding
supplement each day. She is underweight at 105 pounds and her prealbu-
min=2mg/dl. Her vital signs are stable, and she is afebrile. Her hemoglo-
bin=10g/dl.
Past Health History: smoking, malnutrition, COPD, osteoporosis
Skin Assessment Findings:
• Full thickness skin loss on her sacral area (length=3cm, width=2cm,
depth=2cm). The ulcer presents as a deep crater with no undermining.
Gauze dressings are saturated twice a day with serosanguinous drainage,
no odor, and the wound base is yellow slough with a small amount of
granulation tissue. Periwound skin is erythematous and macerated with a
rash present.
• Perianal and crease between the buttocks are red and erythematous with a
rash present around her perianal area.
Braden Scale Score: 15=preventable risk.
Sensory=4 Moist=2 Activity=3 Mobility=2 Nutrition=2 Friction and
Shear=2
(continued)
14 Management ofSkin Damage Associated withFecal andDouble Incontinence
328
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Box 14.5 (continued)
Interventions
1. Address risk factors for skin damage:
(a) Order use a skin care cleanser with topical protectant barrier cream at
night and with a pad change and evaluate the incontinent pad for
proper t and quality.
(b) Protect heels from pressure, shear, and friction. Evaluate the need for
a trapeze to assist with moving in bed.
(c) Consult dietician for poor nutrition and anemia.
2. Topical Skin Care:
• Sacral area stage 3 pressure injury with fungal infection: apply light
dusting of topical antifungal powder to peri-wound skin, apply calcium
alginate gauze into the wound and cover with foam border dressing.
Change every day.
• Irritant contact dermatitis with fungal infection: order use of a skin
cleanser and a topical antifungal powder twice during the day and at
night covered with a protectant/barrier cream.
Outcomes
On evaluation 72h later
• Sacral area stage 3 pressure injury with fungal infection; maceration, ery-
thema, and rash have resolved. The wound measures length = 3 cm,
width=2cm, depth=2.5cm, slough is present in 25% of the wound base
with 75% granulation tissue. When the calcium alginate was removed it
was 50% dry. This indicates that the dressing can be changed less fre-
quently. Discontinue the antifungal powder, apply calcium alginate gauze
into the wound, and cover with foam border dressing. Change every
other day.
• Irritant contact dermatitis with fungal infection: the perianal rash has
decreased but is still present perianally, but there is no more itching. Irritant
contact dermatitis in the buttocks crease has resolved. Continue to apply
antifungal powder twice during the day perianally and at night apply anti-
fungal powder covered with a topical protectant/moisture barrier.
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14 Management ofSkin Damage Associated withFecal andDouble Incontinence
335
© The Author(s), under exclusive license to Springer Nature
Switzerland AG 2025
D. Z. Bliss (ed.), Management of Fecal Incontinence for the Advanced Practice
Nurse, https://doi.org/10.1007/978-3-031-94526-7_15
15
Absorbent Products: Types, Selection,
andPros andCons
JoAnnErmer-Seltun andKathleenBorchert
Abstract
Absorbent products are a component of fecal incontinence management. Features
and design of absorbent products are not optimal for fecal incontinence, but they
are the best available option for containment of leaked feces currently. This chap-
ter will provide a brief historical review of absorbent hygiene materials and dis-
cuss product categories, designs, and features. It outlines objective assessment
considerations to obtain the best match between the user, type, severity, and tim-
ing of incontinence. It discusses advances in the technology of the products,
offers consumer and clinician resources, and examines related environmental
issues that are emerging. The chapter will also appraise evidence-based selec-
tion, use, and evaluation of body-worn absorptive products to guide advance
practice nurses in the most advantageous use of these products for those who are
challenged with fecal incontinence.
J. Ermer-Seltun (*)
WEB WOC® Programs, Minneapolis, MN, USA
MercyOne North Iowa Vascular Wound Center & Continence Clinic, Mason City, IA, USA
e-mail: jermerseltun@webwocnurse.com
K. Borchert
WEB WOC® Programs, Minneapolis, MN, USA
WOC Program Manager, University of Minnesota Health, Minneapolis, MN, USA
336
15.1 Introduction
Traditionally, by design and performance features, absorbent products (body worn
or underpads to protect surfaces) are considered a primary containment strategy for
those with urinary incontinence [1–5]. However, absorbent products are also con-
sidered a rst-line containment measure for people with fecal or double (urine and
feces) incontinence, despite designs primarily aimed at urinary incontinence, which
result in insufcient odor concealment and limited ability to reduce skin exposure
to feces, particularly formed feces [4]. Frequently, this strategy is an adjunct to
conservative (lifestyle modications, pelvic oor exercises) or more invasive inter-
ventions (surgery) for fecal incontinence described throughout the textbook chap-
ters as the individual is working toward optimal bowel control. Moreover, people
periodically select the use of absorbent products during incontinence exacerbations
even if treatment was successful or ‘just in case’ to prevent a potential public embar-
rassment when going outside their residence. The primary goals in the use of absor-
bent products are to achieve social continence also referred to as contained or
managed continence, maintain dignity, and ultimately optimal quality of life
(QoL) [6–8].
15.1.1 Prevalence ofAbsorbent Product Use
The widespread use of absorbent products as a mainline containment option is a
multi-billion-dollar business as the prevalence of urinary and fecal incontinence is
substantial. For instance, a systematic review and meta-analysis by Mack etal. [9]
convey the global prevalence of fecal incontinence in community dwelling adults is
1in 12 people with the prevalence higher in women and older adults. To underscore
this point further, Fortune Business Insights [10], a company that provides in-depth
research, trend analysis and forecasting, noted a signicant rise in global market
size of incontinence care products usage with absorbent products as the largest
share proportion (~67%) in 2022. It was appraised at $14.30billion United States
Dollars (USD) in 2018 and forecasted to increase to $36.60billion USD by 2032,
realizing a compounded annual growth rate (CAGR) of 7.0%. This tremendous
increase in supply and demand for incontinence care products, particularly dispos-
ables, is attributed to several factors, the most signicant of which is the aging
population, with two billion people over the age of 60 expected by 2050, up from
900million in 2015 according to World Health Organization (WHO). Additional
variables include the high prevalence of urine, fecal, and double incontinence in the
adult population, as well as increased public awareness and acceptance of conti-
nence care products via social media, electronic commerce, and digital marketing
channels.
A noteworthy trend is the amplied supply and demand of incontinence products
specically designed for men, driven by increased interest and consumerism. The
female segment is expected to maintain the largest share of the market [10]. Price
Hanna Consultants [11], a consulting rm specializing in absorbent hygiene
J. Ermer-Seltun and K. Borchert
337
products and raw materials, has also noted a substantial increase in global consump-
tion of these products and key raw materials used in manufacturing absorptive prod-
ucts such as cover stock, super absorbents, uff pulp, etc.
15.2 Historical Review of“Diaper” Materials
15.2.1 Before theEighteenth Century
Primitive cultures utilized absorbent materials for infant diapering that were indig-
enous to their surroundings and acclimated to the climate. In cold climates, animal
fur or seal skin along with dried moss provides warmth and dryness. In warm arid
regions, the Navajo people ingeniously used the shredded bark from the dense
branches of the dessert cliffrose shrub placed under the infant while in a cradleboard
strapped on the mother’s back. Other diapering materials used before the eighteenth
century included boiled clay, milk weed, grass, loose wool swaddling, our sacks,
and layered paper sheets [12, 13].
15.2.2 The Nineteenth Century andAfter
The advent of the safety pin by the 1880s afforded a more body-hugging garment
made from old cloth to avert excrement seepage. Parents commonly used reusable
closures and cloth diapers covered with snug knitting and paired with ill-tting
baggy plastic pants to prevent clothing soiling in the late nineteenth and early twen-
tieth centuries. Harsh detergents in hot water were used to launder cloth diapers
[12]. The prolonged contact of urine and or stool from the reusable diapering mate-
rials plus laundering practices produced, not surprisingly, frequent episodes of ‘dia-
per dermatitis’ that affected 25% of the infants [13].
15.2.3 Birth ofSingle Use Disposable Diapers andInnovations
1940s–1970s
The debut of the rst disposable diaper was an innovation of the 1940s initially by
Paulistrom Bruk (Sweden, 1942) and Marion Donovan (United States, 1946).
Paulistrom used cellulose sheets (paper made from insoluble ber derived from
wood) to create a cellulose cloth diaper held in place with rubber underpants while
Marion later invented the outer plastic cover to create a leak-proof disposable dia-
per. Vic Mills, an engineer at Proctor & Gamble, further revolutionized disposable
diapers. He developed a cellulose pulp core diaper, enhancing absorbency and com-
fort. This breakthrough led to the launch of Pampers in 1961. Innovations in the
1970s triggered changes in fasteners design, rst Velcro then later, a plastic material
that opened and closed repetitively. In addition, absorbency materials continued to
enhance performance, elastic gathers around the legs reduced soiling, as well as
15 Absorbent Products: Types, Selection, andPros andCons