Clothing for Continence and Incontinence
INTRODUCTION
Carefully chosen clothing, together with equipment for independence and establishing a routine, can often make the difference between continence and incontinence, dependence and independence
For up-to-date information on specific products and suppliers in Ireland, visit the ‘Products and Suppliers’ section of the Assist Ireland online database (www.assistireland.ie). The information in this resource can also be accessed using the telephone support service on 0761 079 200 during office hours.
GENERAL GUIDELINES
- Keep fastenings to a minimum, eg elastic waisted trousers or skirts.
- Keep garments to a minimum, eg replace petticoats with lined garments.
- Looser garments can be easier to put on/pull down than tight garments.
- Choose clothes that enable you to undress quickly, eg drop-front/back trousers, underpants can be attached to trousers, and zips replaced with Velcro.
- Choose clothing that is washable.
- If a garment gets wet or soiled, it should be washed as soon as is practical or at least soaked in cold water to minimise staining and odour.
- Choose clothes which disguise drainage bags, and allow access for emptying.
WOMEN'S UNDERWEAR
Knickers
- Bikini briefs, thongs and tanga pants may be easier to manage than traditional knickers as they are easier to push or pull down.
- French knickers at least 40cm wide can be used if an individual is having difficulty getting knickers up or down. The crotch can be pulled to one side to use the toilet or female urinal.
- If catheterised, any style can be worn, provided that the leg elastic does not constrict the catheter tube causing back pressure.
- Open-crotch and drop-front knickers can eliminate the need to pull pants up and down, and are useful if using a hoist to transfer onto the toilet or when using a male or female handheld urinal.
- Crotchless knickers may be brought from adult shops/mail order catalogues.
- Caminickers, bodies and teddies are two-in-one garments, replacing vests and knickers. They fasten at the crotch with small press studs.
Adaptations
- Ordinary knickers can be adapted to have a crotch opening by undoing the front of crotch seam and extending the crotch flap to an accessible place at the front of the pants. This
adaptation is also useful if tummy control pants are worn as their high elastane fibre content and fiddly fasteners make them difficult to remove in a hurry. - Removal of the crotch gusset from a traditional pair of bloomers and binding the opening enables them to become open crotch. If necessary, the opening can be extended by opening up the centre of the back seam.
Petticoats
- Waist slips are more easily changed in case of accidents.
Stockings/Tights
- Hold-up stockings, or stockings attached to a girdle or suspender belt are easier than tights as they do not need to be removed; however they are not recommended for anyone with circulation problems.
- If tights are preferred, two pairs of one-legged or open crotch tights may be the easiest options, particularly for individuals with catheters or who need to self-catheterise.
- Open gusset tights are widely available and when worn under the pants can be left in position when using the toilet or handheld urinal.
MEN'S UNDERWEAR
Underpants
- Boxer shorts tend to have short fly openings; lengthening the fly will provide ease of access.
- Underpants with a horizontal opening may be helpful to some people; most high street clothing retailers stock men's underwear with openings on either side, horizontal or vertical.
- If catheterised, any style of underpants can be worn, provided that the leg elastic does not constrict the catheter tube causing back pressure, eg boxer shorts.
- Drop-front pants are now made for men.
- 'Comfi shorts' are pants available for men and women; they are designed to fit snugly and to hold drainage bags securely against the thigh in a convenient position for emptying.
Vests
- Long length vests are difficult to remove quickly and would need to be changed when wet and may get in the way during transfers on and off the toilet.
TROUSERS
- Trousers with a completely or half elasticated waistband may be the easiest to manage because they can be pushed down.
- Styles with front pleats, rather than those which are straight across the front, are easier to remove at speed.
- Trousers with a longer fly fastening are available from traditional suppliers and enable men to lower their trousers more easily giving clearer access when using a hand held urinal.
- Men may find braces easier to manage. Edgware braces may be particularly helpful - these enable trousers to be lowered without removing garments worn over the braces or undoing the braces. Contact a clothing advice service for details.
- Trouser styles which have looser fitting legs will enable drainage bags to be well concealed.
- Choose leisure trousers with a zip at the knee for better access when emptying catheter bags.
ADAPTATIONS TO TROUSERS
- A 25cm zip inserted head down in the thigh or leg seam gives easy access for emptying bags. A pocket can be sewn into the inside of the trouser leg to hold a bag.
- Changing a standard hook and bar to a larger size, or replacing it with a large button or trouser weight press stud, makes fastening easier.
- Replacing the hook and bar with Velcro is another alternative but, to hold securely, the Velcro must be doubled back through a 'd' ring.
- If someone finds zips difficult to manage, zipper pull attachments or replacing the zip with Velcro may be a solution; plain Velcro does tend to come undone on trouser fastenings.
- Cargo trousers and shorts with a pocket at knee or thigh level can be adapted to carry the catheter bag.
- Drop back/front trousers are another adaptation which involves inserting a 30cm long zip into each side seam, so that the front or back can be dropped. An elastic waistband keeps up the side which is not dropped.
- Underpants can be altered by opening the side seams and attaching front and back waistbands to the trousers with Velcro. The two garments can then be taken off together. Always ensure the hooked scratchy surface Velcro faces away from the body.
- Extending the fly opening as far as the crotch seam prevents spillage when using a handheld urinal.
- For women who self-catheterise, continuous openings can be inserted into the inside of the leg seams from knee to knee, through the crotch, and fastened with a simple zip or Velcro strip. This will give easy access if worn with crotchless pants.
- For men who self-catheterise, trousers with pleats or which are elasticated at the waist may be easier to manage.
DRESSES AND SKIRTS
- A-line dresses and skirts are the easiest to lift out of the way quickly. Straight or very full skirts are more difficult to move.
- A wrap-over skirt can be unfastened quickly for quick access.
- Wheelchair users may find wrap-over or completely button-through styles, which can be left behind on the chair, convenient.
NIGHTWEAR
- For women, knee length nightdresses and nightshirts are the easiest to cope with.
- Choose pyjamas with short jackets and trousers with elasticated waists.
- For men, knee length nightshirts can be a useful substitute for pyjamas and can be easier to manage when using the toilet.
DRESSING TECHNIQUES
- Removing underpants while still sitting is easier if they fit loosely. A seated individual can push down underpants each side alternately whilst rocking from buttock to buttock.
- People who can support themselves with one hand on a very secure toilet rail may be able to lift their buttocks at the same time as adjusting their underpants with the free hand. If shoulder movement is limited, pulling up pants and trousers with arms crossed over the front of the body
reduces the shoulder movement required. - Someone with poor grip may find that loops positioned so that he/she can insert a thumb into them are helpful. This technique can be used for both pants/knickers and trousers.
EQUIPMENT TO ASSIST WITH DRESSING
- A dressing stick with a cleft at one end can be useful to help push trousers or underpants down. The hook at the other end can be used to pull them up if loops have been sewn into the tops.
- A 'pant clip' is a pair of sturdy clips joined together by a length of elastic. One clip is fastened to the waistband and the other to the upper garments so that when trousers and pants are
lowered they do not fall out of reach during transfer onto the toilet. - Handheld urinals for men and women have been improved in recent years and now offer an acceptable alternative to transferring on and off the toilet so frequently during the day and night.
INCONTINENCE PANTS AND PADS
There are many styles of pants and pads available. However, the style of pant is often specific to the type of pad chosen. Incorrect mixing of pads and pants of different types may well result in leakage. Pants should always be close fitting. Pants with built-in pads may seem more acceptable for men and women with occasional continence needs, but when wet the whole garment will need to be removed and washed.
A public health nurse can offer advice on the treatment and management of incontinence and can be contacted through the local health centre. A continence advisor is a specialist public health nurse who can give advice and support on all aspects of continence care and can be contacted through the local health services.
Trousers from traditional suppliers with a high waist and a fly fastening that is 2in longer than standard will accommodate pads more comfortably than hipster or low waist trousers.
USEFUL ADDRESSES
*It should be noted there is currently no statutory system of registration to either an independent chartered institute or representative professional body for allied health professionals eg occupational therapists, chartered physiotherapists and speech and language therapists in Ireland. This is likely to change soon as the Health and Social Care Professional Bill published in October 2004 sets out a system of legal registration for health and social care professionals irrespective of whether they work in the public or private sector or are self-employed.
TIRIM
Bladder Control Information Service
PO Box 6235
Dublin 17
Tel: 1850 476 476 (recorded message service)
Irish Enuresis Advisory Group (IEAG)
c/o Ferring Ireland
United Drug House
Belgard Road
Tallaght
Dublin 24
Tel: 01-404 1562
Freephone Helpline: 1800 718 888
Continence Promotion Unit
Dr Steeven’s Hospital
Dublin 8
Tel: 01-635 2775
Disabled Living Foundation (DLF)(UK charity providing advice and information and a comprehensive up-to-date database of disability equipment available in the UK)
380-384 Harrow Road
London
W9 2HU
England
Tel: 0044 207 289 6111
Email: dlfinfo@dlf.org.uk
Website: www.dlf.org.uk
Ricability(independent research body in UK which produces guides for older and disabled consumers based on professional research)
30 Angel Gate
326 City Road
London
EC1V 2PT
England
Tel: 0044 207 427 2460
Fax: 0044 207 427 2468
Email: mail@ricability.org.uk
Website: www.ricability.org.uk
Enuresis Resources and Information Centre
34 Old School House
Britannia Road
Kingswood
Bristol BS15 8D
England
Tel: 0044 117 960 3060
Fax: 0044 117 960 0401
Email: info@eric.org.uk
Website: www.eric.org.uk
