Hypothesis / aims of study
Climate change is a major threat to public health (1). Incontinence products contribute substantially to environmental pollution, accounting for up to 50% of waste in long-term care, with significant resource use and CO₂ emissions (2). This burden is expected to rise with population ageing. While prevention is most effective, it is often insufficient. Reusable products offer the greatest potential to reduce environmental impact (3).
We therefore aim to promote washable absorbent incontinence products. A prior survey by our group (not published) showed that nearly half of respondents were unaware of these options. Also, the lack of reimbursement was a major barrier. Other concerns included absorbency, hygiene, odour, gentital skin signs, extra laundry, use outside the home, and limited information.
This study explores experiences of women using both disposable and reusable products for mild to moderate urinary leakage, and examines barriers, attitudes, and factors influencing the willingness to switch, including environmental motivation.
Study design, materials and methods
Women who currently use disposable incontinence products for mild to moderate urinary leakage (25–100 ml per 4 hours) were asked to switch to washable products for a period of 6 weeks. 15 women were provided with 8 pieces of washable incontinence underwear, provided by the company Underwunder. They were allowed to additionally use disposable products when they wanted to.
They completed a questionnaire before and after the test period. Questions were about practical issues like washing, drying and changing, but also about comfort, absorption, genital skin signs, and self-esteem.
Categorical and continuous variables will be expressed as frequencies, means, and percentages. Responses to open-ended questions will be analysed descriptively and summarised thematically.
Results
Fifteen women participated (mean age 63 years). All had used disposable incontinence products for ≥12 months (1-7 pads/day). Mean satisfaction was 6.7 (median 7.0), with costs often covered (13/15). Eight were unaware of washable alternatives. Although 10 viewed these as more environmentally friendly, willingness to switch depended on cost, absorption (moisture/odour), and ease of use.
Thirteen women evaluated washable products after 6 weeks. Most washed them at home with regular laundry; 10/13 reported no issues. Five required more frequent changes than with disposables, while three required fewer. Participants estimated needing between 10 and 21 pieces for one week of use. Seven used disposables less than 2 times/week, while six used them more often, mainly outdoors. Mean satisfaction with washable products was 6.0 (median 7.0). Five women found the washable underwear more comfortable, while four others experienced more skin problems. Lower satisfaction was mainly due to feelings of wetness (causing insecurity and genital skin signs) and difficulties changing underwear.
Interpretation of results
This is the first study to investigate the use of washable continence products in an adult outpatient population.
As nearly all women washed the underwear with regular laundry and air-dried it, this approach appears both practical and environmentally friendly. Although the mean satisfaction score for washable products was acceptable, it was slightly lower than for disposable products. Improvements in fit, ease of use (e.g., with inserts), and better absorption of moisture and odour may increase satisfaction.
In this study, women tested only one type of washable underwear, while disposable products offer more choice. This limited variety may have affected the satisfaction; more options in washable products could lead to a better personal fitting.
Concluding message
The use of washable continence products in a female outpatient population appears practical and environmentally friendly. However, improvements in moisture and odour absorption, as well as ease of changing, are needed to increase satisfaction. Greater awareness of washable options, the possibility of 'mix and match' for outdoor activities, and adequate reimbursement are also important to accelerate the transition to this sustainable alternative.