Increasingly, in all aspects of life people are aware of the environmental impact of the products they use and the activities they take part in. This is no different for people who use products to manage a bladder or bowel problem. For example, there have been recent developments to try and reduce the amount of plastic waste that is produced, because this often ends up in our seas. However, while we can all do our bit, many of these developments require systemic and societal changes, and you should not feel anxious or guilty about needing to use these products and their potential impact.

The adoption of the three R’s (reduce, re-use, recycle) can provide a way to consider continence product use.

• Reduce - effective treatment (cure or symptom reduction) and careful selection of the best method(s) of management can mean reducing the quantity of products used. For example, substituting products that can be used for a longer period may reduce the bulk of material to be sent for recycling or disposal.
• Reuse – choosing reusable products whenever possible may have some environmental impact. Little research has been done in this area and the impact of cleaning processes may offset to some extent the benefits of reduced waste.
• Recycle - some products and/or packaging may be suitable for recycling and this is an area that continence-product manufacturers and suppliers have focused on. There may be recycling guidelines on the packaging or you can ask the supplier.

Here are some examples where reusable products might be considered:

Disposable versus washable absorbent products

An important consideration when comparing washable and disposable designs is the relative environmental cost, particularly disposal (landfill) costs of disposable designs and pollution and energy costs associated with washing and drying the washables.

There has been very little research on the environmental impact of disposable and washable products for adults. Research looking at the environmental impact of diapers for babies in the UK concluded that there was no significant difference in environmental impact between three diaper systems (disposables, home and commercially laundered washables) although the types of impacts did vary. ¹

More recently, a study that considered the environmental costs associated with absorbent incontinence products from manufacture through to disposal identified a number of ways to reduce environmental impact, including more efficient use of resource materials and effective recycling. Notably, they concluded that shifting to a partly multiple use product system (disposable pads with washable fixation pants) had the largest potential to decrease global warming effects.⁷

Reusing catheters for intermittent catheterisation

Intermittent catheters which are usually flexible and made from PVC or silicone, are almost universally licensed for single use only. However, around the world many people re-use intermittent catheters, washing them after each use and stowing them in a clean receptacle. Stainless steel intermittent catheters - designed to be cleaned and reused multiple times for long-term use - are also available for women.

Cleaning non-coated catheters (that is, those not having a hydrophilic coating) using soap and water and a 15-minute soak in Milton fluid has been shown to leave them free of the organisms that can cause infection. ²³

The decision to use single-use catheters or to reuse non-coated catheters depends on many factors. In some health systems single-use catheters are supplied to users free of charge, whereas in others catheters are an out-of-pocket expense so that re-using them saves users' money.

Catheter users have reported advantages and disadvantages to both single-use and re-use of catheters. ⁴⁵⁶

Advantages of single use catheters:

• They are always ready to use
• As they are thrown away there is no need to carry used products

Disadvantages of single use catheters:

• most people need several per day which is expensive
• large quantities of non-biodegradable catheters are thrown away
• regular supplies are needed and you may run out
• several catheters must be carried when away from home

Advantages of re-using catheters:

• confidence that you will always have one available and won’t risk running out
• fewer catheters are required with potentially less associated cost (note, these are unlubricated catheters so you may have to pay for lubricant and cleaning products)
• fewer catheters to be thrown away to landfill so potentially more environmentally friendly
• fewer catheters to carry when away from home or travelling

Disadvantages of re-using catheters:

• you must clean them between uses and carry them after use which may be inconvenient if away from home
• if going on holiday you may have to take cleaning items
• currently, uncoated catheters which could be re-used are not available in the most discreet designs
• there is a perception that re-using catheters may cause more infection although the research evidence for this is unclear.

You may find that a combination of single-use and re-usable catheters works best for you; for example, re-using your catheters when at home and using single-use disposable catheters at times when you can’t easily wash the catheter after use.

Please note, manufacturer and local country or state guidelines and licensing should be followed.

Sheaths versus absorbent pads

Men can use a sheath system to manage urinary leakage. As only one sheath is used each day and a urine collection bag can be used for several days, this may mean using fewer products overall than if you use several disposable absorbent products per day. However, to get the most out of this system and to stop problems occurring you need to find a product that works best for you and is fitted correctly. Therefore, it is best to ask a healthcare professional or advisor (often a continence / urology nurse) linked to the supplier, who will often have a wealth of experience in this area and can suggest particular products and with sizing and the correct fitting.

This type of system does not work for all men but can be very effective in those that it does, and while the potential impact may be less than other products, it is still a disposable system and will have environmental costs.