Pad Testing 2020
Pad Testing 2020
Pad Testing 2020
3.1 Introduction
Pad testing, most often used as an objective assessment of urinary incontinence, involves
the use of pre-weighed continence pads to capture urinary leakage over a period of time. On
completion of the tests, the pads are then weighed to calculate the amount of leakage.
14
Downloaded from https://www.cambridge.org/core. University of Birmingham, on 13 Apr 2020 at 16:26:12, subject to the Cambridge Core terms of
use, available at https://www.cambridge.org/core/terms. https://doi.org/10.1017/9781108346351.005
3 Pad Testing in Assessment of Urinary Incontinence in Women
15
Downloaded from https://www.cambridge.org/core. University of Birmingham, on 13 Apr 2020 at 16:26:12, subject to the Cambridge Core terms of
use, available at https://www.cambridge.org/core/terms. https://doi.org/10.1017/9781108346351.005
3 Pad Testing in Assessment of Urinary Incontinence in Women
1. Women are provided with five incontinence pads (such as Tena Lady Normal™, SCA
Hygiene Products, Göteborg, Sweden; these pads are less evaporative than panty liners,
less absorptive than thicker pads and more accurately reflect the fluid deposited on
them).
2. Each pad is pre-weighed within a snap-lock bag. Women start the test in the morning
and change to a new pad every 4 hours during the day. Whenever a pad is removed, it
must be reinserted in its original snap-lock bag together with the wrappings and
adhesives that were originally weighed. At the end of the day, the women wear their final
pad for about 8 hours overnight and complete the test upon waking.
3. The pads are returned within 7 days, as they are shown to hold moisture if sealed [4].
4. Women do not need to undertake any particular provocative activities apart from their
usual activities. It is useful to perform any vigorous activities that usually produce
leakage activities while undertaking the test.
5. Twenty-four-hour pad tests are particularly informative when performed
simultaneously with a bladder chart.
Clinical Scenario 1
A woman has constant moistness in the vagina, causing her to wear a pantyliner. The
pantyliner tends to be damp but does not contain obvious significant amounts of urine.
Despite this, the patient insists the panyliner smells like urine. In this case, the cause of the
dampness could be urine or vaginal mucus. A 24-hour pad showing >4 g of loss would point
towards a urinary loss.
Tip. Encouraging the woman to take Vitamin B complex tablets during the 24-hour pad
test can be helpful because urine on the pantyliner ought to stain orange, and help confirm or
negate whether urine is the cause of the dampness.
Clinical Scenario 2
A woman who leaks only during sport has a normal urodynamic assessment. Pelvic floor
muscle training and the use of continence devices fail to control the leakage. The woman
wants to proceed with surgery, but there is no objective evidence of urinary incontinence.
In this case, a 24-hour pad test conducted during a weekend of sport together with a
bladder diary showing activity can confirm significant leakage during sport. Activity has been
shown to increase 24-hour pad weight gain in women complaining of stress urinary
incontinence [9].
16
Downloaded from https://www.cambridge.org/core. University of Birmingham, on 13 Apr 2020 at 16:26:12, subject to the Cambridge Core terms of
use, available at https://www.cambridge.org/core/terms. https://doi.org/10.1017/9781108346351.005
3 Pad Testing in Assessment of Urinary Incontinence in Women
3.7 Summary
Pad tests are of most value in the research setting before and after treatment, as an objective
endpoint of urinary incontinence. The activity undertaken by the women during a test may
influence the results such that a similar level of activity should be performed when pad
testing for comparison before and after treatment. Women’s compliance with 24-hour pad
tests decreases once cured. The same types of pad should be used for all patients before and
after treatment, as pads have different absorptive and evaporative qualities. The major
limitation of the pad test is the lack of diagnostic ability.
Learning Points
Pad tests are most commonly used in the research and clinical settings as an objective
endpoint of urinary incontinence.
Pad test methodology varies in duration and type of activities undertaken, with 1-hour
and 24-hour tests being the most common types.
The same type of pad should be used throughout and Tena Lady Normal™ pads are the
most suitable absorptive type.
A positive 1-hour pad test is urine loss greater than 1 g and a positive 24-hour test is urine
loss greater than 4 g.
17
Downloaded from https://www.cambridge.org/core. University of Birmingham, on 13 Apr 2020 at 16:26:12, subject to the Cambridge Core terms of
use, available at https://www.cambridge.org/core/terms. https://doi.org/10.1017/9781108346351.005
3 Pad Testing in Assessment of Urinary Incontinence in Women
18
Downloaded from https://www.cambridge.org/core. University of Birmingham, on 13 Apr 2020 at 16:26:12, subject to the Cambridge Core terms of
use, available at https://www.cambridge.org/core/terms. https://doi.org/10.1017/9781108346351.005