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Absorbent Products and the Pad-Weight Test

Absorbent products (pads, liners, pull-ups, diapers (briefs), underpads, and reusable washable variants) are the most widely used management strategy for urinary incontinence in both urology and urogynecology. They are containment products, not treatments: they reduce the adverse sequelae of leakage (skin damage, clothing soiling, odor) and improve coping, whether used alone or alongside treatment. The same products are used in reverse as a diagnostic and outcome tool through the pad-weight test.[1][2][3]

For external collection devices in men, see Condom Catheters. For mechanical penile compression, see Penile Clamp. For intravaginal continence devices, see Continence Pessary and Poise Impressa. For the SUI ladder, see Female Stress Incontinence Database.

Classification of Absorbent Products​

Products are classified by severity of incontinence and design.[2][3]

CategoryDesignsAbsorbencyNotes
Light incontinenceDisposable inserts; menstrual pads; washable pants with integral pad; washable inserts; pouches / leafs (men)50–500 gSmall, discreet; worn with close-fitting underwear[1]
Moderate–heavy (body-worn)Disposable insert pads with mesh pants; disposable diapers / briefs (all-in-ones); pull-ups; T-shaped diapers2,000–3,000+ g (typically only ~10% capacity used in practice)Larger, bulkier; day vs night variants[2]
UnderpadsBedpads and chairpads (disposable and washable)VariableBackup for body-worn products, primarily at night; chairpads not recommended routinely (dignity concerns)[2]

All major designs are available as disposable (single-use) or reusable (washable) variants. Superabsorbent polymers, introduced in the late 1980s, are now ubiquitous in disposable products and have substantially increased absorbency while reducing bulk.[2]

Guideline Position​

The AUA/SUFU 2024 OAB Guideline classifies pads, liners, diapers, absorbent underwear, and barrier creams as "incontinence management strategies" and recommends that clinicians discuss these with all patients with urgency urinary incontinence .[1] The guideline states that no RCTs have compared the clinical or cost effectiveness or patient satisfaction of these strategies. Randomized crossover trials have, however, compared specific absorbent designs in particular populations.[1][5] The 2026 EAU female-LUTS guideline strongly recommends discussing treatment options before containment alone and offering pads or containment devices for wet OAB as temporary control or when other treatment is not planned or possible.[25]

The NEJM stress-incontinence review notes that absorbent products "play an important role in the care of women with stress incontinence" and that purpose-made incontinence pads outperform menstrual pads for leakage prevention, though they cost more.[4]

Gender, Setting, and Cost-Effectiveness​

A UK Health Technology Assessment (Fader 2008, three crossover trials in community and nursing-home settings) compared preferences and cost-effectiveness under its product mix and prices; its rankings are study-specific:[5]

PopulationPreferred designMost cost-effective design
WomenDisposable pull-ups by day and in the community at night; disposable diapers in nursing homes at nightDisposable inserts were a cheaper alternative for community women; nighttime nursing-home results differed[2][5]
Men, day and nightDisposable diapers were favored by community men by day and over inserts in nursing homes at night; washables were acceptable to most community men at nightDisposable diapers were the most cost-effective disposable design; washables may be more cost-effective for community men at night, while the nursing-home daytime ranking was uncertain[2][5]
Washable productsBetter for nighttime leakage in the community trialUnacceptable to 27/36 community women (75%); 31/49 community men (63%) found them highly acceptable at night[5]

Combining designs (pull-ups when going out, cheaper inserts at home) may be more effective and less expensive than a single design.[2][5]

In the 2008 UK trial of 85 community women with light incontinence, the tested products ranked as disposable inserts, then menstrual pads, then washable pants with integral pads, then washable inserts. Some women prefer menstrual pads (6 of 85) or washable pants (13 of 85) despite inferior leakage performance; both designs cost less.[3][5]

Post-Prostatectomy Incontinence — A Major Use Case​

Absorbent pads are the dominant containment strategy for post-prostatectomy incontinence (PPI):

  • ProtecT trial. In the prostatectomy arm, pad use rose from 1% at baseline to 46% at 6 months, declining to 17% by year 6 (versus 4–8% in radiotherapy and active-monitoring arms).[6]
  • In a conference abstract from 118 certified centers in Germany, Switzerland and Austria (n = 14,920 with baseline and 12-month questionnaires), 12% of men using no pads before radical prostatectomy used ≥ 2 pads/day at 12 months.[7]
  • Austrian insurance-claims data: among men who ever received a pad prescription after RP, the average number of prescribed pads per patient per month fell from 12.61 at 3 months to 4.91 at 36 months.[8]
  • A randomized trial of 56 men with persistent incontinence after prostate-cancer treatment (44 after radical prostatectomy) compared pads with devices (sheaths, body-worn urinals, penile clamps). Pads were good for everyday activities and best for nighttime use, easiest to use and most comfortable when dry, but most likely to leak and most uncomfortable when wet. Men preferred a mixture of products for daytime needs, and about two-thirds used a combination of pads and devices after testing.[9]

The Pad-Weight Test​

The pad-weight test is a noninvasive tool to quantify leakage severity and monitor treatment response. An ICS working group review calls it underutilized: fewer than 10% of urologists perform it routinely.[10]

TestUsePerformance
1-hour pad test (ICS-standardized)Optional assessment or treatment-response quantificationThe 2026 EAU female-LUTS guideline recommends pad testing when quantification is required, particularly for treatment response , and a standardized duration and activity protocol when testing . A 2022 diagnostic review found 1-hour protocols more accurate but less reproducible than longer tests; 60–93% sensitivity and 60–84% specificity describe long-duration protocols, not this test alone, and results could not be pooled.[10][11][25]
24-hour pad testQuantitative treatment-outcome assessmentOften used for outcome assessment; protocols, conditions and thresholds vary[10][12]
7-day pad testTreatment outcomes; captures peak leakage daysTest-retest reliability was excellent in 32 men; among 51 men, up to 12 would have been misclassified by severity with the 24-hour test alone[12]
Pads-per-day (PPD) countPractical follow-up toolIn one 2026 post-prostatectomy cohort, 8,787 paired measurements had overall ρ = 0.94; 0–1 PPD usually tracked lower leakage and ≥ 5 PPD often tracked severe leakage, but 2–4 PPD varied widely.[13]

Threshold: The >15 g pad-weight gain cited by the JAMA review relates to a 48-hour home-pad test; in the underlying study, the 95% upper confidence level for gain in continent women was <15 g.[26] Thresholds vary across 1-hour, 24-hour and longer protocols.[14][26]

Incontinence-Associated Dermatitis (IAD)​

Prolonged skin exposure to urine or stool can lead to IAD, an irritant contact dermatitis.[16] Among older adults, reported IAD prevalence is 3–30%, depending on setting and diagnostic criteria.[15] For the dedicated treatment of barrier-cream selection, structured cleanse-moisturize-protect protocols, cyanoacrylate-based protectants for denuded skin, and management of established IAD, see Barrier Creams & IAD Prevention.

  • Clinical features. Erythema, maceration, erosion, scaling, frequent secondary infection; symptoms of burning, itching, and pain.[15][16]
  • Risk factors. Moderate-quality longitudinal evidence associates more frequent stool exposure, including diarrhoea, limited mobility, and friction/shear with IAD in older adults; obesity has observational associations, and lower Braden scores were associated with IAD in a six-week institutional cohort without multivariable adjustment.[15][16][18]
  • Prevention. Reduce skin exposure to urine and stool: select a suitable absorbency and breathable design, change wet products, change products immediately after faecal-incontinence episodes, cleanse gently and consider an appropriate skin protectant. Comparative trial evidence does not establish that one cleanser or leave-on product reliably prevents IAD better than another; the 2025 Cochrane review rated it low or very low certainty.[15][16][17][18]
  • Disposable versus reusable. Cochrane reviews found no firm evidence that skin health differs between disposable and washable designs.[2][3]
  • Brand variability. In a prospective cohort of older institutionalized adults, anonymized absorbent brands A and B were associated with different IAD incidence (p = 0.024).[18]

Quality-of-Life Impact​

The ICIQ-PadPROM (Yearwood Martin 2018) is the first validated questionnaire specifically designed to measure the QoL impact of absorbent product use, with four domains: pad design / physical effects, psychological effects, social effects / pad leakage, and burden of pad use.[19]

  • The dominant QoL driver is achieving effective and discreet containment; high anxiety is associated with perceived risk of poor pad performance and lack of discreteness.[20]
  • The five most important pad characteristics for daytime use are ability to hold urine, contain smell, stay in place, discreteness, and comfort when wet.[20]
  • Women using pads 24 hours/day (approximately one-third of incontinent women) had worse King's Health Questionnaire scores in all domains except general health, and lower QALYs, than daytime-only users in a cross-sectional study of 270 women.[21]

Practical Counseling​

  • Purpose-made incontinence pads outperform menstrual pads for leakage prevention; some patients prefer menstrual pads because they cost less, so discuss the trade-off.[3][4]
  • There is no single best design; optimal management may combine designs across circumstances (day versus night, home versus out). The 7th International Consultation on Incontinence recommends trying brands within a design and securing pads with stretch underwear or mesh pants (Grade B).[5][2][27]
  • Discuss skin care with barrier creams and gentle cleansing with all chronic pad users to prevent IAD.[15][22]
  • Frame pad use as an incontinence management strategy that can be used alone or alongside treatment according to patient goals (behavioral therapy, pharmacotherapy, devices, or surgery as appropriate).[1][23]
  • In one trial of men with PPI, most preferred pads at night and a mixture of pads and devices during the day.[9]

Key Principles​

  • Absorbent products are the most widely used incontinence management strategy. They contain leakage without treating it and can be used alone or alongside other therapy.[1]
  • There is no head-to-head RCT across all containment strategies in the OAB guideline, but randomized crossover evidence compares specific absorbent designs.[1][5]
  • In the 2008 UK trials, many women preferred disposable pull-ups despite cost, whereas diapers often performed best and were cost-effective for men; local prices and individual preference may differ.[5]
  • Combining designs may be more effective and less expensive than a single product.[5]
  • In ProtecT's prostatectomy group, pad use was 46% at six months and 17% at year six[6]; leakage requiring pads occurred in 18–24% across years 7–12.[24]
  • The 24-hour pad test often quantifies outcome leakage; longer tests can capture day-to-day variation. In one post-prostatectomy cohort, ≥5 PPD often indicated severe leakage.[10][12][13]
  • IAD risk rises with prolonged moisture exposure, especially faecal incontinence; appropriate product changes, gentle cleansing and skin protection are reasonable, but specific cleanser or barrier superiority remains uncertain.[15][16]
  • Around-the-clock pad use (about one-third of incontinent women in one cross-sectional study) is associated with worse QoL and lower QALYs.[21]

References​

1. Cameron AP, Chung DE, Dielubanza EJ, et al. The AUA/SUFU guideline on the diagnosis and treatment of idiopathic overactive bladder. J Urol. 2024;212(1):11-20. doi:10.1097/JU.0000000000003985.

2. Fader M, Cottenden AM, Getliffe K. Absorbent products for moderate-heavy urinary and/or faecal incontinence in women and men. Cochrane Database Syst Rev. 2008;(4):CD007408. doi:10.1002/14651858.CD007408.

3. Fader M, Cottenden AM, Getliffe K. Absorbent products for light urinary incontinence in women. Cochrane Database Syst Rev. 2007;(2):CD001406. doi:10.1002/14651858.CD001406.pub2.

4. Rogers RG. Urinary stress incontinence in women. N Engl J Med. 2008;358(10):1029-36. doi:10.1056/NEJMcp0707023.

5. Fader M, Cottenden A, Getliffe K, et al. Absorbent products for urinary/faecal incontinence: a comparative evaluation of key product designs. Health Technol Assess. 2008;12(29):iii-iv, ix-185. doi:10.3310/hta12290.

6. Donovan JL, Hamdy FC, Lane JA, et al. Patient-reported outcomes after monitoring, surgery, or radiotherapy for prostate cancer. N Engl J Med. 2016;375(15):1425-1437. doi:10.1056/NEJMoa1606221.

7. Hammerer P, Sibert N, Breidenbach C, et al. EPIC-26 urinary incontinence score results and pad use 12 months after radical prostatectomy for localized or (locally) advanced prostate cancer: results of a cohort of 14,920 patients from 118 certified centers. J Clin Oncol. 2023;41(Suppl 16):e17102. doi:10.1200/JCO.2023.41.16_suppl.e17102.

8. Mun DH, Yang L, Shariat SF, et al. Difference in incontinence pad use between patients after radical prostatectomy and cancer-free population with subgroup analysis for open vs minimally invasive radical prostatectomy: a descriptive analysis of insurance claims-based data. Int J Environ Res Public Health. 2021;18(13):6891. doi:10.3390/ijerph18136891.

9. Macaulay M, Broadbridge J, Gage H, et al. A trial of devices for urinary incontinence after treatment for prostate cancer. BJU Int. 2015;116(3):432-42. doi:10.1111/bju.13016.

10. Krhut J, Zachoval R, Smith PP, et al. Pad weight testing in the evaluation of urinary incontinence. Neurourol Urodyn. 2014;33(5):507-10. doi:10.1002/nau.22436.

11. Medeiros Araujo C, de Morais NR, Sacomori C, de Sousa Dantas D. Pad test for urinary incontinence diagnosis in adults: systematic review of diagnostic test accuracy. Neurourol Urodyn. 2022;41(3):696-709. doi:10.1002/nau.24878.

12. Martínez-Cuenca E, Sánchez JV, Bonillo MÁ, et al. Longer is better than shorter: the added value of the seven-day pad test in the post-radical prostatectomy urinary incontinence. Neurourol Urodyn. 2021;40(4):994-1000. doi:10.1002/nau.24655.

13. Domínguez Argomedo R, de Pablos-Rodríguez P, Palop Moscardó A, et al. The 24-h pad test in the assessment of post-prostatectomy incontinence: is there still a role for counting pads per day? BJU Int. 2026. doi:10.1111/bju.70224.

14. Holroyd-Leduc JM, Tannenbaum C, Thorpe KE, Straus SE. What type of urinary incontinence does this woman have? JAMA. 2008;299(12):1446-56. doi:10.1001/jama.299.12.1446.

15. Kottner J, Dissemond J. Incontinence-associated dermatitis in older adults: a critical review of risk factors, prevention and management. Drugs Aging. 2025. doi:10.1007/s40266-025-01227-z.

16. Graham T, Beeckman D, Kottner J, et al. Skin cleansers and leave-on product interventions for preventing incontinence-associated dermatitis in adults. Cochrane Database Syst Rev. 2025;7:CD011627. doi:10.1002/14651858.CD011627.pub3.

17. Runeman B. Skin interaction with absorbent hygiene products. Clin Dermatol. 2008;26(1):45-51. doi:10.1016/j.clindermatol.2007.10.002.

18. Garcia-Ruiz MP, Torres-Bautista RM, Lopez-Franco MD, et al. Influence of sociodemographic factors and incontinence care practices on the development of incontinence-associated dermatitis. J Clin Med. 2026;15(5):1752. doi:10.3390/jcm15051752.

19. Yearwood Martin C, Murphy C, Cotterill N, et al. Development and psychometric evaluation of ICIQ-PadPROM: a quality of life questionnaire to assess the treatment effect of absorbent continence products. Neurourol Urodyn. 2018;37(5):1650-1657. doi:10.1002/nau.23389.

20. Getliffe K, Fader M, Cottenden A, Jamieson K, Green N. Absorbent products for incontinence: 'treatment effects' and impact on quality of life. J Clin Nurs. 2007;16(10):1936-45. doi:10.1111/j.1365-2702.2007.01812.x.

21. Grzybowska ME, Wydra D. 24/7 usage of continence pads and quality of life impairment in women with urinary incontinence. Int J Clin Pract. 2019;73(8):e13267. doi:10.1111/ijcp.13267.

22. Beele H, Smet S, Van Damme N, Beeckman D. Incontinence-associated dermatitis: pathogenesis, contributing factors, prevention and management options. Drugs Aging. 2018;35(1):1-10. doi:10.1007/s40266-017-0507-1.

23. Silva LA, Andriolo RB, Atallah ÁN, da Silva EM. Surgery for stress urinary incontinence due to presumed sphincter deficiency after prostate surgery. Cochrane Database Syst Rev. 2014;(9):CD008306. doi:10.1002/14651858.CD008306.pub3.

24. Donovan JL, Hamdy FC, Lane JA, et al. "Patient-Reported Outcomes 12 Years after Localized Prostate Cancer Treatment." NEJM Evid. 2023;2(4):EVIDoa2300018. doi:10.1056/EVIDoa2300018

25. European Association of Urology. EAU Guidelines on Management of Non-Neurogenic Female Lower Urinary Tract Symptoms. Limited update March 2026, section 3.7.1. Full guideline.

26. Versi E, Orrego G, Hardy E, Seddon G, Smith P, Anand D. "Evaluation of the home pad test in the investigation of female urinary incontinence." Br J Obstet Gynaecol. 1996;103(2):162-167. doi:10.1111/j.1471-0528.1996.tb09669.x

27. Murphy C, Fader M, Bliss DZ, et al. "Management using continence products: Report of the 7th International Consultation on Incontinence." Continence. 2023;8:101049. doi:10.1016/j.cont.2023.101049