Disposable products

Most products used today for incontinence are disposable. Most consist of three main layers ²:

• A non-woven top surface that allows urine to pass through while keeping the skin dry

• An absorbent core made from fluffed wood pulp fibres: Many pads have in their absorbent core special super-absorbent polymer (SAP) powders that absorb much more urine - weight for weight - than fluff pulp and holds it far more tenaciously under pressure (for example, when you are sitting or lying on the pad). The SAP is usually concentrated in the central area of the pad.

• A waterproof backing: Some pads have simple plastic waterproof backing, while others have non-woven “breathable” backings with a waterproof element, intended for improved comfort and skin health. Pads are also available with no waterproof backing, which can be used to boost the absorbency of products with waterproof backings, or sometimes for bowel leakage.

Depending on the product type, pads may have other features intended to improve their performance. Small pads may have adhesive strips on the outer backing to help secure them in underwear. Some pads are rectangular in shape, but in order to improve the way they fit many are shaped and some have elasticated edges so that they adopt a “cupped” shape in use. Larger pads often have elasticated “standing gathers” at the sides, intended to reduce the risk of leakage, and “indicator strips” that change colour when the pad is wet. These indicators can be particularly useful for people who rely on helpers for pad changing. It helps to ensure that their pad is changed at appropriate times and reduces the likelihood of the pad leaking onto clothing.

Washable products

Some people use washable products to absorb and contain urine leakage. Washable absorbent pads have generally the same layers as disposable products, but are made of re-usable materials:

• A top surface that allows urine to pass through while keeping the skin dry, usually made from polyester

• An absorbent core made from felted or woven fibres

• A waterproof backing

Washable products that are available commercially reflect the same product designs as disposable products, with insert pads, pull-on pants and all-in-one products designed for varying levels of urine leakage. Some people have found that traditional terry towelling worn inside waterproof pants is reliable for nighttime use, but this is more acceptable to men than women probably because men often require greater absorbency than women.³

Disposable versus washable

Different factors may influence your decision to use disposable or washable products:

• Cost: Although washable products may be expensive to purchase initially, used over time they may be more economical than disposable products in terms of the cost per use.⁴ However, because they have been found to leak more often than disposable products, there may be additional costs associated with laundering clothes and bedding or cleaning soft furnishings.⁵⁶

• Convenience: Although disposable products may be convenient, they must be thrown away after a single use, which contributes to landfill. On the other hand, washable products require laundering. There is more information about the environmental impact of pads here.

• Discreetness: Washable products tend to need to be more bulky if they are to match disposable ones in terms of urine absorption, which means they may be less discreet than disposable products.²

• Effectiveness: In one study, washable leaf pads for men with light leakage were less effective than disposable leaf pads. ⁷ Washable insert pads were not acceptable to most women with light leakage in another study.³

• Practicalities: Washable products for moderate or heavy leakage were associated with practical problems, for example carrying used products, when worn out of the house, but were more acceptable at home.³

• Skin health: There is no clear evidence as to whether disposable or washable products are better or worse for the skin.⁴⁶⁸

• Laundering: Washing by hand may lead to washable products becoming stained and a washing machine is desirable. Drying can be done by machine but is relatively expensive. Air drying may be difficult if it cannot be done discreetly. The high humidity in some countries makes air drying impossible.

Choosing pads that work for you

In most countries there is a large range of different sizes, designs and brands of pads, and selecting products can be difficult.

It is useful to think about what your priorities are when making your selection. Research has shown that some pad characteristics are particularly important for both men and women, such as⁹:

• Ability to contain leakage
• Discreetness
• Ability to contain smell
• Ability to stay in place
• Comfort when wet and dry
• Ability to keep the skin dry

It is also important to consider your own personal characteristics and preferences:

• The frequency and severity of your leakage
• Where and when you will be using the pads
• How often the pad can be changed
• Whether the product is for day or night
• Your mobility and how well you can use your hands
• Access to laundry facilities

Pads come in a wide range of sizes and type, from small insert pads much like sanitary towels/napkins to larger all-in-one disposable pads. And for each size or type of pad there may be a range of absorbency levels, so that similar-looking products may be intended to absorb and hold different amounts of leakage.

A pad’s efficiency in absorbing urine and holding it without leaking depends on a number of factors:

• In general larger pads can absorb and hold more urine.

• Disposable pads with super-absorbent polymer (SAP) powders can absorb and contain more without leaking than pads without SAP.

• Fitting is critical - a product that fits well and stays in place is less likely to leak than one that does not.² Insert pads and pouches are designed to be worn inside underwear, and it is important that the underwear should be close-fitting so that the pad is held securely in place. Pull-up pants with integral pads and all-in-one disposable pads are often produced in a range of absorbency levels and a range of sizes (to fit different body shapes and sizes). You may need to know your weight or waist / hip measurement to select the correct size.

• Pads may perform differently according to activity and position. For example, a pad may absorb and contain urine well when walking or standing, but if quite wet it may leak when you sit down, which will place pressure on the absorbent core.

So when you are thinking about which types of pad may suit you, it is best to think not only about how much you leak, but also about what you may be doing when wearing them. There is much more information about which pads may suit which people and situations on individual product pages.

Another consideration when choosing pad types is how independent the user is and whether they need help changing. Products for moderate/heavy leakage are frequently used in care homes for people who require more help and their performance has been evaluated. Large disposable pads and disposable pants were the most popular with caregivers, who found them the easiest designs to manage.³

Users and carers vary in their perception of how long it is acceptable to wait before changing products, with users mostly intolerant of wait times more than 1 hour after an episode of urinary incontinence, while carers considered longer wait times acceptable. Both agree that products soiled by feacal incontinence required changing within 15 minutes. User perspectives are important in promoting person-centred care.¹⁶ An adequate supply of products is important for quality of life in people affected by incontinence.¹⁷

Large pads or small pads?

People with heavier leakage tend to require bigger pads.¹⁰¹¹ Larger pads may also be suitable for lighter leakage if you are relatively immobile and/or require help with changing your pad, because fewer pad changes may be needed. Larger pads may also be more appropriate for use when asleep.

However, larger pads may be more easily noticed by others when you are out and about. For more discreet protection, many men and women, especially if they are mobile and independent, prefer to use a smaller pad and change it more frequently.

Disposable leaf-style pads work well for most men with light leakage, but for some simple small disposable insert pads are also effective.⁷

Research suggests that, for men and women with moderate or heavy incontinence, the larger disposable insert pads may be more likely to leak both during the day and when asleep than disposable pull-ups or all-in-one pads, and that whereas women may prefer pull-ons, men may prefer all-in-one designs.³

Using a mix of product types

You may be able to manage your bladder or bowel leakage more effectively if you use more than one type of product. People often find that using a mixture of different pads at different times works best for them.³¹²

For example, at work or when socialising you may be more concerned about confidence that the pad won’t leak and discretion and choose to use the most effective and discreet disposable pads (which may be more expensive), changing them frequently. However, at home or when sleeping, when discretion may be less of a concern, you might use pads that are bulkier or less reliable but cheaper pads. Pads may also be used in conjunction with other product designs such as male or female devices, to suit your needs at different times.

Pad absorbency

Pad manufacturers often indicate on packaging the severity of leakage that each pad type is designed for, for example, by stating an exact fluid measurement or by using an increasing number of droplet symbols for higher absorbency. These absorbency levels may be misleading if based on laboratory tests in perfect conditions rather than on real life use and should only be used as a guide.

When similar-looking products have different absorbency levels, it can be difficult to establish which will suit you best. The only sure way to find out is to try them and see.

Many manufacturers offer free samples in the post. Look out for advertisements in magazines and on the internet or contact the manufacturer directly through their customer helpline.

It may seem unusual that there is not a standard way of testing how much a pad can hold and indicating this on the packaging. But in fact, it is difficult to do so, because one type of pad can work very differently for one person compared with another.

There have been considerable efforts to devise laboratory tests that will give a good idea of how products will work in real life. So far, the only international standard test for pads is called the Rothwell Method, which is used to measure how much liquid a pad will absorb under a standard set of laboratory conditions.¹³ The test is quite useful for knowing how well pads will work for very dependent, less mobile people (e.g. in nursing homes) with moderate or heavy leakage.¹⁴¹⁵ But the test cannot take into account factors that may affect how much a pad can reliably hold in different situations, such as when users are active. In recent years a mannequin-based method for testing pad absorbency showed promise, showing greater agreement with user reports, and being able to detect the benefits of elastication in products. But the need for more reliable testing methods remains.¹⁸

Which pads can be used for bowel leakage?

Although most pads are designed and most commonly used for bladder leakage, some people need a pad for bowel leakage or combined bladder and bowel leakage. Much less is known about how well pads work for bowel leakage.

If you have bowel leakage without bladder leakage and the stool is solid, you may be able to manage with a thinner more discreet disposable pad as the pad does not need to be particularly absorbent. However, you are likely to want a pad which is shaped to give maximum coverage over your bottom and some people find that they prefer a pad that is very secure such as an all-in-one or a large insert with very secure pants.

If you have liquid bowel leakage you may find a more absorbent pad is useful. This type of stool can irritate the skin and you will probably want to change your pad as soon as possible to help avoid odour and skin soreness. Some people find a barrier cream helps to protect their skin and as long as this is used sparingly it should not affect the absorbency of the pad.

Washable products are generally considered to be unsuitable for managing bowel leakage. They are harder to launder when in contact with faeces and quickly become stained. Replacing washable products regularly reduces their cost-effectiveness.

Small washable pads are unlikely to provide cover over the bottom required for effective containment of stool. Larger washable products (such as traditional terry towelling or purpose-made all-in-ones) may be acceptable to you. If the stool if fairly solid, a flushable liner, placed in the pad before use, can prevent the stool coming into contact with the pad and allow the stool to be flushed down the toilet.

How can I get these products?

The availability of all products varies around the world, and so does the cost.

Some products such as pads and all-in-ones are widely available, whereas less commonly used products may only be available through specialist suppliers. Large chain stores or supermarkets often sell own name products that may be cheaper than branded products. Many products can be ordered directly via the internet.

In some countries people may be eligible for products free of charge by the local health care system, or their cost may be reimbursed by health care insurance. In other countries users must pay for products themselves.

Individual product pages include information on manufacturers and whether they supply in different areas of the world. Click here for more information about obtaining products and on worldwide for information on how to find support where you are.