Categories of pad

Pads are either worn on the body (body-worns) or placed on the bed or chair (bed /chair protectors).

Body-worn pads come in four main types:

• Inserts (‘liners’ or ‘shields’)

• All-in-ones (diapers)

• Pants with built in pad (pull-ups)

• Male pouches

They are usually unisex but some are specifically designed for men or women. They are designed for either light or moderate/heavy urinary leakage. Some are suitable for bowel leakage. Most are disposable but some are washable.

Click on the pictures below for information about pads to suit you.

Click here for information about bed and chair protectors.

More about pads

Important features of pads

Pads typically have many features which affect their performance, and selecting appropriate pads can be confusing. It is important to think what your priorities are when making your selection. Research has shown that for both men and women there are certain features of pads ³ which are particularly important including:

• 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

Choosing pads that work for you

When choosing one or more pads to meet your needs, you will need to consider:

• Your personal characteristics - factors such as the frequency/severity of your leakage, whether you need pads for day and / or night, whether you are able to change your pad independently or need help, and your pad changing position e.g. standing or sitting.

• Personal preference – personal preference is important when choosing pads. Not surprisingly, people with heavier leakage tend to prefer using bigger pads ⁴⁵ – using a larger pad generally means fewer pad changes which may be preferable if you are relatively immobile and/or require help with changing your pad. However, both men and women often prefer to use a smaller pad and change it more frequently if they are mobile and independent.

People do not always choose pads based only on the amount the pad is designed to absorb. For example, some people have frequent, dribble-type leakage and others may be dry for days and then experience a 'gush' or 'flood'. Both may prefer to use a small pad (which is likely to offer greater discreetness) changing it often.

• Convenience - different factors will influence your decision to use washable or disposable products. Washable pads add to the laundry, but can be more cost effective than disposable pads if used repeatedly. On the other hand, disposable pads may be more convenient than washable pads as they can be thrown away, although they cost more in the long-term and contribute to landfill (See Other FAQ's below for more information about the environmental impact of pads).

• Using a mix of pad types - people often find that using a mixture of different pads works best for them. For example, selecting very discreet / disposable pads (which may be more expensive) for social circumstances such as when at work, and cheaper, bulkier / washable pads for when at home. Pads may also be combined with other product designs e.g. male or female devices, to suit your needs at different times.

Understanding your needs is the first step to appropriate pad selection. For more help with self-assessment, click on People.

Comparing pads

• Pads come in a wide range of absorbencies and it can be difficult to establish which will suit you best, and to compare similar looking products from different suppliers. The only sure way to find out is to try them and see. However, this is often impractical for individuals and time-consuming and expensive for bulk buyers and so there have been considerable efforts to devise laboratory tests which will give a good idea of how products will work in real use.

• So far, the only international standard laboratory test for pads is the so-called Rothwell Method ⁶, and this is used to measure how much liquid a pad will absorb under a standard set of laboratory conditions. It has been shown to produce results which correlate quite well with the findings of very dependent people (in nursing homes) using pads for moderate / heavy leakage ¹²¹³; that is, the bigger the Rothwell capacity in the laboratory, the more absorbent the pad in real use.

• The Rothwell method has a number of short-comings and limitations and work is going on to develop an improved method. Meanwhile, some organisations - such as health services and insurance companies - use the method to compare products when they make bulk buying decisions and some companies include the Rothwell capacity (or a number based on it) in the literature accompanying their products.

Of course, pads can work very differently for one person compared with another and so the best test for you is to try out lots of different pads!

Other FAQ's

How are disposable pads made?

Disposable pads usually have three layers:

• Top sheet - in contact with the skin and designed to keep the skin dry.

• Absorbent core – made from fluffed wood pulp fibers. This is usually combined with a superabsorbent polymer (SAP) powder which absorbs much more urine - weight for weight - than fluff pulp and holds it far more tenaciously under pressure – that is when you are sitting or lying on the pad. The SAP is usually concentrated in the central area of the pad closest to the urethral opening (where urine exits the body).

• Waterproof backing – some disposable pads have ‘breathable’ plastic backings designed to promote healthy skin. Non-waterproof backed pads are available and can be used as a booster pad inside a larger waterproof backed pad or for bowel leakage.

Other features of pads:

• Adhesive strip - many small disposable pads have an adhesive (sticky) strip on the outer layer to help secure them to underwear.

• Indicator strip - larger pads often have an ‘indicator strip’ running through the pad and visible from the outside, that changes colour when the pad is wet and needs changing. This is 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 overfilling and leaking onto clothing.

• Elastication - insert-style pads may be flat but are often slightly elasticated along their length. This is intended to improve fitting to the body.

• Standing gathers – some insert pads have ’standing gathers’ or cuffs which are intended to reduce the risk of leakage from the side.

• Shaping - insert pads are sometimes rectangular but are more usually shaped to fit the body more snugly.

How are washable pads made?

Washable pads can be broadly split into two groups - traditional terry toweling products and purpose-made products. Traditional products are only made for moderate to heavy incontinence whilst purpose-made washable pads are available in a range of designs for very light to heavy incontinence.

Traditional:

• The traditional washable product is a terry toweling square which is made entirely out of cotton and can be folded into different shapes to suit different people. Absorbency can be increased by simply adding a smaller quantity of folded terry toweling. Cotton tends to feel comfortable against the skin when it is dry but can be uncomfortable when it is wet this is because cotton is hydrophilic and quickly becomes saturated and soggy.

For a guide to folding and fitting terry towelling squares click on ¹.

Purpose-made:

• Purpose-made washable pads are usually made up of three separate layers:

• Top sheet – this is the layer closest to the skin. It is usually made from polyester and has the advantage of feeling dry against the skin even when wet because polyester is hydrophobic.

• Absorbent core – this middle layer is usually made from a felt or knitted material comprising rayon and / or polyester fibers.

• Water-proof backing - a variety of plastics are used for the water-proof backing. In general, thicker, stiffer materials are more hard wearing but less comfortable.

Are washable products better than disposables for the environment?

• An important consideration when comparing washable and disposable designs is the relative environmental cost, particularly disposal (landfill) costs of disposable designs 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. However a recent report looked at the environmental impact of diapers for babies in the UK and 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 ⁷

Are washable pads or disposable pads better for the skin?

• There is no clear evidence that either disposable or washable products are better or worse for the skin ⁸¹⁰¹¹

Are washable pads cheaper than disposable pads?

• Although washable pads can be expensive to buy compared with disposable pads, they can work out cheaper per use if they are re-used repeatedly ⁸. The more frequently they are used, the more cost effective they become!

• With all products, if there is a failure to contain leakage there will be costs associated with laundering clothes, bedding or soft furnishings. Research studies have found washable pads to be generally more leaky than disposable pads and therefore associated laundry costs to be higher ⁹¹⁰

• People often consider using a combination of washable and disposable pads; for example, using washable pads when at home or leaving the house for short periods and using disposable pads at other times.

The pack of pads I have suggests it holds 100 mls or has 5 droplets on it - what does this mean?

• Pad manufacturers generally indicate the severity of leakage that each pad type is designed to accommodate. This is often printed on the packaging, for example, using a droplet symbol. This should only be used as a guide and can be misleading if based on laboratory tests in perfect conditions ⁶

• Pads come in a range of absorbencies to cater for people with different degrees of leakage. Understandably, people buying products wish to know how much urine pads will hold. But there is no simple answer: a pad does not have a volume of urine below which it is guaranteed not to leak although it is more likely to leak the more urine it has to hold.

• When you start to wear a pad you will find that a number of factors influence how well it works, for example, how active you are and how well the pad fits. You should try out samples of pads whenever possible before buying large amounts.

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

Which size pad do I need?

• Pads come in many different sizes and absorbencies. You need to consider the size and absorbency of the pad together as you will find that:

• Pads generally increase in size with increasing absorbency – the bigger pads hold more.

• Fitted pads e.g. all-in-ones or pull-up-style pants, have a range of size (to fit different size bodies) for each absorbency level.

• Depending on the manufacturer, you may need to know your weight or waist / hip measurement to order your pads in the correct size.

Click on Amount of leakage for help working out how heavily you leak.

I have bowel leakage which pads should I use?

• 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 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.

Click on Faecal Devices for suitable products.

Can I use washable products if I have bowel leakage?

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

• Stool can be more easily disposed of when wrapped in a disposable pad.

• Small washable pads are unlikely to provide cover over the bottom required for effective containment of stool. Larger washable products (such as traditional terry toweling 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 much do pads cost and where can I buy them?

• The cost of pads varies according to the make and absorbency, and which country you live in, so it is not possible to give an exact price range.

• However, it is important to remember that the price of a pad is not necessarily a good indicator of its performance; buying a more expensive pad will not necessarily guarantee you better performance.

• In some countries, pants and pads are supplied by the health service. In this case, you are likely to be offered a small quantity from a limited range. You may then wish to buy additional products to supplement what you are given or different products if those you are given are unsatisfactory.

• Disposable pads can often be purchased through retail outlets, for example, supermarkets or chemists. All pads (washable and disposable) can be purchased directly from the manufacturer by phone or on the internet.

• Supermarkets/ large chain stores often sell own name products which may be cheaper than branded products. However, they may be the plain, older style white designs rather than the newer more feminine ones.

Click on worldwide to go to organisations where you live for local information about cost.

Will pads take up much storage space in my home?

• Disposable pads can take up significant storage space depending on how many packs you buy at one time. Some disposable pads come in smaller pack sizes than others e.g. disposable pants in packs of 12 compared with disposable pads/all-in-ones in packs of 28.

• Storage may be less of a problem if you buy small packs regularly.

• All types of disposable pad should be stored somewhere dry and not in a hot or steamy place as they may absorb moisture from the atmosphere and be less effective in use. They are best kept in the packet until you need to use them.

• A major advantage of washable pads there is a much smaller quantity of product to store at any time e.g. 10 pairs of pants.

• After laundering, washable pads should also be stored somewhere dry.

How do I launder washable pads and pants?

• Washable pads and pants are generally no harder to wash and dry than normal washing although there are aspects that differ e.g. not using fabric conditioner.

Click on ² for guidance on how to launder washable pads and pants.

How should I dispose of used disposable pads?

• Disposal can be a problem particularly if you are using large quantities of pads. Wrap used pads up and place them in carrier bags, or nappy sacks which are available perfumed. Some manufacturers supply disposal bags.

• Some disposable pads e.g. disposable pants have a sticky tab on the back to conveniently secure the pants for disposal once they have been rolled up. Similarly, the adhesive tabs on all-in-ones can be re-used to secure the rolled up pad for disposal.

• Waste disposal systems (similar to those used for baby diapers) are an option for managing waste pads in the home. These are expensive as you have to buy the unit and special replacement bags/cartridges. However, they have the advantage of providing a closed bin in the home (reducing trips to the outside bin) and contain odor.

• If you are staying away from home or travelling, you will need to consider in advance of your trip how best to dispose of products discreetly.

Click on Travel for advice on managing pads when away from home.

Click on worldwide to go to organisations where you live for local information about disposal.