Abstract
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.
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.
3.2 Why Are Pad Tests Performed?
Pad tests are most commonly used in the research setting but can be an important clinical aid, especially in cases where it is uncertain that the ‘leakage’ is urinary in origin. Generally, pad tests are employed:
To provide objective confirmation of urinary incontinence before and after treatment.
To measure objectively the quantity of urine loss as a measure of severity: a 24-hour pad test loss of greater than 75 g represents severe incontinence in women with stress urinary incontinence [1].
As a general aid when determining the type of incontinence: women with pure stress urinary incontinence have been shown to leak less than 100 g in 24 hours and those with overactive bladder have more severe leakage [1]; however, there is significant overlap, such that pad tests cannot be used to make an accurate diagnosis.
To help to differentiate between urine and vaginal discharge in women who may have excessive vaginal fluid loss: urinary incontinence is unlikely if less than 2 g of loss is found on 24-hour pad test [2]; such tests should not be conducted with panty liners, as they have a tendency to evaporate their fluid.
3.3 Types of Pad Test
Pad testing methods differ with regard to duration (ranging between 1 and 72 hours) and in the activities undertaken during the test. The two most common methods used for pad testing are 1-hour and 24-hour tests.
3.3.1 One-Hour Pad Testing
One-hour pad tests are performed in a clinical setting, under the supervision of a continence nurse or doctor. They include a filling phase, during which the patient spends 15 minutes drinking 500 ml of fluid. This is followed by a series of provocative manoeuvres, such as coughing and jumping, to try to stimulate urinary leakage. Pads are weighed before and at the end of the test. Pad loss greater than 1 g is designated as significant or a ‘positive pad test’ [3].
3.3.2 Twenty-Four-Hour Pad Testing
Twenty-four-hour tests are performed at home. Women are provided with a set of pads and advised not to modify their normal drinking or activities. The aim of such tests is to document leakage in a normal home environment. Pad loss greater than 4 g is designated as significant or a ‘positive pad test’. The values for 24-hour pad test are classified as follows: mild (4–20 g/24 hour), moderate (21–74 g/24 hour), and severe (>75 g/24 hour) incontinence [3].
3.4 Performing a Pad Test
3.4.1 Equipment
There are three components needed to perform a pad test:
pads;
snap-lock bags (one per test) to keep moisture in (all pad wrapping and adhesives should be placed in the bag to maintain an accurate post-test recording);
weighing scales: scales accurate to 0.1 g should be used.
3.4.2 One-Hour Pad Test
The ICS Standardisation Committee has set out a standard protocol for the 1-hour pad test [3].
1. Test is started without the patient voiding.
2. Pre-weighed pad or collecting device is put in place by the subject and the first 1-hour test period begins.
3. Subject is given 500 ml sodium-free liquid to drink within a short period (maximum 15 minutes) and then the subject sits or rests for 15 minutes.
4. Half-hour period: subject walks, including stair climbing equivalent to one flight up and down.
5. During the remaining period, the subject performs the following activities:
i. standing up from sitting, 10 times;
ii. coughing vigorously, 10 times;
iii. running on the spot, 1 min;
iv. bending to pick up a small object from floor, 5 times;
v. wash hands in running water, 1 min.
6. At the end of the 1-hour test, the pad or collecting device is removed and weighed.
7. If the test is regarded as representative, the subject is asked to void and the voided volume is recorded.
8. If the test is not regarded as representative, the test is repeated, preferably without voiding.
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