Urinary incontinence (UI) is a common condition in women. For up to 77% of them, absorbent continence products remain a staple of day-to-day management. Despite the frequency of their use, there is limited research into the factors underlying women's satisfaction with absorbent products, choices of products and what motivates them when they change them. Rather than a careful and holistic assessment in the process of product selection allowing individualized, customized use of absorbent incontinence products, healthcare reimbursement schemes often fail to provide a full range of products which are customizable for end users. Reimbursement schemes may also ration the availability of products, the type of products available and constrain overall expenditure [1]. In an Italian study of the “appropriateness” of absorbent product provision based on potential absorptive capacity, 75% of products were found to be inappropriate [2]. However, when asked to rank the most important features of pads, the ability to hold urine was only one of five features (holding urine, containment of smell, staying in place, discreteness, comfort when wet) cited as being important. Factors external to the pad which have been cited as important include the planning of changes and disposal, particularly in the social environment [3]. This original study investigated factors underlying pad use and change choice in women with urinary incontinence to shed light on additional factors influencing their decisions. We hypothesized that women with UI change their pads for a variety of reasons other than pad saturation and that changes occurred at low saturation levels.

A multiple-methods study design was used to assess pad use. Community dwelling women with daily incontinence episodes of any subtype and using absorbent products to achieve contained incontinence were eligible for inclusion. Only women with cognitive impairment sufficient to render them unable to engage with study procedures were excluded. Incontinence severity was measured using the International Consultation on Incontinence Questionnaire-Urinary Incontinence – Short Form (ICIQ-UI SF). Continence-related quality of life was measured using the International Consultation on Incontinence Questionnaire – Lower Urinary Tract Symptoms Quality of Life (ICIQ-LUTS QoL). Participants also completed a short bespoke questionnaire on satisfaction with their current absorbent product. The scale was ordered from 0 (completely unsatisfied) - 20 (extremely satisfied). Based upon the participant's estimate of daily pad use (number and type) the participant’s personal pads were individually weighed, and the weight was recorded along with an identifying number discreetly marked on each pad with a permanent marker. Participants placed used pads in a sealed ziplock bag and stored them in a cool box for 3 days. Participants recorded, at each pad change, the reason for that change. Following collection, each pad was weighed. Pre and post-weights of pads were used for calculating the saturation of each pad at change. Participants then took part in a one-on-one interview in person exploring their pad choices and use, satisfaction with current pad use and supply, circumstances surrounding each pad change and reasons for that change. The interview used comments and notes from the 3-day pad use diary as a reference frame. Interviews were transcribed verbatim and the data were analyzed via conventional content analysis. Two researchers independently coded the first two transcripts and then jointly developed a preliminary coding framework. The remaining transcripts were then coded by a single researcher with any new codes reviewed by the rest of the team and added to the framework. Codes were then collapsed into categories and themes.

A purposive sample of 11 women with urinary incontinence in the community were included. The participants were aged 65-95 years, (mean 78.1, SD 8.2 years). Using ICIQ-SF categories, one participant had slight incontinence, two had moderate incontinence, six had severe incontinence, and one had very severe incontinence. The median ICIQ-SF score was 16 (IQR 10-17) out of a total possible score of 21 (Table 1). The satisfaction of pad use survey scores had a median of 9 (IQR 8-12) out of a total possible score of 20. The median number of pads used per day was 2.3 (IQR 1-4) The median absorbance capacity at the time of pad change was 9.5% of potential absorbency (IQR 7-19). The median ICIQ LUTS QoL score was 62 (IQR 55-67) out of a total possible score of 76.

Qualitative analysis resulted in 43 codes which were categorized into 7 categories and collapsed into three themes. The themes were “Product factors”, “Lifestyle” and “UI and other health factors”. Table 2 illustrates the 7 categories which were encompassed into the 3 themes.

Participants changed their absorbent products because of highly individual reasons. Lifestyle factors, type of UI and factors related to the absorbent products (e.g. pad odor, heaviness, and cost) were frequently mentioned by participants. Pads were frequently changed at a degree of wetness far below their advertised capacity. Regarding the theme of lifestyle factors, routine pad changes such as changes in morning and night were common. Furthermore, daily activities such as leaving the home prompted pad changes for fear of any noticeable odor. Product factors specific to the pad type and brand affected changes due to wetness and heaviness, and certain pad types were found to be more irritating or uncomfortable on the skin, prompting more frequent changes. Concerning the theme of “UI and other health factors” some participants taking medications for other conditions experienced an increase in the flow of urine prompting more frequent changes. Medical conditions such as hemorrhoids and fecal incontinence caused soiling of the pad with minimal urinary loss also prompted changes. UI-related factors such as stress urinary incontinence were a common reason for change. Many reasons were given for changing pads although wetness and heaviness of the pad remained a prominent concern.

Women using UI absorbent products change for multiple reasons other than saturation although saturation remains an important concern. Women appear to “overuse” absorbent products and may benefit from more individualized education and support in usage. Reimbursement schemes may benefit from adopting a more person-centered approach to their support.

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Continence 12S (2024) 101551
DOI: 10.1016/j.cont.2024.101551