Perineal Pad Tests

Perineal pad testing can be helpful in evaluating a patient complaining of urinary incontinence, when objective urine loss has not been demonstrated on routine office testing. The patient should be observed over a long enough period of time to witness their symptoms, with most common time intervals of either 1 hour or 24 hours.

The 1-hour pad test is usually performed in the office. The patient's bladder is prefilled, either with a catheter or by having the patient drink water, until it feels full or a set volume is reached (i.e., 250mL). The patient then performs a standard set of activities for the hour. These activities must be representative of routine daily life such as bending, coughing, and climbing stairs. The pad must be weighed before and after the test and the weight gain represents the volume of fluid loss. Every effort should be made to prevent drying of the pad. Ideally,waterproof underclothing should be worn during the test period and, once removed, the pad should be sealed in a plastic bag until it is weighed. It is important to note that a weight gain of up to 1 g over an hour can be accounted for by sweat and vaginal discharge.

The 24-hour pad test is performed at home. This test is not as standardized as the 1-hour test. The patient is sent home with a preweighed pad and is instructed to wear it for a set period of time (usually 4-6 hours) and then seal it in a plastic bag. The pad is then reweighed to estimate fluid loss.

Changes in weight often do not correspond well to patient and urodynamic assessment of incontinence severity. A 1998 study by Ryhammer et al.8 showed no significant difference between increases in pad weight between self-reported incontinent and continent women over a 24-hour period. This and the time required to perform the tests have relegated pad weights to a second-line diagnostic option. They can be useful, however, as an assessment of severity or to assess improvement after treatment.

In women in whom office evaluation fails to demonstrate urine loss, Pyridium or another urine-coloring agent can be used to make objective urine loss on a pad more obvious. The woman ingests a Pyridium tablet and then wears a pad for a set period of time. The major shortcoming of the Pyridium pad test is the high false-positive rate. Fifty-two percent of healthy, continent women in a study by Wall et al.9 had a positive test.

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