Will a menstrual pad help when urine need?

In Bladder Dysfunction by Emily Tran5 Comments

By Morgan Conner, DPT, PHRC Los Gatos

Let’s set the stage here, you just peed your pants. I’ll let you fill in the details of the backstory, but here are a few possibilities. Maybe you just gave birth last week or perhaps six months ago (or six years ago!)  and whenever you pick up your little one or laugh when they do something silly, you leak. Maybe you’ve been peeing a little in your pants every time you jump since you were a high school athlete but it’s gotten worse lately (if this is you check you this awesome blog post by Lis Thompson ). Maybe you just had your prostate removed and, no matter how hard you try, every time to stand up from a chair it just comes out. Perhaps you’ve been through menopause and since then, when ever you go upstairs, you can’t seem to stop yourself from wetting your underwear. All of these are examples of Stress Urinary Incontinence (SUI), or the involuntary loss of urine with physical movement or activity.1 If your SUI has gotten to the point where you need something to keep the urine from soaking through your underwear or outer garments, what are you going to grab? If you or you partner is someone who has menstruated recently, you probably have a menstrual pad in your bathroom somewhere. Because they are already there or are easy and not embarrassing to purchase, you might think, I’ll just slap one of these suckers in and go about my day. Let’s take a closer look and see if that’s really the best idea.

Menstrual pads and incontinence pads have roughly the same general composition. They are both a series of three, sometimes four, different layers of material each with a different task. The first, topmost layer, (the part that is in contact with your skin) is a perforated sheet whose job is to transfer fluid away from the skin to the absorbency layers below. The second layer is the absorbency core. As the name implies, it absorbs the fluid and stores it. The third, and outermost layer, is the backsheet which is water-proof and prevents the fluid that is absorbed from leaking out onto your clothes. Some brands will put in an additional fourth layer between the second and third layers called the acquisition or distribution layer. This layer helps distribute the fluid evenly throughout the pad and can also help to retain fluid in the absorbency layer.2

Now let’s talk about how these two types of pads are different. While the perforations in the top layer of menstrual pads have larger holes to accommodate thicker liquids, these same holes in an incontinence pad as well as the distribution layer in, are designed to accept a large amount of less viscous liquid, i.e. urine, and distribute it throughout the absorbency layer. Tena® is one brand that highlights this difference with an easy-to-understand graphic. (Link in references) Additionally, the absorbency layer of incontinence pads are typically made with higher absorbency materials because it needs to be able to absorb more fluid, more quickly, and in a very short period of time, unlike menstrual pads which absorb fluid more slowly over a longer period of time. Moving on to the backsheet, incontinence pads often have an elastic component which helps to prevent leaking when full. Finally, let’s turn to odor control. Menstrual pads often control odor via deodorants whereas incontinence pads control odor via pH control. Healthy urine is slightly acidic (pH of ~6.0), which means if not neutralized, (neutral pH is 7.0) it may irritate the skin.3

Now, it’s decision time, albeit a little bit more informed decision time than when we started. Here are my recommendations. If you are experiencing moderate to heavy leaking or are having full bladder losses, put the maxi pad away for another day and use an incontinence pad. The high absorbency and pH neutralization capabilities of the incontinence pads will be important for maintaining good skin health and preventing leaking onto your clothes. If you are only having small infrequent losses AND you are actively addressing this issue (I’ll get to this in a second), you might be fine with a menstrual pad, however, I am still going recommend an incontinence pad as the skin irritation factor is still present.

So, now that you’ve gotten your incontinence pads in your shopping cart (either online or at a brick and mortar store) what are you going to do next? Just deal with it and keep buying pads for the rest of your life?? I hope not. I would encourage you to talk with your doctor or schedule an appointment with a pelvic floor physical and occupational therapists.  Pelvic floor physical and occupational therapistss are uniquely suited to treat urinary incontinence as we are trained to evaluate and help you improve your pelvic floor muscle function which can play a role in incontinence (you can read a little more about what to expect at a pelvic physical and occupational therapy evaluation here. Here at the Pelvic Health and Rehab Center, we are here to help you with this and we can also help with many other pelvic conditions and disorders (https://pelvicpainrehab.com/our-services/)

References:

  1. https://www.mayoclinic.org/diseases-conditions/stress-incontinence/symptoms-causes/syc-20355727
  2. Bae J, Kwon H, Kim J. Safety Evaluation of Absorbent Hygiene Pads: A Review on Assessment Framework and Test Methods. Sustainability. 2018; 10(11):4146.
  3. https://www.tena.us/Inco-vs-fempro-women/Inco-vs-fempro-women,en_US,pg.html

FAQ

What are pelvic floor muscles?

The pelvic floor muscles are a group of muscles that run from the coccyx to the pubic bone. They are part of the core, helping to support our entire body as well as providing support for the bowel, bladder and uterus. These muscles help us maintain bowel and bladder control and are involved in sexual pleasure and orgasm. The technical name of the pelvic floor muscles is the Levator Ani muscle group. The pudendal nerve, the levator ani nerve, and branches from the S2 – S4 nerve roots innervate the pelvic floor muscles. They are under voluntary and autonomic control, which is a unique feature only they possess compared to other muscle groups.

What is pelvic floor physical and occupational therapy?

Pelvic floor physical and occupational therapy is a specialized area of physical and occupational therapy. Currently, physical and occupational therapistss need advanced post-graduate education to be able to help people with pelvic floor dysfunction because pelvic floor disorders are not yet being taught in standard physical and occupational therapy curricula. The Pelvic Health and Rehabilitation Center provides extensive training for our staff because we recognize the limitations of physical and occupational therapy education in this unique area.

What happens at pelvic floor therapy?

During an evaluation for pelvic floor dysfunction the physical and occupational therapists will take a detailed history. Following the history the physical and occupational therapists will leave the room to allow the patient to change and drape themselves. The physical and occupational therapists will return to the room and using gloved hands will perform an external and internal manual assessment of the pelvic floor and girdle muscles. The physical and occupational therapists will once again leave the room and allow the patient to dress. Following the manual examination there may also be an examination of strength, motor control, and overall biomechanics and neuromuscular control. The physical and occupational therapists will then communicate the findings to the patient and together with their patient they establish an assessment, short term and long term goals and a treatment plan. Typically people with pelvic floor dysfunction are seen one time per week for one hour for varying amounts of time based on the severity and chronicity of the disease. A home exercise program will be established and the physical and occupational therapists will help coordinate other providers on the treatment team. Typically patients are seen for 3 months to a year.

What is pudendal neuralgia and how is it treated?

Pudendal Neuralgia is a clinical diagnosis that means pain in the sensory distribution of the pudendal nerve. The pudendal nerve is a mixed nerve that exits the S2 – S4 sacral nerve roots, we have a right and left pudendal nerve and each side has three main trunks: the dorsal branch, the perineal branch, and the inferior rectal branch. The branches supply sensation to the clitoris/penis, labia/scrotum, perineum, anus, the distal ⅓ of the urethra and rectum, and the vulva and vestibule. The nerve branches also control the pelvic floor muscles. The pudendal nerve follows a tortuous path through the pelvic floor and girdle, leaving it vulnerable to compression and tension injuries at various points along its path.

Pudendal Neuralgia occurs when the nerve is unable to slide, glide and move normally and as a result, people experience pain in some or all of the above-mentioned areas. Pelvic floor physical and occupational therapy plays a crucial role in identifying the mechanical impairments that are affecting the nerve. The physical and occupational therapy treatment plan is designed to restore normal neural function. Patients with pudendal neuralgia require pelvic floor physical and occupational therapy and may also benefit from medical management that includes pharmaceuticals and procedures such as pudendal nerve blocks or botox injections.

What is interstitial cystitis and how is it treated?

Interstitial Cystitis is a clinical diagnosis characterized by irritative bladder symptoms such as urinary urgency, frequency, and hesitancy in the absence of infection. Research has shown the majority of patients who meet the clinical definition have pelvic floor dysfunction and myalgia. Therefore, the American Urologic Association recommends pelvic floor physical and occupational therapy as first-line treatment for Interstitial Cystitis. Patients will benefit from pelvic floor physical and occupational therapy and may also benefit from pharmacologic management or medical procedures such as bladder instillations.

Who is the Pelvic Health and Rehabilitation Team?

The Pelvic Health and Rehabilitation Center was founded by Elizabeth Akincilar and Stephanie Prendergast in 2006, they have been treating people with pelvic floor disorders since 2001. They were trained and mentored by a medical doctor and quickly became experts in treating pelvic floor disorders. They began creating courses and sharing their knowledge around the world. They expanded to 11 locations in the United States and developed a residency style training program for their employees with ongoing weekly mentoring. The physical and occupational therapistss who work at PHRC have undergone more training than the majority of pelvic floor physical and occupational therapistss and as a result offer efficient and high quality care.

How many years of experience do we have?

Stephanie and Liz have 24 years of experience and help each and every team member become an expert in the field through their training and mentoring program.

Why PHRC versus anyone else?

PHRC is unique because of the specific focus on pelvic floor disorders and the leadership at our company. We are constantly lecturing, teaching, and staying ahead of the curve with our connections to medical experts and emerging experts. As a result, we are able to efficiently and effectively help our patients restore their pelvic health.

Do we treat men for pelvic floor therapy?

The Pelvic Health and Rehabilitation Center is unique in that the Cofounders have always treated people of all genders and therefore have trained the team members and staff the same way. Many pelvic floor physical and occupational therapistss focus solely on people with vulvas, this is not the case here.

Do I need pelvic floor therapy forever?

The majority of people with pelvic floor dysfunction will undergo pelvic floor physical and occupational therapy for a set amount of time based on their goals. Every 6 -8 weeks goals will be re-established based on the physical improvements and remaining physical impairments. Most patients will achieve their goals in 3 – 6 months. If there are complicating medical or untreated comorbidities some patients will be in therapy longer.

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