Many women use menstrual pads to manage their urinary incontinence. I understand this line of thinking. First of all, they’re almost always familiar with the product. In addition, if they are not menopausal or are just on the other side of menopause they may have menstrual pads around the house.
However, many women also tell me they are too embarrassed to buy incontinence pads because it makes them think of “diapers” and that is what “old women” need. And there is nothing worse in our patriarchal society than being an “old woman.”
Women get diminished and men, distinguished.
I’m always fascinated by the lack of public discussion about incontinence. I don’t buy “societal squeamishness” about urine as as reason. Women’s magazines produce articles with great regularity on vaginal mayhem (sigh) and there is an increasing number of articles on menstrual products (yeah!).
If we can talk about discharge and blood, why not urine?
(Or right, the association with aging thing).
I see this even in my office, when no one is looking an all conversations are private. Many women can’t hear my diagnosis that their vaginal discharge is normal and continue to try useless and potential harmful interventions to treat this non existent problem. Why? Because the patriarchy has led them to falsely believe that a dry, tight vagina that smells like Island Splash or a Delicate Blossom is deal.
(Oh hey, Summer’s Eve. Fuck off. And no, I’m not sorry. When you tell women that “feminine freshness” is some standard or elusive goal you are the actual fucking patriarchy. Prove me wrong and produce a men’s scrotal wash called Puppy Paws. I’ll wait).
On the other hand, I often feel as if am bullying a woman with incontinence into managing that condition more effectively. I don’t mean arm twisting into surgery or medications, just trying to get them to use incontinence pads instead of menstrual pads, or get some help with pelvic floor exercises, or try an incontinence ring. All reversible options!
Also, when I write or post videos about incontinence they get far fewer hits than similar ones on vaginal discharge.
Why the global interest in vaginal discharge and the disinterest in incontinence? It’s not numbers, at least 40% of women over the age of 65 have urinary incontinence and many younger women do as well. My personal opinion is the patriarchy sees vaginal discharge as problematic because it is thought of as visible during sex and incontinence is not. I have nothing to back this up, just my observations.
OK, back to incontinence products!
(Come for the snark and the patriarchy smack down, stay for the science).
Choosing the right protection matters as when the pad can adequately hold the urine, some will leak back onto the skin, which can cause irritation and itching. These symptoms may even be mistaken for a yeast infection. This contact with urine, when chronic, can lead to skin breakdown.
To demonstrate the difference in absorbency between menstrual pads and incontinence pads I made the video below. I poured 30 ml of fluid on a heavy flow menstrual pad and onto a light flow incontinence pad. To put this volume in perspective, the average blood loss a day with a period is 30-50 ml. A medium leakage for an episode of incontinence is probably about 30 ml (enough to make you wet, but not soaked).
What happened? The menstrual pad was drenched and leaked fluid every where, there were just drops released back from the incontinence pad and the surface was dry.
I repeated the experiment with 15 ml (no video, sorry) and there was no leakage from the incontinence pad, the menstrual pad was still very wet and leaked. The incontinence pad that I used was probably designed to hold about 15 ml, so it performed very well even when asked to hold more urine that it was likely designed to manage.
Hopefully, this video helps convince people to switch to incontinence pads from menstrual pads.
Your vulva with thank you!
If you liked this content, my new book The Vagina Bible is filled with this kind of practical information!
And in case you are curious about incontinence rings, here’s that video!
Dr. Jen Gunter 
Love a feminist gynecologist. New favorite blog.
Great article, Dr. Jen! I have not had this issue yet, but am deep into perimenopause and have been using Thinx underwear instead of tampons and pads. You and your readers probably know this, but Thinx makes an underwear line for bladder incontinence too, called Speax by Thinx. I’m buying these for my mom and for myself when I need them, and I appreciate companies like Thinx that fight back against the patriarchy by normalizing these bodily processes and making effective (and dare I say, fun) products. Suck on that, Summer’s Eve ;).
Great info, Dr. Jen. Another issue to consider is bowel incontinence. Women, I hear you groaning – but it can become a thing. I am “only” 65 & have had this issue for 12 years due to a form of colitis – it can also be caused by bad reaction to an antibiotic, or many other issues.
For minor to moderate bowel leakage, incontinence pads of higher absorption are far more effective than menstrual pads & less bulky than adult diapers.
No shame in our bodies’ changes over time. “Forever young” can be your attitude but it ain’t physical reality.
Jen — Thanks for bringing up this important topic! I did not watch the incontinence ring video so I do not know if you mentioned it…..but if you did not — Poise also makes a tampon like insert called “Impressa” which functions like a pessary to treat stress incontinence (leakage of urine with coughing, sneezing, trampoline jumping etc). Many of my patients use this successfully, esp if their incontinence occurs only with exercise plus it does not require a doctors appt for fitting etc. Here is a link for your blog readers ( https://www.poise.com/en-us/products/impressa/faq/how-do-i-use-poise-impressa-bladder-supports). Good luck with your book tour! Andy
I can understand it to some extent. At a point where you are comfortable with who and what you are, suddenly everything is upended and you are a stranger to yourself. I was an athlete and I found myself losing strength no matter how much I trained, for example. My pretty friend looked in the mirror and saw a stranger. Needing incontinence pads is a part of that. Nonetheless it is made far worse by societal attitudes towards older women.
I’m pretty young and nulliparous, but when my old tailbone break flared up I started experiencing some mild urinary incontinence (given that it went away when my tailbone break stopped aching every time I sat for more than a half-hour, I’d guess it was a pelvic floor spasm). I’m ashamed to admit that I was far too ashamed to be the 20-something buying incontinence pads at the grocery store. I knew I should have used incontinence products, but as an anxious person by default I couldn’t get over the shame and buy what I actually needed. So I made do with menstrual pads.
Point being, there are women who know this but are held back by the shame society heaps on urinary incontinence.
Dr. Jen…. I am sorry that you built your comments with four letter words. Therefore I will not be passing your article to my five precious granddaughters who need to
know and believe in trust, not have to learn and see such filthy language written by a doctor, no less. Anyone can talk dirty. No brains to that. I will now delete your article before I get ill from a knowledgeable and supposed helpful person. ❌❌ and out
🙄
Lighten up, Frances.
You are a Goddess Dr. Jen!!!! Thank you for all the hard work you do/have done on behalf of women. I am so very glad that information you provide is so accessible. I have 2 adult daughters and 1 granddaughter. Things have changed a great deal since the first time I went to Planned Parenthood as a teenager. Let’s hope the misogynists don’t drag us back to the fucking dark ages for women.
BTW- My husband and son said they would buy “Puppy Paws for Scrotums”. Maybe the proceeds could be donated to Planned Parenthood?
Fun fact – there’s a company over here that produces all types of incontinence pads (as well as other sanitary products). They advertise their products both for men and for women, I’ve heard their commercials on the radio and saw their posters in pharmacies.
Thank you Dr. Jen! Definitely something that needs to be talked about and I all is forgiven about the coffee thru the nose when reading about “puppy paws”. 🙂
I’m so glad to read that; it means I wasn’t alone in the spewing of coffee!
Excellent read!! I use pads for incontinence & not ashamed to admit it. My husband has to buy mine ( I cannot walk too far) & he is not embarrassed They come in various sizes so one may have to try different sizes until correct size is found.However; if you live in Canada (as I do) & are deemed handicapped by your physician & are eligible for disibility on income tax you can ask for a receipt for them & claim them on income tax.
Thank you. I’m so frustrated with my body since my hysterectomy. It’s changed completely and I don’t feel like myself at all. I’ve got a tummy, have gained weight and am now have trouble with incontinence. It’s keeping me from exercising, it makes me worried about leakage and I can’t talk to anyone about it. Even my gynaecologist didn’t have many ideas or ways to council me. I recently went to a urologist and she prescribed physical therapy. I’m nervous and worried. You are the first doctor who has made me feel unashamed and normal.
Incontinence is very common! I am so sorry your doctors made you feel that way. Pelvic floor physical therapy can be very helpful though!
Thank you for bringing this issue to light.
We have a Premium Sanitary Napkin that can lock away 50ml of fluid and keep a woman dry (actually more if you watch the video I attached). It also has a strip infused with Graphene that can have additional benefits beyond the dryness.
Better than initiating this conversation with my provider. Informal works best. Now I have the information, I feel comfortable talking about it.
Hi Dr. Gunter,
I wish I understood the pessary video better, but I am confused about what angle the pessary sits at inside the vagina. Horizontally? Vertically? Some other option?
Thanks.
The pessary sits vertically in the vagina
Confused.
Why not use an incontinence pad for heavy days?
Thank you! I’m 29 and struggling with incontinence after having kids. I appreciate the frank and honest discussion. ❤
So if incontinence pads are that good, why are we using menstrual pads at all? I can soak the heaviest pad in just a couple of hours on the first day of my period, could I safely switch?
I came here to ask this!
I believe you can, my sister and I used to use incontinence pads. The only problem is price I believe, incontinence pads are often more expensive, it may not be the same for you but for us that was a problem. You could try the always super overnight pad, its pretty thick, I used to be able to use one of those only changing twice, there wasn’t any excess odor or dryness. An incontinence pad could cause dryness or irritation as it’s meant to absorb liquid, but I only have personal experience. I no longer have a period due to getting the depo shot. But use depends due to incontinence issues brought on by problems with my nerves from back issues, also not recieving the urge notice until my bladders become what would be painfully full to others, but feels like cramps to me. As I said above, give your gynecologist a call, I am sure she or a nurse could answer this over the phone, even call Planned Parenthood I am sure one of the Providers could also answer the question if you need the question answered asap.
Can we collaborate on a poster to hang in my exam rooms? Haha! I am an NP in a urogyn office and I preach this each and every day, and I’m shocked that more women don’t know this. I have also wondered if there is a higher percentage of lichen sclerosus in women who leak urine and wear pads. Thanks for this!
What irritates me is those commercials for getting your incontinence products delivered to you in a discreet fashion. I mean, if I order in bulk somewhere (like Amazon), it isn’t going to come in a box with a flashing sign saying “LOOK! THIS PERSON BOUGHT PEE PADS!!!!
And even if it did come in such an over-the-top box, how many people would really notice? People can be so wrapped up in themselves that they don’t see much of anything. Or, they can be so full of themselves that they think that everybody is interested in what they’re doing and buying.
I think these ads are just another way of shaming people for natural aging processes.
And I just looked at the first hit on Google for “discreet delivery incontinence supplies” and all the pictures on the front page were of women. *sigh*
You asked “Why the global interest in vaginal discharge and disinterest in incontinence?”. I think the answer lies in ignorance of female genitalia. Many men are unaware that women have both a urethra and a vagina, and that urine doesn’t come out of the vagina. To them, it’s the same issue.
Speaking of taboo how about bowel incontinence or worse the inability to evacuate the bowel. I finally got surgery to fix the pouching but it didn’t help much.
My question doesn’t actually relate to the current topic but is one that I feel is important. I am 71 years old, way past menopause and wonder why menopause is listed on my medical record as a “disease” or “illness” when it is not. It is a natural process that all women go through during their lives. I went through menopause during my 50s and all was good. I did not have a hysterectomy (I still have all those body parts) so for me, this was a normal part of how my body worked. Unlike my older daughter who had breast cancer at 41 and then did need to have her ovaries and fallopian tubes out to avoid estrogen production and then she went into instant menopause. I did have breast cancer but it was after menopause, so I see no reason this is listed as abnormal and a “disease” on all of my medical records. Any thoughts? I would love a bloy on this or a comment and suggestions as how I get this off of me medical records as a disease?
This is a great question! I can think of some answers off the top of my head, but I suspect there is more to it. Let me see what I can find out!
Thank you! I have had various illnesses, but I still do not think of menopause as any disease??? I will also recheck my own records too. I see my GYN soon, after my diagnostic mammogram and bone density test near the end of July. I do not know if any of this has anything to do with the sexual abuse I had as a child and longer? My periods were irregular for a long time. I did miscarry twice and my first live birth was a placenta abruptus and one very premature baby (who is now 45 and is the one who had breast cancer but does have two teenagers now). My second daughter was full term and I was able to nurse her (for over three years)…she is now almost 42, no children, but does have Hashimoto’s Thyroiditis, my Thyroid was also removed a few years ago…this runs in our family. All of this may have something to do with why menopause is listed how it is, but that was the one thing that did happen as it was supposed to.
Thanks for this. It’s on my list to discuss the next time I see my gyn. I always prided myself on my “excellent pelvic floor” (quoting my doc), even after seven pregnancies. Yay, Kegels! But alas, the last couple of years (just turned 65) have brought on incontinence issues just as you describe. So very glad you brought it up. Women need to have these issues out in the open. We shouldn’t hide from our bodies!
Do you have a way for people to email you questions?
You can send questions via the New York Times there is a link here https://drjengunter.com/what/
In my experience as a physician and woman, men are very comfortable with the natural smell of a vagina. It’s the women themselves that think they need to smell like a tropical island. Again, it’s a communication issue!
Women need to accept their natural smell and wear it proudly… and steer clear of the extensive aisles of nasty douches.