Urinary incontinence (UI) is a common condition, which has a substantial impact on quality of life (QoL). UI is perceived as truly debilitating from a physical, psychological and social point of view, it may cause both isolation and loss of independence [1]. Whereas wearing continence pads in women with bladder control problems is common and perhaps more accepted, in men it is less so [2] and even small amounts of incontinence is associate with high levels of bother in men with post prostatectomy incontinence. Containment with absorbent products may be an option for men with unresolved incontinence, although little is known about to what extent men seek out this method of management although there has recently been an increase in advertisements of pads specifically for men. While it may be assumed that pad usage is an effective means to achieve social continence, there is little evidence on men’s attitudes towards pad use.

This was a qualitative study to assess attitudes and experiences of pad use in men. After 6 weeks in a feasibility trial, pad use participants were invited to take part in one to one interviews focused on their experience. Community dwelling men ≥ 18 years with UI and had never used pads prior to the feasibility study were included. Men with faecal incontinence and cognitive impairment were excluded. Written consent was obtained from all interview participants. Demographic data of participants were gathered. The semi-structured interview guide was created focusing on perceptions of utility, benefits and disadvantages of containment products. Interviews were digitally recorded and transcribed verbatim. All identifying information was removed at the transcription stage. The first interview was independently coded by two researchers and compared to develop a coding framework. One researcher coded the remaining 10 interviews, adding new codes as they were identified. The coded data were then analyzed by three researchers, collapsed into categories, and subsequently themes.

11 men completed interviews. Ages ranged from 33-89 (mean (SD) 67.6 (15.7)). Four themes were identified: Perceptions of incontinence; The experience of wearing pads; Experimenting, and Taking a risk (Table 1). Some men perceived incontinence as a normal part of aging, while others viewed it as an abnormal condition largely due to its association with women’s health issues. Some men found pads helped with odour control and provided positive psychological benefits, while others reported no significant impact. An adjustment period was required whilst men got used to pad positioning and usage patterns to find what worked best for each. Men carefully selected with whom they would discuss their incontinence and pad use in order to avoid embarrassment in social interactions and dismissal of their concerns from physicians.

Men who were first time pads users were of the opinion that UI made them abnormal. This may be influenced by the focus on women’s incontinence in product advertisements and from other sources of health information. Some participants attempted to deal with the social discomfort of being incontinent by trying to normalize it or associate it with aging. When discussing the experience of wearing pads men tended to describe a feeling of confidence due to control of odour and being able to take part in more activities. This achievement of social continence was one of the most important aspects of their pad use, and many indicated that they would continue to wear them in the future. While the opportunity to try pads as a means of addressing their incontinence was a positive experience, no-one indicated that they would seek further assessment and treatment beyond this degree of management. This may be linked to having had their concerns previously dismissed by physicians.  As these were men who had no previous experience with using absorbent products it is not surprising they had to experiment with pad fit, placement, and even changing their undergarment style to accommodate the pads. Unlike women who have used menstrual products, men have no experience with using pads, so experimentation is important in adaptation.

This study shows stigma associated with UI and pad use among men stemming from sex related interpretations of what it means to be incontinent and who incontinence affects. Pad use became more acceptable after an opportunity to try containment products. Healthcare professionals should be aware of not dismissing concerns about incontinence as this may discourage men from seeking assessment and treatment. Men’s attitudes towards incontinence and use of absorbent products as well as their experience in accessing services needs further attention from continence researchers.