title: Quantification of cough-related urine loss using the paper towel test.
abstract: OBJECTIVE
  To develop and test a simple and rapid method for quantifying the urine loss resulting from three deep coughs using an ordinary brown paper towel.
  
  
  METHODS
  A brown paper towel is held lightly against the perineum during three single coughs performed in the upright stance. The resulting wetted area was calculated using simple geometry; if desired, leakage volume can be interpolated from a calibration curve, which demonstrates the relationship between wetted area (cm2) and volume (mL) of leakage. Four bench tests of the method were performed. In addition, the test-retest reliability of the method was evaluated in eight elderly women with mild stress urinary incontinence, a sample size adequate to detect a 1-mL difference with 80% power.
  
  
  RESULTS
  The smallest measurable quantity of fluid resulted in a wetted area of 0.04 cm2 (equivalent to 0.2 microl). For leakage volumes up to 6 mL, the regression showed that each 1 mL of fluid volume resulted in an average 25.4 cm2 increase in wetted area (coefficient of determination: 0.97). In eight women with stress incontinence 95% of within- and across-visit comparisons of urine loss were within 1 mL.
  
  
  CONCLUSIONS
  The paper towel test is a simple and reliable measure providing immediate visual and quantitative feedback of cough-related urine loss typical of mild-to-moderate stress urinary incontinence.
authors.affiliation: Institute of Gerontology, Department of Mechanical Engineering and Applied Mechanics, University of Michigan, Ann Arbor 48109-2125, USA.
authors.forename: J M
authors.initials: JM
authors.lastname: Miller
authors.forename: J A
authors.initials: JA
authors.lastname: Ashton-Miller
authors.forename: J O
authors.initials: JO
authors.lastname: Delancey
mesh_terms: D000368:Aged; D003371:Cough; D005260:Female; D006801:Humans; D008875:Middle Aged; D012680:Sensitivity and Specificity; D014550:Urinary Incontinence, Stress / Q000175:diagnosis*