Objective To determine in a large population of community‐dwelling incontinent patients the accuracy and determinants of pad count as a measure of urinary incontinence ( UI ), using data from a multicentre 48‐h pad test study. Materials and Methods Incontinent patients, who were provided with absorbent products for the period January 2012 to March 2016, volunteered to perform a 48‐h home‐based pad test and to fill in a diary with information on pad usage. Correlations between UI measures (48‐h pad count and pad weight gain, mean pad weight gain per pad) were calculated. Logistic regression analyses were conducted to investigate patient‐related and pad usage‐related factors influencing pad count. Results A total of 14 493 patients (median age 81 years) were included, with a total of 98 362 continence products used overall during the study period. The 48‐h pad count showed a weak correlation with 48‐h pad weight gain ( R 2 = 0.12; 0.19 for men and 0.11 for women) and mean pad weight gain per pad ( R 2 = −0.03). The weakest correlation was observed among patients using >6 pads/48 h ( R 2 = 0.02). A statistically significant negative association between pad absorption capacity and pad count was observed. Patients using products with a shaped and rectangular design had 34% and 40% higher propensity to use more pads than those using briefs ( P < 0.001), respectively. Conclusions The results of this very large observational study confirmed that pad count is a poor measure of UI severity. Pad count only measured 12% of the variability of UI volume and was affected by several patient‐related and pad usage‐related factors. Consequently, pad count should not be used instead of the pad test as an objective measure of UI when an accurate evaluation is required for research or clinical purposes.