As you know, or will soon learn as you visit various web sites dealing with incontinence, there are many types of incontinence. The causes are many and varied, but the cures very few and far between. This is NOT to suggest it is a waste of time to discuss your incontinence with your health care professional! Many types of incontinence can be helped, if not cured outright, and you will want to investigate those avenues thoroughly before resigning yourself to managing your incontinence on your own. The purpose of this primer is to discuss diapers as one of the ways to manage the problem of incontinence.
What are some of the other ways? Diet can affect continence. Exercises to strengthen pelvic muscles can help. Timed toileting may work. Clean intermittent catherization is an option. Drugs help some but not all folks, and results vary greatly. External (condom) catheter and leg bag are used by some. More infrequently, males have used penile clamps. Surgical intervention with grafting of muscle tissue or implantation of artificial sphincter muscle represents an alternative medical-surgical route. This list is not necessarily complete, but it gives you topics to discuss with your health-care provider when discussing your particular incontinence and what options might be available to you.
Perhaps you've been incontinent for a long time; or possibly incontinence may have just entered your life, and you haven't yet gotten over the emotional trauma. It is a big emotional adjustment to find that your body has double crossed you and that a basic function such as elimination has slipped outside of your control. Perhaps your health-care professional has suggested that you wear "protection," or perhaps you have come to that point on your own. In a majority of cases, we find that health care professionals do NOT recommend diapers but recommend instead one or more of the alternate management methods mentioned above. Yet many of us who've been experiencing incontinence for a while feel that diapers are the most effective, most secure and safest method for dealing with our incontinence. (See Chapter 2, "Diapers get a bum rap")
We will not be "politically correct" here. We will call a diaper a diaper. Others may choose to call them absorbent products, disposable absorbent undergarments, disposable briefs, protective underwear, disposable absorbent underpants or whatever. Call them what you want, we shall be very basic here, and call them diapers.
Let us define diapers as follows:
Diapers are worn in place of underpants to absorb and contain bodily excretions over which a person has lost control or has little effective control.
To try diapers, you need only go to the pharmacy and buy a bag of disposable briefs, such as Attends or Depend. "Briefs" means a diaper that wraps around your waist completely and tapes on. All other designations such as pads or "undergarments" refer to less product (and less protection). It is not a case of promoting the two big brand names, but they are national brands and one of the two will most likely be available in a pharmacy or supermarket near you, regardless of where you live. While not "great" diapers, they are acceptable for the purpose of trying out diapers. If you find such diapers will work for you, then you can seek higher-quality diapers, generally only available by mail order and on-line, such as through the website http://www.xpmedical.com/. This site is run by Gary, a reputable businessperson, who is himself a disabled diaper wearer and carries only quality products.
If you don't like the idea of going into a pharmacy and buying a bag of diapers, we understand! There are still many of us who have accepted wearing diapers as an effective means of dealing with incontinence but we wouldn't be caught dead in a store buying diapers -- even with that handy excuse that we are buying them for an elderly aunt!
Nowadays it's simple to go on-line and buy diapers. You can find lots of sites selling diapers. Recall that all diapers are not the same, so there will be a "learning curve" involved. We recommend starting with the basic commercial products such as Attends, Depend or Tena. You will have purchased a decent, though not great diaper. And if you find diapers are just not for you, you've cut your losses money-wise. We think it makes sense to try 75-cent diapers before spending $1.25 and up per diaper.
For commercial products, use size information on the package; "medium" will fit the majority of people. Do not get "large," thinking it will provide "more diaper". It really won't, and it will be harder to tape on and get to fit you comfortably and securely unless you have a large frame.
The following remarks are very basic, but this is a "diaper primer" and thus we wish to provide information for the person who may be holding a diaper in hand for the first time.
Putting on a disposable diaper may be done lying down, but most of us find it can be done easily and effectively standing up. Take a diaper out of the bag and unfold it. What's inside and outside? It's a bit harder to tell with the "cloth like" outsides that are common now. All diapers are packaged with the outer side facing outwards. The tapes are always on the back or rear portion of the diaper.
Hold that unfolded diaper with the rear waist up and the front hanging down. Slip it behind you with the outside toward the wall and the inside against your skin. Holding the waist band where it belongs at the small of your back, place yourself back against a wall to hold the diaper in place so you can let go of the back portion with your hands. Reach down to pull the front through your legs, and flare out the leg gathers as you do so. When you have the front waist in place, adjust the diaper so that to match the front and back waist comfortably. Continue to hold the rear of the diaper by keeping pressure against the wall.
Next, smooth the front of the diaper at the leg across your thigh, around your sides and towards the back. Bring the lower back portion of the diaper over the front portion, pulling it smooth and snug and peel and stick a lower tape on one side. Allow an inch or so of diaper below the tape to prevent that tape cutting into your leg uncomfortably when you sit down. Repeat this procedure for the other side. Now do the same thing for the waist portion. Some diapers have gathers at the waist. Be sure the gathers are fully pulled out (extended) before you tape. Tape one side, then move away from the wall to snug the waist and tape the other side. A snug fit at the waist will help keep the diaper up and comfortable as it becomes wet and heavy and tends to sag down.
If your diaper has middle tapes, fasten them last, pulling the front of the diaper up slightly as you tape the middle tapes. Most people find that 6 tapes provide a superior fit.
Also, push the leg gathers well up into your crotch; they should go there on their own as you pull the front of the diaper up to your waist, but if you don't have your legs apart, they may not. You want the diaper leg gathers to be high up so that the crotch of the diaper forms a pouch and liquid will gather in the center and not run to the outside where a leak between the diaper and your leg would be inevitable.
Be sure you have pulled the diaper material down below the (lower) leg tapes to act as cushioning between the edge of the tape and your leg. Sit down and see whether the tape cuts into your skin. That effect will become very uncomfortable if it is allowed to happen. If the diaper works its way up and the tape is getting close to your skin, pull the diaper sheet back down and sit and get up a couple of times to be sure the diaper won't "walk" back up.
Apply talcum or corn starch now, between your thighs and the diaper and sprinkle some down inside, at the sides of the waist. Your sides will be pressure points holding the diaper on and you may find the powder contributes greatly to comfort.
Do not powder beforehand, as powder on your hands or on the plastic portion of the diaper will prevent tape sticking. Lotion is even worse than powder so I'd caution you to stay away from lotion during these early experimental stages. Tape "popping" can be common with cheap disposables and will even happen with good national brands if contaminated with powder or lotions. Tape popping is a failure of the adhesive or stickiness and putting the tape back doesn't work, after a minute or so...pop...and the tape is undone again. The only fix is a new diaper (costly fix) or good old duct tape. More about this in the disposable section.
You will quickly get the knack of taping on a diaper. By the sixth diaper or so you'll be taping it on as though you've been doing it for years!
Some suggest wearing plastic pants over disposable diapers as a safety measure against tape tearing or popping. While it may not happen often, you only need to experience it once to decide you don't want a wet diaper sliding down under your clothes. This idea makes sense, but don't feel that you have to get plastic pants right away, not in this early stage of your just trying diapers out to see if they are going to be your management tool of choice or not.
Anything you wear over disposables will cut down on the plastic "rustling" sound, including the aforementioned plastic "back up" pants. Cheaper diapers tend to be the nosiest while better ones use a softer and quieter plastic. Simply wearing cotton underwear, especially boxer briefs, will greatly reduce noise and help keep your undershirt tucked in. This subject gets considerable attention from time to time on various internet forums with ideas from everyone on dealing with the "rustling diaper" sound. My feeling is the noise issue is over rated and people concerned with noise are perhaps a bit too sensitive and they need to lighten up and not worry so much about what many feel is a "non issue".
Deciding when to change will involve a bit of experimentation and has a lot to do with your personal preferences. You might assume that you would want to choose "dry diaper wear" since that would seem more comfortable than wearing a wet diaper. This means you change to a dry diaper as soon as you notice the diaper you are wearing has become wet. Disposable diapers are excellent for this type of diaper wear. They are well designed to take up the first wetting and tie up the liquid. If you change then and there, you will probably never experience a leak. The diaper manufacturers will love you because you will use a lot of their product. There is no question you will always be very comfortable because you will be dry about 99% of the time.
There is "down side" to dry diaper wear: Unless your type of incontinence allows you to go long periods between wetting incidents, diaper changing will run your life. Perhaps the better word would be "ruin" your life. Incontinence has already done a pretty good job of messing up your life; consider whether you want diapers to continue to mess up your life or to make life better? With dry diaper wear you must carry a supply of diapers with you and face changing in a variety of circumstances and deal with interrupting whatever you were doing when you experience a wetting incident. We would recommend dry diaper wear only for those whose incontinence is a type where the bladder empties only after a few hours so that the number of (inconvenient) diaper changes is minimal.
If you suffer from bowel incontinence, you have no choice other than dry diaper wear, however. In contrast to urine, fecal matter is extremely harsh on the skin since it contains digestive acids and enzymes that will quickly attack your skin and create severe diaper rash. Odor is a significant problem with fecal matter and not socially acceptable, thus forcing an immediate clean up and diaper change in order to remain "out and about" in society.
On the other side, some, if not most of us, wet relatively frequently and lose small amounts with each incident; dry diaper wear is simply not feasible. Wet diaper wear makes more sense in this case. It consists of wearing a diaper for a given period of time and changing it based on a schedule. Wearing a wet diaper is not as bad as you might think it will be.
The major advantage to wet diaper wear is you control changes. That gives you the flexibility to plan changes where you want them, hopefully where it will be easier for you from a stand point of privacy and comfort and convenience of having things you need (disposal bag, powder, wipes) available. The disadvantage to wet diaper wear is much greater potential for leaks and perhaps some discomfort. Some of us are more bothered than others by a wet-diaper sensation. Many of us hardly notice.
What you drink and how much you drink will obviously impact the timing of diaper changes. If you are new to diapers, we want to stress that you do your experimenting over the week end and nights, so that you gain confidence in your diapering skills and confidence in your selection of diapers and their leak-free performance before you add the stress of a social or work setting. We also suggest that you advance to social settings before trying the work setting, following successes in the privacy of your home. After you become confident that your diapering method will work for you, plan an outing to the mall or to lunch. If you join someone, that someone does NOT need to know you are wearing a diaper. You will see lots of internet forum discussion about concealing diapers. We think the concealment issue is over-blown, but when you are new to the diaper scene, we will concede that you will most likely be very self-conscious and feel that the whole world is looking at you and that they all can instantly detect that you are wearing a diaper. We say "hogwash" and will leave you to discuss it with others in posts and chat-forums. We predict that you will soon get past that hang-up and realize that your wearing a diaper is NOT obvious, and your fears and anxiety are unfounded.
For nearly guaranteed leak-free wear, using a decent disposable such as Attends: figure 3 hours between changes. Most of us find we can extend that to 4 or even 6 hours. But err on the conservative side until you find what is safe for you given your liquid intake (coffee, tea and soda for the most part, but beer and wine can play a significant role in the afternoon and evening considerations for some of us).
If we assume you drink a couple of cups of coffee and perhaps an orange juice with breakfast and head off to work, we'll suggest a mid-morning change, a mid-day change and possibly skip a mid-afternoon change if you lay off the coffee and beverages in general. If you are a soda drinker, you may find that you cannot skip the mid-afternoon change.
Be careful when assessing the wetness of a diaper at a change. Disposables have poor wicking ability, and if the diaper is quite wet in the crotch, it is time to change. It may be very dry over much of the rear and sides! Disposables do well up to a point and then they "fail" suddenly. You may come up to a change time and stick your hand inside the diaper and feel the back or top is dry and figure you can keep on going. With the next wetting incident you could find yourself with wet pants sitting on a wet piece of furniture. That's what we don't want to happen.
Check out the Disposable Diaper section (1A) for discussions on various types, brands and discussions by users along with various comments and opinions. We will claim that disposables have generally been poor in providing protection. That is why we strongly advocate frequent changing, as in every three to four hours. That is expensive, yes! And frequent changing is not all that convenient... diaper changes are not what we could ever call convenient! Disposables have only recently improved in quality. Our cries of indignation over poor quality and leaky performance have finally been heard. Many "premium" diapers are now available, and the internet is an ideal source to find them.
Keeping pajamas and the bed dry is a major challenge for all of us suffering the indignity of incontinence. For those who are married, there is additional incentive (or is that pressure?) to keep the bed dry. Whether or not one has a partner to consider, everyone likes sleeping in a dry bed with dry pajamas. Waking up in a cold, wet bed is a miserable experience!
Since this is a diaper primer, we'll assume you are considering diapers and have tried and been unhappy with other bed protection measures such as underpads, whether disposable or washable, condom caths with bedside collection bag, or setting the alarm to get up frequently during the night. If you are tired of wet beds and are now considering diapers, we still recommend starting with disposables, as it's most practical approach for most.
At the risk of exasperating you with repeated praising of cloth diaper superiority, let us observe that wet beds are truly a thing of the past with cloth diapers. But we'll let you come to that conclusion later on and only if you want to. At this juncture, you are wondering whether (disposable) diapers will provide you with night-time protection. The extra challenge of keeping you dry in bed calls for better disposable diapers. And that means higher costs for you.
If you'll allow a digression, let us touch on diapers leaking and when they are apt to do so. Our safest position when wearing a wet diaper is standing. Wetness is well contained in the crotch, and that wetness is not putting pressure on leg bands. Sitting is our most dangerous position and most leak prone, as pressure is put on the wet diaper material near the leg band at the back of our leg. If we wet while sitting down, liquid will be free for a period while seeking some drier portion of the diaper. This is when it can easily find its way out the leg openings and onto our pants and the seat we are occupying. When lying in bed, the same problem is there for the back of the legs and the rear waistband. For those who sleep on their stomach, there is the front of the legs and the front waist. If you sleep on your side, a disposable is at a serious disadvantage: leaks can easily occur at the waist and leg areas of the side since most disposables have little or no padding in the sides in order to be as thin as possible and as unobtrusive under clothing as possible.
If you are interested in achieving dry nights overnight while depending on disposable diapers, let us urge you to try a premium "overnight" diaper and to wear something under it, in addition, for added absorbency. The best diapers for overnight without doubt are the Molicare thick diaper and the Abena X.
Our disposable-diaper section (1A) will discuss various diapers and other products to boost their absorbency. Nevertheless, many disposable-diaper wearers use cloth at night. They get the convenience and stealth of disposables by day and the security of cloth and the comfort of a dry bed overnight.
For mattress protection, read our section (10) on protecting your own investment in the mattress you sleep on, but remember always to take along a plastic or rubber sheet to protect the mattress that belongs to somebody else!
This Diaper Primer is organized in some 15 short sections that cover a wide range of situations and challenges that diaper users meet. The topics relate both to disposable diaper use as well as cloth, although several topics, such as laundry and diaper pinning refer specifically to cloth use.
1. ALL ABOUT DIAPERS
An introduction to diapers as one way to manage incontinence and get back out in the great big wide world.
1A. Disposable Diapers
1B. Cloth Diapers
2. DIAPERS GET A BUM RAP
A discussion of the social stigma associated with diapers.
3. HOW DIAPERS WORK
Absorption and wicking explained in non-technical way.
4. HOW MUCH DIAPERING DO I NEED?
Doubling up on your underpants won't do; we explain what it takes.
5. LAUNDRY
Can't avoid it with cloth; here's what's involved in diaper laundry.
6. HYGIENE AND DIAPER RASH
The obvious and not-so-obvious is covered here.
7. DIAPER TYPES
Lots of types and styles; let's introduce you to the basics.
8. WATERPROOF PANTS
A necessity with cloth and learn what "rubber pants" really are.
9. PINNING ON DIAPERS
Our method to get diapers to fit right and stay on.
10. BED AND FURNITURE PROTECTION
Don't take chances with your own stuff or risk the embarrassment of leaking on someone else's stuff.
11. WHAT TO WEAR
Just a few tips to help you discover "diaper friendly" clothing.
12. BOWEL (FECAL) INCONTINENCE
Some tips on dealing with this difficult situation.
13. ADDITIONAL DIAPERING TECHNIQUES
Interesting ideas from various contributors.
14. CONDOM CATHS-LEG BAGS
You need this basic info to consider this option.
15. SUMMARY & SOURCE LISTING
You've got the info; no more excuses to "sit out" life!
©2005 Incontinence Support Center