www.incontinentsupport.org

For many people, incontinence is a distressing condition: the embarrassment of wetting or soiling in view of others; for some, even the embarrassment of friends or colleagues finding out that they are incontinent by seeing their supplies or noticing the outline of their incontinence wear through tight-fitting clothes. Incontinence is not a fun condition: I take any opportunity to make it less depressing. I have had much correspondence on social media with ladies who are incontinent and have children, a sibling or a friend who is too. They tell me that they have been able to reduce the distress by making the changing of their incontinence wear a time of arousal for both; simple things like showering together, changing together or touching each other while changing have made incontinence less distressing for them.


Many people are reticent to talk about incontinence. Finding the best kind of protection is a big concern. Brand names are often used instead of generic names; even generic names are not always precisely used with the same meaning. I am often left confused about what kind of incontinence wear is being referred to. The sex of the intended user is not always specified on the packet. Maybe there is no need: perhaps it should be left to the user to choose whether they feel it would be suitable for them. There are several types of incontinence with different amounts and regimes of leakage (Urinary incontinence - NHS (www.nhs.uk; Bowel incontinence - NHS (www.nhs.uk)): which partly accounts for the variety of protection. A good way to start the search for suitable protection is the Internet. Typing 'How to choose incontinence wear' into your search engine will reveal much useful advice but it will be as well to remember that most of it is posted by firms who sell incontinence products. A click on incontinence pants - Google Search or incontinence knickers - Google Search reveals some of the enormous variety. This can be followed by choosing a few of what look the closest to your needs; then a click on these sites to follow through with your requirements - size, level of absorption, appearance, cost ....

I have been unable to find on the Internet good sites explaining how incontinence wear can be fitted and changed - except on some sites advertised as pornographic. I have just been watching a video on how to change a diaper in which the lady model was fully clothed. The diaper was fitted on top of her close-fitting trousers - not the best place to wear a diaper! I would agree that most pornographic sites about incontinence are silly and disagreeable but I have found a few which give useful demonstrations of how to clean and apply antibacterial cream or powder as well as showing clearly how the diaper or pull-ups are made. https://sasporn.com/dvds/pampered-penny ... ime-night/

If sites such as this are pornographic, them I am engaged in pornography every morning with nurses and carers when carrying out their duties.


Many people express concerns on social media about whether incontinence wear will be detectable beneath outer clothing; some feel restricted to clothing which will hide the fact that they are incontinent: so a less bulky alternative might be preferable so long as it does the job. Some are concerned about keeping their incontinence products out of sight of others, such as where to put spare pads and pants when at their place of employment or going through airport check-outs. There is also the issue of how we feel about the appearance of our incontinence wear when it is seen by nurses, carers, partners or whoever. Certainly manufacturers pay attention to making their products look attractive, in many cases, as close in appearance to normal underwear as they can.

For some, life style will influence the significance they attach to appearance. I spend all day in a wheelchair and all night flat on my back in bed. More active people are perhaps likely to be more concerned about whether their incontinence wear is hidden by their outer clothing.


TYPES OF INCONTINENCE WEAR
There is some imprecision in defining what is incontinence. Long before an accident in 2013 made me doubly incontinent, I wore paper towels in my underwear to soak up any dribbles. I did not think of myself as being incontinent. How much dribbling makes someone incontinent? How often must a considerable accident have to occur for someone to be incontinent?
Many kinds of normal underwear, both male and female, have a double layer or gusset where there is likely to be a small amount of leakage.
For those who are more heavily incontinent, protective wear is often thought of as being in two groups: pull-ups and diapers. Pull-ups are those which are held in place by a continuous waistband like normal underwear; diapers are those which open at the waist. Each of these two main groups have many varieties. Some of those with a continuous waistband are sometimes referred to as 'diapers'. Perhaps whether they open at the waist or pull up is not important - but it does make some difference to how they are put on and changed and to their appearance: pull-ups are perhaps closer in appearance to normal underwear, a significant consideration to some users. It is also related to their capacity and level of protection: low capacity pants are usually pull-ups whereas high capacities can be accommodated by either pull-ups or diapers.

Pull-ups
There are many kinds of adapted pants and knickers on the market for light incontinence. There are many brands of washable or disposable pants and knickers adapted to take pads or with absorbent areas. Some are intended to be single-sex. The pads when sold separately can be single- or unisex. Fixation pants and knickers are non-absorbent; it is the incontinence pad that they 'fix' (hold in place) that is absorbent. Many are unisex - no front exit. The manufacturers often just refer to them by their brand name chosen to give a hint of what they are; mine have a pictogram to give a further clue, announcing that they are fixation pants for incontinence pads in microscopic print in 20+ languages on the back of the packet. Another minute pictogram showing how to determine your size (from your waist measurement) shows a figure of indeterminate gender, leaving the sex of the intended user equally uncertain.
They are more stretchy than is usual for ordinary underwear and so take a pad more readily. The pad can be unisex or female according to the length at the front. Ladies who have fairly heavy incontinence might prefer a longer front as for unisex pads.
Most kinds of pants or knickers for light incontinence are pull-ups but some can be used for much heavier leakages. I use my fixation knickers with a pad of 1,200 ml. capacity but could take a pad of greater absorbency.
Whether the pad is fixed to the pants, such as in a pocket, or just covered by them might be significant for those who have an active lifestyle. Some fixation pants, including mine, allow the pad to be moved a little in them.

Some kinds of incontinence wear consist of a waistband to which a pad with adhesive patches fixes to it. I am unsure whether these are pull-ups or diapers or neither; they are just pads with a means of holding them in place but not covering them. I was issued with some on a recent hospital stay: on returning home I got rid of them as soon as possible.

Diapers
These open out flat. A large absorbent pad to covers the area likely to be affected by urine or faeces. Usually they have plastic sides with one or two adhesive tabs, or in some kinds of diaper, 3 or 4 studs on each side to hold them securely around the body between the groin and the waist. Diapers can be bulky: some users would feel that they would not like to wear close-fitting trousers or other outer wear which would reveal the outline. They can also make a crinkling sound as the wearer moves.
Cloth diapers (USA)/nappies (UK) are made of square, absorbent, washable material held in place by safety pins or something more modern. There are many brands of cloth diapers/nappies shaped like plastic ones with fastening studs at each side. Occasionally they are referred to as 'napkins' but in the UK, this is more usual for smaller squares of lighter material used at the dinner table to clear up stray bits of food from around the mouth or fingers or to prevent the soiling of clothes - similar in purpose to nappies but at the other end of the alimentary canal. In the UK, 'nappies' usually refer to babies: some adults would be offended if their incontinence wear were referred to in this way.

Pants made of plastic, rubber or other waterproof material can be worn over any of these types of incontinence wear for extra protection.

Diapers, pull-ups, fixation pants, nets or knickers with many brand names are really all variations of ways to hold a pad of absorbent material in place and to be able to get access to it as needed. The differences between the variety of incontinence wear amount to a few features: amount of absorbency; whether they open with tapes or studs (diapers), usually at the sides or whether they are sufficiently stretchy so that no opening is needed (pull-ups or fixation pants); material used: waterproof (usually plastic or rubber) or textile; washable or disposable. This is likely to affect cost. My washable fixation pants cost very little. I use only about six per year. The last pack I bought cost £6 for 25. I use one disposable pad per day costing around 30-35p.
Are Washable Incontinence Knickers Suitable for You?
Clothes washing and incontinence | Mumsnet

MY CHOICE
When choosing knickers the thoughts going through my mind are arousal, appearance and protection of my outer clothes. In 2013 I had an accident resulting in spinal injury at the base of my neck with paralysis from there down, spasticity (muscle contractions and spasms) and double incontinence. Both my anus and my urethra have been left closed except with manual intervention: I rarely pass urine via the usual route (I have a suprapubic catheter); nurses visit on alternate days to give me a bowel evacuation. Sometimes I do have faecal leakage such as when I have a stomach upset: my pad is an insurance against such leakage.

I have tried several kinds of men's underwear without being fully satisfied: gusset not big enough to cover my penis and my anus; front exit awkward to get out to urinate; waistbands deteriorating quickly. I like to keep my penis pointing upwards with my foreskin lodged under the base of my glans: some kinds of men's underwear, such as those where the front exit is an inverted Y shape, seem to be suited for men who keep their penises pointing downwards. I do not find that good for arousal.

For many years now, I have been wearing unisex knickers, (Abena Abri Fix large ref:9251 or Allanda iD Expert Ultra Large ref: 5400300250. They can be washed many times and last more than three months. The most recent pack of 25 that I bought cost about £7. (Usually there are discounts and reduced delivery costs for larger orders). They are made of lightweight lycra netting, and having no gusset, are intended to hold a pad. I wear an Abri San Premium 5 pad, big enough to extend from an inch or so below my navel to the top of my bum crevice; capacity 1,200 ml; cost about £12 for 36. Unlike sanitary pads, incontinence pads have a hydrophobic layer which draws liquid away from the skin and reduces the chances of rashes Products to help with urinary incontinence - NHS (www.nhs.uk) . My knickers can be pulled up to take a full erection, when the sides are about 8 inches or rolled down to 2 inches. So my penis points upwards with my glans and bum hole rubbing against my pad, giving a very exciting feeling; the pad soaks up anything coming out. Their stretchiness makes them suitable for urinating by the 'over the top' or the sitting down position.

I find that briefs such as these tend to be tight around my groin, the boundary between the top of my leg and my pubic triangle and cheeks, so I buy a size larger than my waist measurement indicates. Sometimes I buy a version of knickers with short legs (Abri Fix Pants super about £7 for five or Allanda iD Expert about £9 for 25). These reduce the issue of tightness and also that briefs occasionally come adrift at the crotch. I am not particularly keen on their appearance but the legs can be rolled up.

Welcome.

I feel inadequate to respond to your thoughtful post. Perhaps you should aim your concerns and questions in the direction of a continence nurse. Living as you do from bed to wheelchair makes anything I might type, however well intended, irrelevant. Your situation and the ways you deal with it make your contribution here invaluable. Thank you, and report back when you can.

Thank you for your kind reply, Patrick. Not much has changed since my post. Increase in urinary sediment has meant that I have to take more Nitrofurantoin to prevent catheter blockages; also bowel incontinence has become something of an issue but I hope that will be temporary. Again, thank you for your kind words which mean a lot to me.

Most likely, the reason for the ban on underwear and incontinence wear in the hospital was to prevent pressure sores and dysreflexia which can occur when creases or seams dig into the skin, especially if you don't have sensation. Once you're out of hospital, you can decide how you deal with incontinence but underwear is still discouraged.