At this point we assume you've tried a disposable diaper in the safe environment of your home and after some success, you have ventured out in the world and found that you can do what you want with much less worry about finding washrooms. Wetting episodes no longer have the awful consequences they may have had in your past. The diaper did its job, your clothes, car seat and all remained dry ... great! That's the way we want it. We want you to be able to get on with your life and not be held back by the fear of a wetting episode while out and about! Now you are wondering about longer periods and even about changes when not home, as you decide you're not going to let incontinence get in the way or take over your life any longer. That's just the message we want to get across here!
You now have experience with Attends or Depend ... the national brands available every place, and perhaps you also have experience with cheaper store-brand diapers. This is a good time to direct your attention to how tough it is to tell when a disposable is wet enough to change. Have you tried wearing a single cheap store-brand diaper? I hope it was just around the house in secure surroundings where you sat only on protected furniture! Did you find how quickly they will leak? Possibly by the second wetting and certainly by the third wetting, leaks become bothersome and downright embarrassing!
Perhaps you have also discovered that wearing diapers is not the end of the world, the "wet feel" is not what you thought it was going to be, and you find the whole world can NOT tell you are wearing a diaper. Hopefully, the only thing different about wearing a diaper is that you can relax and enjoy what it is you went out for; errands, a ball game or a movie.
Now, outings such as a sporting event or movie call for longer periods away from home and that requires a diaper that will last longer or must be changed while away from home. Folks are split on this issue of changing or wearing more protection. And it's a personal issue. Some are more fastidious than others and want to be clean and dry. Others feel those concerns are overrated. If odor is not a problem and the skin stands up to longer periods in a wet diaper, they would rather avoid the hassle of a change away from home. Clothing types enter the picture, too, since some want to wear pants that are tighter fitting, and perhaps they can get away with wearing a standard disposable (Attends) but a premium disposable (Molicare, Abena-X) would bulge more than they would feel comfortable with. They are faced with a trade-off between concealing bulk when wearing more diaper or bringing a diaper with them for a change so they can wear the thinner diaper.
We want to mention, as an aside, that we used to suggest doubling up on disposable diapers. That is out-dated by the advent of premium diapers. Doubling meant taking a cheap store-brand diaper and slashing the waterproof back sheet with a razor blade and then taping that diaper on first, followed by a standard diaper such as Attends, Depend and Tena. This was effective before Molicare and Abena-X became available. Now, the cost and work involved in slashing one diaper and taping on two diapers is not worth the time and effort. A single premium diaper costs less and performs better than the two diapers we once recommended for extended wear.
Let's mention some of the incontinent-wear products that are less than a diaper. Let us insert a quick lesson in semantics here. As you know, advertisements never use the word "diaper". A diaper is usually called a "brief", sometimes "full brief" or "fitted brief". Take away the wings and tapes of these briefs, and you have "undergarments" that are best described as a loin cloth, held in place (more or less) by little elastic button-on belts. The loin cloth with its protection from waist to waist through the crotch offers nothing on the sides, so there is better concealment. Next step down, shorten the loin cloth, and you have the various "pads" and "guards" that depend on mesh pants or your own close-fitting (Jockey-style) underwear to hold them in place. Some of the better pads (European, of course) are comparable to a diaper for protection, but they lack the wings and tapes of a diaper. They had a clear function before the advent of the very popular pull-on diapers now available, called "protective underwear". The mesh pants with pad are easy to pull down to use the toilet.
As you try anything new, whether it be a new diaper or combination of a diaper and an insert or pad, always assume the worst; that it will somehow fail! Experiment around the house or other safe environment. When you go out in wider society, wear something proven! We stress this point from many disasters when we experimented with something that "just had to be better" and found out the hard way that it was not; or something unanticipated happened. For your peace of mind, make it a rule to wear only proven protection when you are going to depend on your diaper to keep you and your surroundings dry.
Let's look at a work day that will generally mean 10 to 12 hours away from your home. Home is the only place where diaper changing is a no-hassle private affair. It's risky trying to make any disposable combo last reliably for 10 to 12 hours, so you have to consider changes of some sort. If your circumstances are such that you can carry or have spare diapers and a nice private place to change them, then you are truly lucky and clearly in the minority of us in the work world.
Most of us are faced with changing in the office or factory rest rooms. Some of us even have to deal with changing in public rest rooms that lack privacy and are sometimes in need of cleaning. There has been discussion on internet forums and will likely be lots more. This issue does not go away, and you may pick up some ideas and tips from others on how to get a diaper change done in a public-restroom stall. A complete diaper change provides the opportunity to cleanse the skin with a wipe, such as a moistened anti-bacterial "towelette" in a resealable packet or plastic container. For many, this additional step may be very important.
Some prefer not to do a complete diaper change when away from home. If your skin can stand up to the "neglect" of not using a wipe, simply using "Fresh Again Incontinent Odor Spray" may be successful in preventing diaper odor from urinary incontinence.
A friend has provided a valuable feminine point of view to managing incontinence with diapers. She recommends changing inserts of some sort, instead of the entire diaper. Inserts may be any absorbent product from baby diapers to guards, to pads, to undergarments.
When you tape on that "good" diaper in the morning, you will have a baby diaper or a pad, or an undergarment slung into the crotch of the good diaper. For this technique, it is not slashed, and it is important that the inside absorbent product be decidedly narrower than your good diaper. The pad will get wet first and will retain the wetness up to a point. If it doesn't get changed, it overflows or "leaks" to your good diaper. The technique requires finding the change intervals or schedule that will get good utilization out of the pad but will minimize leakage into the good diaper.
When you find that ideal time interval, it is not difficult to carry a concealed baby diaper or pad to the rest room, along with a small opaque plastic bag such as provided with small purchases. In the privacy of a stall, pull out the wet pad or baby diaper and insert the dry one. For many, baby diapers, size 6, are a good choice. They have lots of Super Absorbent Polymer (SAP). You may start your day with a Tranquility Slimline ATN diaper and change the baby diaper at mid-morning and again at noon, while enjoying several cups of coffee and orange juice. In the afternoon, if the diaper starts to feel heavy, you may pull the baby diaper out and just go with the single good diaper that your have been wearing all day. The technique may get you through the rest of the day until you arrive home and make a full change.
This routine gets around much of the concern of many folks about the noise of ripping off tapes and applying new tapes. Sliding the wet baby diaper out and the new dry one in is virtually a noiseless operation. The problems of handling and disposing the baby diaper may be easier than disposing of an adult diaper. The package is significantly smaller to hide until you can toss it. You can experiment with different items, including pads, guards, undergarments, but you may just find that, for the money, a size 6 baby diaper just cannot be matched! Most are loaded with the SAP that allow a very thin diaper to start with, one that's easy to slip into place and a diaper that will absorb some really astounding volumes of liquid considering its small size.
This baby-diaper insert technique may not work for folks with arthritic arms and hands or shoulders. You must be reasonably agile to slide your hands inside your diaper in the front and push the wet baby diaper down into the crotch. Then reaching behind you, slide your hand(s) down inside the primary diaper and pull out the wet baby diaper. You can shake some talc into the primary diaper at this point. Unfold the new baby diaper, but do not open the wings. Slide it into your primary diaper from the front, tape end of the diaper leading. Push it down and into the crotch until the front of the diaper is a few inches below the top of your primary diaper. Now reach down the back of your primary diaper and search for the tape end of the baby diaper. Pull it up your back side until it is snug in your crotch. Now, and this may be the most difficult part, take your fingers and unfold the wings with the tapes and fold them back on themselves so that the tape is not against your skin. Otherwise, the tape will be very irritating to your sensitive skin. Finally, in the front of the diaper insert your fingers and open the wings and pull the diaper up slightly to ensure that it is pulled up into your crotch. Finally, snug up your primary diaper, which has probably slipped down just a bit during this operation.
Some may do this with no undressing at all. If males use suspenders to support their pants, they can unbuckle the belt and unzip the fly to enable this insert change. It can even be done when wearing "suspender briefs" which help support the diaper and prevent diaper sag. (More on suspender briefs in Segment 11-What to Wear).
When changing the inner pad or diaper is not an option, and you need to get more wear time from a diaper, you need to look at inserts or "boosters". There is not a lot out there, and in some regions, including Canada, they are not available! There were more available before the days of Super Absorbent Polymer (SAP) that started the whole thin diaper era. The performance of the SAP diapers killed the market for booster products.
A booster is additional padding for increased absorbency with no waterproof barrier. Only one product now seems available in stores in urban United States: Depend Boost Liners. For these, you should read the package and enjoy the directions that exhort you to use them in disposable briefs... etc. In red text within a yellow box the manufacturer tells you NOT to use them in regular underwear. That gives us a laugh! It would seem so much easier to tell us directly that there is no waterproof protection with this product, it must be worn in something with that waterproof protection. If you stick a booster into regular underwear, you will have wet pants ... a dud!
You can make any diaper or guard or undergarment into a booster pad by slashing the waterproof protection with a razor blade to allow wetness to flow through the insert product and into your primary diaper. We touched on double-diapering earlier... slashing the backing on a cheap diaper and taping it on first followed by a "good" diaper. That technique is now obsolete due the premium diapers, but is worth considering if you feel you want more protection from a "good" diaper but don't like the bulk of the premium diaper. Sure, doubling a "good" diaper will be bulkier than the "good" diaper alone, but perhaps less than the premium diaper.
The most boosting that is practical, is to slash a "good" diaper and wear it under a premium diaper. Yes, it will be thick. But it will add about 50% wear time to the premium diaper. If you safely get eight hours from a premium diaper, you should expect to get 12 hours from the boosted diaper. Let's mention right here, there will be someone who will say, "Forget the cost, I want maximum protection for this wedding I need to go to; I will wear a double Molicare or double Abena X, slashing the inner diaper of course". We reply that practice is a waste of money and will go into more detail in the segment on How Diapers Work.
If you wear a baby diaper or pad with waterproof protection within your primary diaper and do not change it periodically, you are asking for a leak. The reason primarily is the very short distance between the saturated inner pad and the leg bands of your primary diaper. There just is NOT enough of your primary diaper in the path of a leak from a saturated inner pad to stop that leak.
If you are not going to change the inner diaper or pad, then it must not be waterproof! Either you have to buy a product with no waterproof protection (such as the Depend Boost Liners) or slash the waterproof protection layer yourself with the razor blade.
Using the internet is the best way to find non-waterproof boosters for your diaper. In our opinion, the best is Tranquility Top Liner Contour, available from HDIS www.hdis.com You will pay a bit more for them, around 45 cents each vs. 30 to 35 cents for most booster pads, but they fit better within the primary diaper and are equal to the boost provided by a store-brand diaper, and they save the hassle of slitting the plastic backing on the store-brand diaper.
Tapes have generally improved to the point that most are now reliable. The premium diaper we keep mentioning, Molicare, was notorious for tapes that failed by unsticking (or popping). Other diapers have had tapes fail by tearing off the diaper itself, and some have failed where the tape itself breaks.
Many feel that there might not be much utility in refastenable tapes on diapers we wear ourselves since we know by feel when the diaper is wet enough to need changing, even though they may appear indispensable for toilet use. Most likely, there is some benefit for caregivers. We feel, however, that once you've put a diaper on a few times, you develop the feel for fit and stick the tapes where they are going to stay. Almost any tape, be it refastenable or not, can be immediately peeled and re-applied when you first put the diaper on. Most tapes however, including the refastenable ones, become set after they've been applied for a while, and peeling becomes difficult to impossible. We do not recommend your planning to peel the tapes and refasten them, whether it's to check on diaper condition or allow the use of the toilet. For using the toilet, it may be a better bet to slide the diaper down like underpants, rather than to disturb the tapes.
Disturbing the tapes generally will result in tapes that won't restick at all or a diaper front that is ripped to shreds. That brings up the reinforced taping surface some diapers "feature". The front of the diaper will stand up to tape-peeling and reapplying, but the tapes will still lose some of their grip if you do re-apply. The two-part tapes common on European diapers remain a mystery to many. While they might be a tiny bit better for refastening, others have never found them particularly useful. It may be better to treat them as a standard single tape and not to attempt to refasten any tape.
We recommend duct tape because it is strong and sticks to every disposable diaper on the market. It can be peeled off the roll, torn and applied with no tools. A diaper change is a bit more difficult since the tape is tenacious and will tear the diaper apart. In most cases that is of no consequence since supplemental taping is normally done only for extended wear which typically means no diaper changes while away from home.
Filament tape (strong shipping tape) works very well and while a bit stiffer than duct tape, has an advantage with its availability in a dispenser roll with a cutter.
When changing a diaper that has been taped with duct or filament tape, it is much easier to undress and slide the diaper down, like cloth underpants, and step out of it. If you must plan to change away from home, consider carrying a small pair of blunt tip scissors with your pack of spare diaper(s) and other needs. This will allow you to cut the diaper off.
At one time every diaper made had a plastic back sheet. Then this idea of sticking a non woven layer to the plastic on the outside to give a "cloth look and feel" came along. This writer is strongly opposed and dislikes the abrasion and clamminess between the legs when wearing such a diaper. Some agree, while others swear by the improved comfort and quietness of the cloth-like outer cover. We will leave this "call" up to each individual.
We are all different in physique and in what we like for feel and fit, so "fit" of disposable diapers is a difficult section to write, and we won't be able to direct you to any particular diaper guaranteed to please you. At best, we can offer some observations and encourage you do your own experimenting.
Baby diapers seem to be very effective for children, based on reports from parents who swear by disposables for their kids and would never consider the hassle of cloth. Adult diapers, however, are not totally effective and satisfactory for the majority of us adults. Adult disposables are improving, especially in recent years, thanks to more padding and more polymer gel. In that regard, adult diapers are starting to catch up with baby diapers, but they have a long way to go! Out of curiosity this writer once weighed a size-six diaper and one of our premium diapers and then compared the weight of the diaper to the weight of the wearer. The kids are getting a LOT more diaper than we are!
The first major fit difference is the baby diaper has a bikini-style fit with single wide tapes on both sides. I've heard of people recutting their disposable diapers to achieve that "fit" but I really doubt that it would accomplish much, and I think it probably would be detrimental. Proportionally, adults have bigger thighs than kids. I think that is the reason we need a diaper cut so that we have a lower tape to achieve a leg band type fit around our thigh (upper leg). The diaper also needs to be snug to prevent leaks from occurring at the back of the leg when sitting down. That is the absolute weakest part of our diaper, and no diaper stands out as best overall, but the premiums and any diaper that fits your body and gives you a snug fit at the back of the leg fit will be better at preventing leaks while seated.
Assuming you've tried the major national brands, Attends with six tapes and the Depend line, you've experienced the fit of these particular diapers. If you've experimented with cheap store brands for inner booster diapers, you know how they fit and probably have discovered that the cheaper diapers do not fit as well as the better diapers.
We happen to like Tena, and internet forums report that others think the fit of the Tena is decidedly better than most other diapers. Users have said the cut of the wings and the tape placement was as though it was custom made for their body. Don't overlook Tranquility; that company makes both a regular and an overnighter called "ATN" for "all through the night". This diaper is hardly ever in stores but always available on-line. When Tena introduced the cloth-like outer backing instead of the smooth plastic cover, some of us stopped using that product. Tranquility has a good fit, but it isn't quite up to the Tena fit. They've stayed with the plastic backing, however, that some of us find more comfortable due to the "slip" allowed by the plastic when you perspire a bit. Some other folks think the Tranquility fit is superb, and they like the absorbency and dependability as well. Of course, there are others who have found the "peach mat" interior very irritating, so keep that in mind when you try them.
All the European diapers are great for absorbency; all beat out most of the American diapers in that category. The undisputed king is the "Molicare thick". Absorbency is its major advantage and it is worth the premium price. Many folks will get adequate protection from a Molicare thick worn as a single diaper. For overnight, the Molicare thick will serve the needs of most. Worn with a slit booster diaper underneath it should be adequate for nearly anyone. For those of us who drink a few beers before bed, we will find better results with more boost provided by a thin Molicare, slit, worn under the thick Molicare.
A bedpad is always a good bet. Your mattress should be well protected (read the chapter on that subject), but for those times you sleep in a hotel or at a friend's house, a bedpad can provide essential extra protection from a leak that is always a possibility with any disposable combination.
We talked enough about tapes and fit, so now we just want to touch on actual flaws with the diaper itself. Clumping is one of the worst faults which affect many diapers. Clumping occurs when the padding falls away from the front and rear of the diaper, inside, and drops into the crotch. This leaves little or no padding in the front or rear. Extended wear contributes to this problem. Attends is one diaper that has a problem with clumping. Many cheap-store brand diapers have this problem, as you would expect. I have not experienced any clumping with Tranquility, Molicare or Abena. Splitting: This is a fatal flaw caused by a weakness in the plastic back sheet that allows the plastic back sheet to split, usually along the backside and often right along a glue line where an internal feature such as a leak cuff is added to the diaper during manufacturing. Tranquility and Abena have had such failures in this writer's experience. This is one time you would really want to be wearing plastic pants over a disposable ... just in case!
Perforations: One has a right to expect the waterproof plastic backsheet to be, well, waterproof. So it's a bit of a surprise to rise up from a chair only to find wet spots and your pants wet. On closer examination, pin holes are found in the plastic backsheet, randomly located. Quite likely, the rolls in the diaper machine are not set just right and they damage the backsheet. If the diaper is changed frequently, as you would do with dry diaper wear, the pinholes would never be a factor. Given extended wear the pinholes weep liquid. Many cheap diapers have this flaw, but so did a favorite, Tena, at one time. This flaw is a "now and again" thing, since it is caused by adjustments to the diaper making machinery.
To conclude this disposable section, let's talk about incontinence products that are not considered diapers. We started you right off with maximum protection products (diapers) since this is all about getting you over your fear of leaks and getting back out in that big wide world. If you start with inadequate protection you will be further frustrated with ongoing leaks and feel your case is hopeless and you are doomed to a life of leaks and isolation. Well, baloney to that! We want you to tape on a diaper, forget about your incontinence "problem" and get back out there and enjoy life!
But all of you may not need all the protection afforded by a diaper, so let's do a quick run through of the other incontinence products you will find on the shelves or at your mail order/web location. Pads and drip collectors are the minimal level of protection good for leakage of a few drops here and there. Giggle or stress incontinence very often can be managed with nothing more than a pad in the underpants. Men with an annoying dribble often find they can get by nicely with the little "sheath diaper" that is also held in place by the underwear. Pads are small and very discreet, so carrying extras and changing them when you use the toilet is fairly easy.
When the level of protection needed is more than what a pad can handle, there are "undergarments" which are simply larger, longer pads that run from front waist to rear waist and generally are wider than the underwear pads. These "undergarments" can be worn alone, using elastic straps that button or velcro on. Another version has a built-in waistband. Loin cloth is the best way to describe all of these. This writer has never found them comfortable or adequate, but the major appeal is stealth! With nothing over your hips, concealment is much easier. The "undergarments" do maintain the advantage of an easy on-easy off function for those who can use the toilet. But for many, the thin wings of a tape-on diaper add almost nothing to the hips while adding a lot of comfort and security.
That easy on-easy off feature to facilitate using the toilet extends to tape-on diapers with the elastic waist band. For those can't use the toilet, we tape a diaper on to stay and want it snug to stay up and comfortable as it gets wet. But many have claimed that elastic waist band diapers are a big help in creating a pull-off then pull back on feature that lets them use the toilet when they can. Male users may tape the lower tapes snugly but the waist tapes loosely. That technique allows the front of the diaper to be pulled down enough to use a urinal.
The proceeding was a bit of history to bring you up to the latest and greatest thing now happening - "protective underwear", or what a lot of us call "Pull Ups" but that term is a protected trade mark, like Coke and Kleenex, so we will call such products pull-ons! Naturally, the whole idea started with the pull-on diapers for kids; a bit of a ploy to use diaper stigma to push toilet training along. Get the kid out of "baby" diapers by a certain age, and keep the dry pants and dry beds going with the new and effective pull-on. Now, what are we going to call these things that no one will want to call diapers? Oh yes, training pants! or disposable absorbent underpants! Of course! That will work!
Well, the same concept has now taking the adult incontinent shelves by storm! Disposable Protective Underwear is now the buzzword, and these pull-ons taking over the shelves! Looks like regular underwear! Feels like regular underwear! Fits like regular underwear! Pulls on and off like regular underwear! Protects like a diaper!
No! you won't find that last claim; diaper stigma is at work here! It's too bad, but diaper stigma is very real! While many of us can laugh about it now that we've overcome our initial aversion to diapers, a whole lot more of us are still having real problems with the idea of wearing a diaper. For them, pull-ons are going to provide a very real element of protection and allow folks to get back to their lives. This writer knows that diaper stigma keeps a good friend from enjoying social outings. She absolutely won't go to a social event. You have to go to her house. Period. She will not wear a diaper! I introduced her to the pull-on product, and while it did not meet with the same out-of-hand rejection as a diaper, we still suspect that it hasn't been worn yet, either! So enough on diaper stigma, we do NOT want to minimize it because it is very real and very powerful, and we know that we can talk forever and never convince some folks that the answer is a diaper because they just won't wear a diaper! Period, end of story! It is my hope that these pull-on products will help some of those folks with that insurmountable diaper stigma.
The other substantial advantage of the pull-ons is ease of using the toilet. Even a urinal can be easily used by men because the elastic waist band is very stretchable, and it's easy to pull the waist band down for urinal use, even in a public setting, without fear of detection. The drawback to the pull-ons is changing them when you have an accident and get them wet. Because they are pull-ons, and pull on like regular underwear, it means you need to be undressed to pull them on ... no pants and no shoes!
A good tip we have heard from someone who does not object to the bulk of wearing two pairs of pull-ons. His incontinence is of the frequency and urge type, so he needs to urinate often and can't wait long when the urge arises. He does want to use the toilet when one is readily available, but any protective product he wears is going to get wet and must be changed periodically. He goes about his routine, and when the inner pull-on gets wet enough, he removes it by tearing the sides. All of these pull-ons are designed with easy tear side seams. Now he disposes of that one and has a fresh one already in place so he doesn't have to undress!
Enter the newest item of all; Refastenable Underwear! Now that idea is the best of both worlds. Protective underwear that has tapes ... like a "you know what" so that you can refasten it for a better fit or, I would imagine, changing it on the run in a public rest room where you cannot easily undress.
We don't feel well qualified to rate all these new products. But the internet forums and chat rooms now provide a way to get the latest information on and reaction to the latest products. As a general observation, we would say that pull-ons are not really "you know whats" and cannot afford the same protection afforded by the "ah-hem". If they are going to get used and wet, they are going to become heavy, and the elastic waist will not be able to keep them up or comfortable. This writer's opinion is that they are very useful and valuable for those who do not plan to get them wet and are wearing protection primarily for peace of mind or for that "just in case" situation.
So "disposable diapers" cover a wide array of products that vary from the full, fitted brief that extend from the waist downwards with tapes along the sides, to various types of pull-on products. The latter are thinner and can be worn without difficulty under almost any clothing. They provide greater flexibility for those who occasionally use the toilet and who need protection only in infrequent cases. The capacity of pull-ons is less than a full diaper brief, and they require frequent changing. Failure to change frequently results in embarrassing leakages. So the array of products ranges from commercial distribution with slim but often undependable fit to well-constructed briefs with ample padding for longer protection. These thicker and far more dependable styles are somewhat more expensive and are usually available only through internet suppliers. The choice is wide indeed!
©2005 Incontinence Support Center