The New Diaper Primer

Chapter 6: Hygiene And Diaper Rash

Somebody once said: "When you can smell yourself, others have been smelling you for days!" OK, that is a rather scary thought but one that we should all take to heart. When we are diaper-dependent, we are eliminating in our diapers what most eliminate in the toilet and flush away. Let us say right off that normal urine is nearly odorless. And urine is also quite sterile, and not normally replete with bacteria. But odor can and does arise from bacteria on the skin breaking down the chemicals and salts in urine. We fight this odor with showers, some choosing daily showers and others choosing every other day or, like the pioneers, once every year in the spring.

Note: Bacteriuria (bacteria in the urine) is ALWAYS associated with a urinary tract infection (UTI). Those bacteria may come from the kidneys or arise directly in the bladder, but in either case there is a UTI that requires medical attention. (The editors are grateful to one of our readers for this important observation.)

When you choose diapers as a method for dealing with urinary incontinence, you have to accept the additional skin cleaning that diapers entail. Twenty-four hours is about the absolute maximum that your skin should be expected to go without a thorough soap-and-water cleansing. A frequency of every 12 hours is much more satisfactory, and it shouldn't pose any special hardship for most of us to take a shower both morning and night. We are accustomed to taking the morning shower. The evening shower need be only from the waist-down to wash that part of the body covered by diapers.

Disposable wipes, especially those with anti-bacterial cleansing agent, serve well for the "through-the-day" diaper change(s). They are available in packets as well as plastic containers with a "pull-up" feature on sale in drugstores and supermarkets. Many like the freshening-up afforded by the wipe. The anti-bacterial agent provides temporary protection against odor-causing bacterial build-up. Powder is a necessary extra for most, and we'd recommend one of the deodorant powders such as or similar to the national brand "Shower to Shower". Every little bit helps when it comes to fighting odor.


A bath is a real luxury for which few of us find time. The shower is more likely to be the usual daily routine. We highly recommend the personal shower attachment which gives you a hand-held shower head connected to your original shower head by a hose. It does not change your taking a regular full-body shower hands-free which you may choose to do mornings or nights. It is indispensable for that second shower where you don't need or want to cleanse your whole body, get your hair wet and so on. In case of these partial showers, the hand-held personal shower head is perfect.

Most of the counsel that we pass along here derives not only from personal experience but also includes advice from a dermatologist. It would be a good idea for you to consider consulting a dermatologist occasionally. Your primary-care doctor may serve you well most of the time, but quite likely he/she has little practical experience with disorders of the skin. In addition, since your doctor is not a pediatrician, he/she may have little more practical knowledge than your own from parenting about diaper rash. More on that topic below.

Washing consists of: Wet; Lather; Rinse; and repeat at least once and if you have time, twice is preferable. That is good skin cleansing. And DON'T SCRATCH! That means: do not use the finger nails! When you pre-wet your perineal (diaper) area and lather with soap and are massaging the lather, any tendency that your skin has toward itchiness will make the massaging feel good and scratching will feel even better. DO NOT SCRATCH! You can do plenty of skin damage with your finger nails even with a thick layer of lather that you think is lubricating and protecting your skin. You may even rationalize that gently scraping your skin by using your fingernails is getting your skin cleaner... hence better. NO! says our dermatologist. Massaging the skin with the finger tips is adequate abrasion to accomplish cleaning. So too is a sponge or soft bath brush. The cleaning is done by the soap picking up and suspending "dirt". That makes the rinse important. A second soap, massage and rinse clean even more thoroughly, and a third cycle is ideal. Then your skin is clean and not unduly abraded by the cleaning process.

While we enjoy using a deodorant soap, our dermatologist feels such soaps contain overly harsh detergents for cleaning. He advocates a mild soap such as Dove or Ivory. We compromise and use my "strong" deodorant soaps until we run into a rash problem and will use the mild soaps while fighting the rash.

Drying is another excuse to abrade (scratch) the skin. Rubbing briskly with that towel feels good on the slightly itchy skin, doesn't it. So that means DON'T DO IT! The name of the game here is to take care of your skin, not to heap additional abuse on it. The skin in your perineal area is already being somewhat abused by constant wetness and assault by more bacteria than would be normal for dry skin. Keep that in mind when you are washing and drying this skin area that is already sensitive and being further stressed by the necessity of wearing diapers! For using "Wipes" between shower cleanings, a "baby wipe" should be fine for your skin. If you choose an adult product (which you may wish to because they are generally larger), read the package carefully to see what's in them. You do not want alcohol as an ingredient. It's a great cleanser, and it dries quickly but it also strips off your natural skin oils leaving your skin dry and more vulnerable to abrasion.


I suppose it's fair to say diapers cause diaper rash... hence the name! Any rash is generally a skin irritation which can result in redness (inflammation), itching and soreness. The most common diaper rash is simple irritation of the skin and responds readily to treatment. The more difficult diaper rash is more like athlete's foot or "jock itch" where the itchiness is generated by micro-organisms that have taken up residency on your skin and are not dislodged by washing. Medicated creams, ointments and powders are necessary to kill such critters to restore peace and tranquility to your skin.

Let's discuss the more common diaper rash first. Diaper rash is a signal that your skin is not happy. Simply being wet is not the problem, but wetness along with rubbing or abrasion will bother our skin. The dry diaper will cause little or no rubbing (abrasion) as we walk along in our daily activities, but a wet diaper will be far more abrasive to our skin. As we walk along, the movement causes skin to rub against and be rubbed by the diaper on the inside and the plastic outer sheet or pants on the outside. The outside rash spots will be found on the inside of the thighs and can be effectively helped with powder, used as an absorbent for perspiration and a dry lubricant between the plastic and your thigh skin. Inside the diaper, the rash spots generally are the buttocks, right where you sit, and perhaps the "panty lines" along the bottoms of your buttocks, as that is where waterproof pants leg bands will generally ride and can create abrasion with movement resulting from normal moving around.

Disposable diapers have an edge over cloth diapers when it comes to diaper rash, primarily because disposables need to be changed more often than cloth diapers. Now that's not to say you can't change cloth diapers more often but the question is: Will we do it? On the other hand, there are many who find that the chemicals present in disposables bother their skin, and they are much better off in cloth diapers. Our individual skins vary so much in sensitivity and what will or will not be tolerated. Therefore we urge you to be careful in applying any advice you obtain here or on the internet. We try to be as general as possible but, still, what may be fine for 99% of the folks may not be for you!

With cloth, you should help that skin on the inside by choosing a very soft inner diaper. In our "Types" segment we tell you about the different cotton fabrics and their absorbency. A judgment call on how the different types will feel to your skin, especially after becoming wet, will be pretty much up to you. We think gauze is an ideal material to have next to the skin, with other materials such as flannel or birdseye and so on, that work well in the outer diapers. Terry cloth may appeal to you because the loop construction may provide a springiness that your skin finds non abrasive as you walk along. Our pinning technique (four-pin method) ties into this as the object is to create "legs" or "cuffs?" that tend stay with your leg as you move and minimize movement between the wet diaper cloth and your skin.

Diaper-rash ointments and creams can be very helpful, but, again we advise caution due to individual differences in skin and what can be tolerated, in contrast to what may cause more irritation and other problems such as allergic reactions. Zinc Oxide is an tried-and-true medication that has been successful for most people. "Desitin" is a well-known national brand of ointment, and there are many others, of course. If you remember "Vaseline" from your childhood, that was a standard for dealing with or preventing diaper rash. We use a diaper rash cream overnight as a preventative measure. The greasy creamy aspect of the stuff acts as a moisture barrier to some extent, keeping wetness from the skin for some period of time. It also keeps zinc oxide in the area to combat the bacteria influence. And, it is death to plastic pants; which we will address further in our waterproof pants segment. While we mention Desitin, the national brand available virtually every place, there are certainly others including A&D Ointment which should be considered by those with sensitivity to zinc oxide, as the "original" A&D is formulated without zinc oxide.

Then, there is a premium ointment, called Triple Paste, that is very effective and quite pricey. It is available from Summer Laboratories. If we think that Desitin is "expensive", we caution you that Triple Paste is nearly double that cost. It may be worth a try if you acquire a diaper rash that won't respond to the usual above-mentioned ointments. If it doesn't respond to the Triple Paste, you then must consult a health-care professional as you probably have a skin disorder that requires a prescription ointment.

Following an evening shower we will apply "Desitin" to the most sensitive spots for rash. We add powder liberally between the legs while diapering with cloth diapers and then powder again after pulling on rubber pants (which survive the Desitin somewhat better than plastic pants) making sure that the leg and waist bands are powdered. So we start the night off as dry and well lubricated with powder as possible.

For daytime, when not using Desitin, we are wearing plastic pants. As perspiration eliminates the external powder between your thighs and water- proof pants, you can replenish that as needed during the day. During diaper changes you can replenish all the powdering. Since we don't have a problem with zinc oxide, we will use medicated powder with zinc oxide for the mid-day change done without the benefit of a soap-and-water cleansing. As a second, less thorough alternative, use of an anti-bacterial wipe will provide temporary protection until a full cleansing at night.

Combating diaper rash - DRY-OUT.

The easiest way to minimize diaper rash and to deal with mild cases is to stay out of diapers as much as possible. Remember that diapers are to protect you from embarrassment out in public. When you are in the privacy of your home, you can protect the furniture instead, and get some "air-out" time in for your perineal area skin. If you live alone, there should be no modesty issue. If you have live with spouse and children, then we cannot recommend sitting around naked, or nearly so! A loose bath robe can serve as a cover up while allowing good air circulation to the private parts for air-out time. One of those long night shirts, like a tee shirt but extend to your knees, are great for this, and they wash easily when you experience the inevitable leak and get it wet. Use time that you spend in front of the TV or at your computer for this "dry out" time. Adequately protect the furniture with a rubber sheet or a waterproof pad; add a nice thick towel or a couple of diapers, and then enjoy your TV, computer routine, or whatever. Most of us can find two or more hours of dry-out time this way everyday.

Need I remind you of Murphy's Law? If your incontinence gives you no warning, and you get up to go to the fridge or answer the phone, guess what's going to happen? So take a towel or diaper with you and hold it in an appropriate position! We don't want to hear about your taking our advice about "airing out", and then you wet the Oriental rug, and your wife threw you out! We could not blame her; we'd throw you out, too. That's being irresponsible!

You can find other air-out time which isn't quite as effective but is still much better than a full diaper. Again, while you are in the privacy and comfort of your home and you can control your surroundings, you can get some air-out while doing chores. Washing dishes? The kitchen floor is a safe (waterproof and washable) surface. Wear a pair of cotton underpants with a small diaper slung into them. No waterproof pants (of course). This will allow some air circulation, and you should feel the warmth of a wetting in time to grab the diaper (or towel) that you have within easy reach. When the wetting stops, the towel/ diaper and the underpants go into a plastic shopping bag that you also had handy ahead of time. Wipe up the few drops on the floor with a paper towel and a squirt of bath-&-kitchen cleaner to disinfect. The plastic shopping bag lets you carry the wet stuff through the house to the bathroom diaper pail without dripping on the rugs. You pull on a fresh pair of underpants, sling a small (toddler size) diaper into them and grab a fresh big diaper or towel to have close at hand for the next wetting incident and go back about your chores. Yeah, it's not super-convenient, but your skin will be very happy for it and diaper rash will clear up much faster and easier.

The next level of dry-out time may not seem as though it would be any better than wearing a diaper, but you'd be surprised how air will manage to circulate a little bit. Again, controlled conditions in your home and be on a safe surface for the most part. Use any of the "lesser" disposable incontinence products. The newer pull-on underpants are great for this. The sides are completely breathable and your walking around tends to pump air through the sides and into the "mini diaper". It will hold one wetting, but probably not a second... you'll have to experiment and they are perhaps a bit expensive for this use and don't allow very much air circulation. Our favorite is the relatively new pull on "undergarments".

Since all disposable products are costly, and we are promoting cloth-use here, we'll conclude this dry-out topic with cloth diaper pants or "training" pants as some may call them. The Canadian supplier Kins makes an excellent diaper pant that has good crotch thickness (protection ) while the sides are thin and let air through readily. Unless you are going to be sitting on a safe surface or standing on a safe surface, you will need waterproof pants, but at least you can wear nylon pants which have some breathability and you will change the diaper pant as soon as it gets wet to continue "dry out" time for your skin.

Now for the NASTY diaper rashes

They can start the same as the mild diaper rash. Wet skin has been abraded from rubbing by diaper fabric. Germs and bacteria get together and have a heyday and cause more skin irritation and break down. Sometimes a fungal or yeast infection can get established. These are nasty micro-organisms that don't wash away! They thrive in a warm, wet, dark atmosphere, exactly those conditions inside your diaper.

Most likely you will need help if you get a case of nasty diaper rash. This is the reason for having a dermatologist all lined up - one who knows you have to wear diapers. When you make your appointment, and get to the hard part, such as "What seems to be the problem?" you can simply say "diaper rash". We have done that several times before ending up with our current doctor, and it really is no big deal. They do understand and generally don't go out of their way to embarrass you but...let us not delve into endless stories at this time.

By examining the rash your dermatologist will be able to diagnose what is causing it, and you will most likely get a prescription for something like or similar to NYSTATIN or, a more potent version such as NYSTATIN / TRIAMCINOLONE ACETONIDE. The dermatologist will tell you exactly how to use the preparation, and you'll be expected to keep the area as dry as possible. For the men, a reasonable solution is an external condom catheter and leg bag. If that simply isn't in the cards, then you need to at least switch to dry diaper wear - change the diaper every time and as soon as possible after wetting. Some of us can't really do that, so we go with wearing the leg bag option. Even if you have to stay in diapers by day at work, as soon as you get home, get out of the diapers and start using one of the dry-out techniques we've discussed.

For bed time, try wetting the bed. Yeah, we know how lousy that is, but the infernal itch of a bad diaper rash is worse! Unless you live alone, this may not be an option. Or, perhaps you can sleep in a different bed from your spouse while you are getting rid of the diaper rash. Your mattress should already be well protected! If you don't toss and turn, you may be able to use the disposable bed pads, called under pads. Try to sleep on top of five or six of them. When you wake up wet, pull the wet one out from under yourself and toss it in a handy trash receptacle you placed next to the bed for this purpose. Go back to sleep on the next pad down which is dry. Repeat with the next wetting. If you only wet 4 to 5 times a night, this should work satisfactorily. If you can't work out a deal with the slippery under pads, consider towels and squares of plastic. Shower curtain would work as would a plastic mattress cover. Both are cheap. Cut them to the same size as the towel. Secure to the towel with a few diaper pins and you have a flat, bed version of plastic pants and a diaper that you sleep on. When you wake up feeling it wet, slide it out and into the bedside container; go back to sleep on the next one down.

These aforementioned techniques are geared toward not having to get up in the interest of minimizing sleep disruption. If you can't stand sleeping on a stack of pads, then try one plastic or rubber square over your bottom sheet and put a heavy towel on it and sleep on that. When you wake up wet, you get up and pull off the wet towel and put down a dry towel and get back in bed.

By the way, all of the above involve sleeping in your birthday suit! If you wore pajamas, they'd be wet and more interruption to change out several times overnight, so you should sleep "in your skin".


As we have already mentioned, normal healthy urine has no unpleasant odor. You should not restrict fluids to reduce your chances of leaking because you risk dehydration which is injurious to your body. The resultant urine which you produce when you are not drinking enough fluids is darker, more concentrated and harsher on your skin. Because it is concentrated, the bacteria normally present are greater in numbers and can start breaking down sooner to cause odor. Several hours in a wet diaper should never result in any objectionable odor as long as you have done your part in skin hygiene and diaper washing. Odor is time-related and can also be influenced by the things we eat and drink.

Let's stress this "time-related" concept. When you first wet a clean diaper there will be no odor. Even subsequent wettings will not usually produce any noticeable odor. The relatively mild odor of normal fresh urine is usually well contained by your plastic pants or the disposable diaper (some, such as Tranquility, utilize a deodorant in the diaper). But time is your enemy. Time is what allows bacteria to start breaking things down and creating odor. The one odor we need to avoid scrupulously is ammonia odor. Ammonia is a byproduct of bacterial break down, and it means only one thing: you wore the diaper too long before changing it! If you keep both your skin and your diapers clean, you should never sniff ammonia odor unless you really stay in a wet diaper for an extended period of time... about 10 to 12 hours. That is enough time for ammonia to form no matter how clean you and your diapers were to start with.

If you get ammonia odor after only 6 hours, you should check how you wash your diapers and whether you are thoroughly washing your skin twice a day. It takes time for ammonia to form from a fresh start, but if there is any trace from the past, it will form much more quickly.

I've been stressing that you don't want ammonia, and are two reasons for this - not just because it is a dead give-away diaper odor. Ammonia is very harsh on the skin. It will give you an almost instant diaper rash. By being concerned about ammonia in order not give ourselves away by a distinctive odor, we are going to be doing our skin a lot of good!

Deodorants for cloth diaper wearers

There are lots of them. Let me share two stories with you, and you can decide what you want to do for yourself. For some time, this writer was "Mr. Scared" - someone would smell "diaper odor" and discover my well-kept secret, especially in my work place. We happen to be very fond of good vanilla ice cream, especially French vanilla, and love vanilla scent! "Fresh Again" is a very good incontinent deodorant that features a vanilla fragrance. Keep in mind the concept that we quickly get accustomed to any fragrance we are wearing so that we no longer notice it. A lady at work commented how nice my "after shave" was that day. Fortunately, I did not shoot my self in the foot by responding that it was "Old Spice" - my fragrance of choice for decades as an after shave and cologne. Instead, I was careful to ask her what she thought it was. When she said it reminded her of vanilla, I knew she had caught a whiff of my diaper deodorant, not my after shave! So I did some quick damage-control and responded it was something my cousin gave me; I didn't recall the name off the top of my head! This story has a happy ending for me, since I subsequently discovered Pinaud Clubman After Shave Lotion in Classic Vanilla! That is now my after shave of choice and complements the diaper deodorant perfectly.

The other story is much more serious in that it involves a real odor situation a number of years ago, well before this Primer had been written. It was a faint diaper odor to my well trained nose. Not ammonia and not the terrible "stale urine" odor, but an odor hard to describe but clearly there, appearing sometimes as early as ten in the morning, at which point my diaper is certainly wet but scarcely four hours old; it should last easily to the 11 to 12 o'clock period for the mid-day change. I had to do my best to avoid any close encounter situation, for sure! It was very disconcerting, to say the least. My diet had not changed, and I was not drinking a different beer or any new beverages. After using every diaper deodorant, the scented, the unscented, the problem was still not solved! I was starting to use disposables instead of my cloth diapers since no odor at all appeared with the disposables! Then it dawned on me! Something I had recently "changed". Bleaching diapers! Yes, I had stopped bleaching because I had read how hard bleaching is on natural fibers such as cotton. The article down played "whiteness" as a requirement for most of our garments, which I go along with. I did not realize the potential for odor that would result from skipping what amounts to a sanitizing part of the wash cycle. I returned to bleaching, and the odor problem promptly vanished! That was a tough way to learn a lesson; but then, that's why we are writing this, to give you the benefit of our experience.

A note for those cases when bleach is not recommended: pre-soak your diapers in the liquid-cleaner and vinegar solution, as indicated in Chapter 5. If desired, add vinegar to the wash water that also contains washing soda. The unpleasant scent will be neutralized as easily in this fashion.

So, you can take it from here. None of us want diaper odor (or any body odor) so we are careful with showering and skin cleaning. We launder clothing properly. We launder our diapers thoroughly and with the sanitizing effect afforded by chlorine bleach or vinegar (not both!). We do not wear our diapers for extended periods of time without realizing the potential for odor and skin damage that can result. Diaper deodorant will not solve a serious odor problem that should never occur in the first place, if we are doing the things we should be doing. Diaper deodorants serve a function for any amongst us who want the extra security, needed or not, of a deodorant to prevent any possibility of diaper odor.

Pubic hair and cleanliness

Hair can always be considered difficult to keep clean. Pubic hair in your diaper area is no different. Cleanliness is the reason we tell you to lather, rinse and repeat. This writer has always found that cleansing routine adequate to get the body hair clean in the perineal (diaper) area involves at least two and better three repetitions. This is a general rule that should be followed without exception.

Shaving the perineal area is an option - but a difficult one. We run a double risk: first, razor burn, since the skin involved is already quite sensitive. Second, risks of actual nicks and cuts, pose a higher-than-normal threat of infection due to the environment within your diaper.

Somewhat less risky but inefficient is clipping with electric hair clipper or mustache trimmer. Some risk of irritation is still present, but there is much less risk of cuts or nicks. The stubble remaining is thought to be easier to keep clean than hair. Stubble can be removed, if necessary, by powdering with cornstarch and using a (previously unused) disposable single-blade razor. This procedure is extremely delicate, as shaving implies removal of hair from the full genitalia, not just from the upper-pubic area. Also, keep in mind that once begun, hair will grow back quickly. Some will find that experience uncomfortable. Take these factors into consideration before you take the clipping or shaving option.

Many of us feel that the cleanliness or ease of clean-up with a shaved perineal area is quite over-rated and not worth the effort to maintain the shaved condition and attendant irritation. We therefore recommend that you not shave (or clip) unless you judge that your personal hygiene will be improved by such shaving or clipping and you are prepared to deal with the consequences of shaving or clipping. Or, if your health-care practitioner recommends shaving for important health reasons, follow the above guidelines.

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