DUDLEY PHYSICAL THERAPY’S FRIENDLY GUIDE TO INCONTINENCE PRODUCTS
Charles Dudley, PT, MPT, COMT
“The Nook” at Hyde Park Station 1559 Hyde Park Rd. Essex, MD 21221
Call/Text: 443-742-0019 [email protected] www.dudleypt.com 1 Call/Text: 443-742-0019 | [email protected] | www.dudleypt.com WELCOME! Hello and welcome to Dudley Physical Therapy’s Friendly Guide to Incontinence Products! As a pelvic health physical therapist, I often hear from people who struggle to find incontinence products that work for their needs. If you’re looking at this, I’d wager a bet that you have been or currently are struggling with incontinence and you have more questions about what to do, how to manage, and how to get back to living your best life on your terms. While there’s no substitute for trying products and seeking info on your own, I designed this guide to give you some perspective from real people who have struggled with urinary and fecal incontinence. None of the people quoted in this document are paid marketers and they’re not fancy researchers. They’re simply people like you who are looking for help in navigating their incontinence.
I hope you find the information in this packet helpful! And of course, if you have any questions or want to hear more about how pelvic physical therapy may be able to help you with your incontinence, in a safe and comfortable environment absolutely free of judgment, here’s how to get in touch with me!
Charles Dudley, PT MPT COMP Dudley Physical Therapy
1559 Hyde Park Road Essex, MD 21221 Phone: (443) 742-0019 [email protected]
1 Call/Text: 443-742-0019 | [email protected] | www.dudleypt.com ABOUT THIS PACKET Kate and Kaia, two doctor of physical therapy students from the University of Delaware working with Charles at Dudley Physical Therapy, embarked on a journey to collect data on incontinence products, only to find that the research is fairly sparse and limited to very contained environments, as scientific research so often must be in order to produce good experiments. What was lacking, of course, was a sense of real perspective: what’s it like wearing a brief (aka diaper) for a few hours when you’re out of the house with your friends? Depends haven’t been working for you, but where do you turn to next? So Kate and Kaia set off to discover more by creating a survey that was posted to groups on both Facebook and Reddit, where we received 50 responses on the daily experiences with some of the most popular incontinence products. Of those who reported their demographics, ages ranged from 23 – 70, with 44% reported as male, 56% reported as female. No respondents reported as trans or non-binary, so further research into what works best for those individuals is needed.
So without further ado, head on over to the next page where you’ll find the good stuff – a handy table (with pictures!) that lists some pros and cons of each product, some “good to knows”, and of course, what the literature has to say. On the following page, you’ll find more descriptive quotes from continence product users that will help to paint a full picture of the user experience, as well as some other products that you may run into in your search to find the perfect product(s) for you. We’ve also included a handy glossary (what the heck is ABDL anyway? What’s UI/FI? Find out on page 7!), as well as, of course, a list of helpful resources if you’re still left with questions. A BIG THANKS TO… Shawn Duffy. Without your help, this guide would not have been possible!
Randy from Must Stop MS
All of the respondents of our online survey, from reddit.com/r/Incontinence and the Must Stop MS Facebook groups, including but not limited to: Ashley, Autumn, Belle, Bill, Brian, Dawn, Debbie, Dylan, Filipe, Gary, George, Janine, Jeff, Jim, JJ, Joe, Kristen, Lacie, M, Martha, Miles, Mindy, Olivia, Rebecca, Shane, Yvette, and Yvonna
2 Call/Text: 443-742-0019 | [email protected] | www.dudleypt.com CONTINENCE PRODUCTS: THE PEOPLE’S REPORT
Product Pros Cons What’s Good to knows science say? Disposable briefs “Best Can be “too “First-line [...] Brands*: North- (diapers) option”, “eas- tight”, some for men.” “Con- shore, Tena, 72% of survey users ily changed”, brands are sider effective Molicare, Abena. tried “best for “leaky at containment, Super-absorbent overnight night”, can comfort, cost, polymer tech- protection”, be “bulky for skin protec- nology can help “excellent daytime use” tion, odor with heavy UI/ value”, gives and “expen- control” FI. Consider skin users “peace sive” care. of mind” Abriform M4 Air is “breathable but moisture wicks thru.”
May allow refas- tening via 2-part tape (Abriform) or plastic front (Northshore Megamax)
Disposable pull-ups “Widely “Terrible “Preferred by Brands: North- (like Depends) available”, for side women” shore, Tranquility, 28% tried “these are my sleeping”, Costco, Unique jam”, some “not good for Wellness, Always look “close to heavy urine Discreet, Abena, regular pant- losses and Goodnites. ies”, “used bedwetting”, Super-absorbent at night as “difficult polymer tech- needed” to change”, nology can help “Depends is with heavy UI/ better than FI. Consider skin underwear care. but not by much”
3 Call/Text: 443-742-0019 | [email protected] | www.dudleypt.com CONTINENCE PRODUCTS: THE PEOPLE’S REPORT
Product Pros Cons What’s Good to knows science say? Booster pads “Great for “Leaky”, “Adjunct to Brands: Abena, 40% tried overnight “uncomfort- brief, pull-up Northshore, Tena, usage with able when or underpad Molicare. a disposable active”, “can for high vol- brief”, “extra be uncom- ume UI” absorbency fortable” gives more relief”, “ensures no leaks”
Pads held by “Use daily”, “Unsuitable”, “Acceptable Brands: Always mesh brief “okay for “bulky”, for women, Discreet, Poise. 36% tried when I drib- “hard to first-line for Can include ble” position women with super-absorbent properly” light daytime polymer tech UI”, “key to success is close-fitting underwear”
Disposable pad “Good for “Less conve- “First-line for with guards/shields minor issues” nient’ men with light 36% tried daytime UI”
4 Call/Text: 443-742-0019 | [email protected] | www.dudleypt.com CONTINENCE PRODUCTS: THE PEOPLE’S REPORT
Product Pros Cons What’s Good to knows science say? Feminine hygiene “Used for “Never “Alternative Brands: Always products years”, “feel comfortable”, in women Deodorant Maxi, 32% tried safe with “quickly with light UI”, Always Discreet them”, “less outpaced “low cost/high Liners. expensive”, needing availability”, “used for them” “not recom- light FI”, mended for “wings help men” feel secure” Reusable briefs “Prevented “Odor, con- “Minority of Helps to have 18% tried 100% of my stant wash- women prefer a local diaper leaks”, work ing”, “bulky”, based on cost, service that also well”, “rarely “a lot of work minority of handles adults had any to manage men prefer at leaks” storing night based on after wetting cost” before wash- ing” MORE THOUGHTS ON THE MOST TRIED PRODUCTS
Disposable Briefs (diapers) “I find briefs to be the most comfortable and have worn them since my 20’s. I change at least 3-4 times per day for skin health, especially if it’s humid out. Even “breathable” briefs have double layers. These are more convenient to change than pull ups if I’m out in public.” “I have UI and use Seni SuperPlus tape-on diapers for overnight and daytime when I can’t change often. For the price these are an excellent value!” “I have SUI and UUI and I have tried single-use tapes. The lack of barrier around the top has led to leaks at night, and can be a bit of a trigger issue for people who have a history of trauma-induced bedwetting.” “I wear an adult tab-style diaper every night for bed wetting. I wake up to a dry bed and just throw away the wet diaper in the morning. They can be hot and uncomfortable during the summer, though.”
5 Call/Text: 443-742-0019 | [email protected] | www.dudleypt.com “I wish more doctors would suggest these to patients instead of any other product on the market.” “Wearing diapers required some mental adaptation to overcome self-consciousness and embarrassment. They can be uncomfortable during the summer and somewhat expensive, but by far the most effective for UI.”
Disposable pull-ups “These are marketed at a younger audience and are more brandable. Diapers can be hard to find in a store; you’ll typically find pull-ups or pull-ups with tabs. I recommend going through companies like Northshore directly.” “Sometimes I wear two pull-ups, one over the other, so when I need to change, I just remove the wet one and I’m good to go.” “I have gone through many, but Always Discreet are good for moderate UI. I will wear panties over the top to cut down the crinkly noise they have. They aren’t good for heavy urine loss or bedwetting. Also, FYI - just because Depends are well-known does not mean that they’re good.”
Booster pads “Sometimes when I am using less absorbent, cheaper diapers during the day, I’ll wear a booster to extend the time I can wear before needing to change.” “Useless. A diaper with a booster pad in it is worse than the same diaper without. Leaky.” “Useful at night, especially if I know I’ll be drinking alcohol or taking a diuretic [water pill].”
Pads held in place by mesh briefs “Wet pants/10, would not recommend.” “These are okay for when I just dribble, but not for large voids.” “Poise is the only brand that works for me; I have used them daily for many years.”
Feminine hygiene products “I use multiple pantiliners each day.” “I use these for light fecal leakage.” “These don’t hold up to more than a dribble.”
Reusable briefs “I used cloth diapers overnight for a year. They worked very well, and I rarely had any leaks, but my partner asked me to go back to disposable diapers because of the challenge of washing and storing the wet diapers, and did not like the odor and the constant washing.” “The cloth diapers I’ve tried leaked and forced me to sleep on my side due to the bulk. The bulk is very noticeable and actually hurts my back.”
6 Call/Text: 443-742-0019 | [email protected] | www.dudleypt.com OTHER PRODUCTS YOU MAY RUN INTO
Catheters (20% of survey users noted that it was a best option. have tried) T-shaped diaper (2% have tried) “Self-catheterizing takes getting used to, and issues arise if I don’t stick to a schedule. One person noted that it never stayed on. Can However, my urology nurses are on call for be easy for caregivers to use. any incontinence products and wound care questions I might have, and are available for Urethral clamp (2% have tried) telehealth if needed.” “Torture device. Unless you are going out into “It can be challenging to find the right size.” the backcountry, I can think of no reason I would “Intermittent use of catheters is almost perfect ever use it.” for me. I’ve been able to go from using 5 diapers “Tried, didn’t like.” a day to 1 or 2, but it hasn’t eliminated the need for diapers altogether.” “Indwelling catheters are useful for drying out when skin degradation is an issue. Belly bags are more comfortable than leg bags.” Other products that we asked Many people mentioned: frequent UTIs, skin about, but nobody used breakdown, discomfort, and challenges learning Body-worn urinals, disposable penile wraps, to self-catheterize. disposable absorbent products positioned over the anus, butterfly-shaped dressing for Brands: Iofric FI, anal pouches. Reusable clothing/swimwear Products We Hadn’t Heard of, But (18% have tried) People Mentioned “I use cloth diapers and plastic pants.” A Peapod mat - like a waterproof towel, used “I’ve used swim products in the past but lost for nighttime UI weight, and since I’m still losing weight I’m Gary Active brief PUL - underwear covers sticking with disposable diapers for now. I liked over briefs them; they look like compression shorts.” Washable menstrual pads - used for light “A reusable swim brief works ok, but not if you’re leaks, but not outside of the home at the pool all day.” Onesies/bodystockings - these help support “The quality varies widely.” the absorbent product as it fills. Can be Brands: Diurnetix custom made.
External collection device (condom catheter) (8% have tried) People noted: leaking, tricky to set up, problems with adhesive that did not remove correctly. One 7 Call/Text: 443-742-0019 | [email protected] | www.dudleypt.com OKAY, THAT WAS A LOT OF INFO. SO WHAT ARE THE BIG TAKEAWAYS?
“I have found that if you wear some type of waterproof pant over the disposable diaper or pull-up, it can really help prevent leaks to clothes or the bed at night. It is really important that people try a variety of products to find out what really works for their incontinence as well as their body shape. I really like the customer service and the products from NorthShore. They are very understanding and will provide free samples of any product...”
“Incontinence can be difficult to talk about and finding the right products can be hard for many folks. However, with all the good companies on the internet, it is much easier to find and order products. Most of the products sold in drug stores or Walmart are only good for very light incontinence.”
“ABDL companies make plain white models of their diapers and they are light years better than even the best medical diapers.”
“The loss of control is terrifying and humiliating. It is hard to talk about with people in your life before something happens, and after an accident, it feels shameful and wrong. It makes you not feel like an independent person. I suffered from IC (incontinence) and used over the counter pads and pull-ups, and they failed. I felt like I failed. Before I found medical grade pull-ups and boosters, I had to make excuses why I couldn’t go out with friends, or see a movie. I had to talk to my managers at work about my IC and tell them that I might have to change my pants, because not only I leaked, but my protection - that was meant to protect against leaks - leaked.”
“It is easier with the right protection to know that I am in control of something I can’t control.”
“I worked with a PT for my stress IC and she was the best. She gave me back confidence and helped with something that I thought was broken forever.”
“I waited 15 years with incontinence before talking to my doctor. Also, brief/ diaper type products are 10000x better for men, but diapers are hard to adjust to emotionally. They are easier to change, less likely to leak and offer better containment in just about any position.”
“If you need to change at work or in public, to change underwear you need to take off your shoes and pants to pull on a new pair. A diaper you pull pants to your knees and swap out.”
“It’s easy to worry that everyone will know—I have told people recently that I have known for 10 years and they never knew. Others may have known and not said anything, but it was never discussed and didn’t change any relationship. I even had roommates.”
“Continence products can be discreet, and UI affects more than just elderly people. Many of us are young adults that still lead an active lifestyle.”
8 Call/Text: 443-742-0019 | [email protected] | www.dudleypt.com OKAY, THAT WAS A LOT OF INFO. SO WHAT ARE THE BIG TAKEAWAYS?
“While diapers may not be appropriate for everyone, they are an important tool for many who deal with incontinence. Store brands and Depends are not sufficient to meet the needs of most people with greater than minor incontinence issues.”
“Skin health issues are big. I only wet the bed so I’m not wearing a diaper most of the time. If I was always in one, I would constantly deal with skin issues.”
“Diapers can feel super embarrassing. The best quality diapers are sold online (I use NorthShore) and they make a world of difference. There are other products available that hide diapers, like special undershirts. “
“I believe that any invasive products such as catheters should be a last resort. My doctor suggested catheters way before talking about disposable brief. They can be very uncomfortable, and I had many UTI’s before switching over to briefs.“
“All bodies are different and finding a product that works well with a given body shape is most important for a good fit.”
“Different products should be considered for different activities. If someone suffers from incontinence overnight they should probably consider something more absorbent than what they may use during the daytime. Even being at home versus going to town may need a consideration of different products.”
“The mental health benefits of wearing protection are important. Feeling secure helps with confidence. If you don’t feel fully protected you don’t want to leave the house in case you have an accident.”
“You can strengthen your pelvic area so that a cough or sneeze doesn’t cause embarrassment.”
“Day to day can be totally different. I am on 2 bladder pills, but I still have accidents. It’s hard to decide which product to use on some days. If I choose to wear a lighter pad, I am afraid I will have an accident. If I use a thicker pad, and don’t have an accident, I feel like I’ve wasted a pad.”
“There’s nothing to be ashamed of. Neurogenic bladder / bowel SUCKS. If we all speak up about our symptoms, it helps others as well to talk to their doctors as well.”
9 Call/Text: 443-742-0019 | [email protected] | www.dudleypt.com GLOSSARY
ABDL: Adult Baby Diaper Lovers. A community of adults with or without incontinence that wear diapers. Can be a great source for support and resources. Some content may be NSFW.
FI: Fecal incontinence.
IC: Incontinence.
Mixed UI: a combination of stress and urge incontinence.
OAB: Overactive bladder. Can occur as a result of irritation to the bladder, which can lead to increased urge to urinate or urge incontinence.
PF: Pelvic floor. A group of muscles that support your abdominal organs and help maintain continence. When they’re weak, they can lead to UI. (Shameless plug: Like any muscles in the body, these can be strengthened! Consider looking into pelvic health physical therapy to learn more.)
PHPT: Pelvic Health Physical Therapy. A branch of PT focused on helping patients with issues such as incontinence, pelvic pain, or sexual dysfunction.
SUI: Stress urinary incontinence. Leaking when you increase abdominal pressure, such as during a run, coughing, or “peezing”.
UI: Urinary incontinence.
UUI: Urge urinary incontinence. Leaking when you get the urge to go, or “key in the door”.
10 Call/Text: 443-742-0019 | [email protected] | www.dudleypt.com SCAN HERE WITH YOUR PHONE HELPFUL RESOURCES TO QUICKLY VISIT THESE LINKS
Product Companies
The Abena Group (includes Abri-Form) LoFric catheters abena.com/products/incontinence-products www.wellspect.com/products/bladder-products/ lofric Adult Baby Diaper Lovers Company – booster pads (ABDL) Molicare abdlcompany.com/ molicare.com.au/ www.northshorecare.com/ adult-diapers/adult-pull-ups/molicare-premium- ABU – bodysuits mobile-underwear us.abuniverse.com/ NorthShore Care Supply Always Discreet www.northshorecare.com alwaysdiscreet.com/en-us Northshore tab-style briefs including Alyne underwear – sample available Megamax, Supreme, Air Supreme alyneforyou.com/ nortonhurley.com/pages/ www.northshorecare.com/adult-diapers/adult- alyne-free-sample diapers-with-tabs
Bambino diapers NorthShore BetterDry (ComfiCare) bambinodiapers.com/ www.northshorecare.com/shop-for/protective- overnight-incontinence-products/overnight- incontinence-briefs/betterdry-tab-style-briefs Butterfly patches for mild fecal incontinence www.butterfly.com Peapod mats www.peapodmats.com/pages/adults
Diurnetix sustainable incontinence store www.diurnetix.com/ Prevail – sample available www.prevail.com/try-prevail/free-samples
EcoAble – cloth diapers Rearz ecoable.net/teen-adult-Incontinence-cloth- rearz.ca/ diapers-/
SaveExpress (German distributor) Forsite www.saveexpress.de/en www.forsite.eu/en/20-adult-diapers Seni Garywear active briefs seni-usa.com/en_US garywear.com/ Suprima vinyl pants Leak Master adult cloth diapers and b4ns.com/index. bodysuit php?PageType=ProductTop&Supplier= www.adultclothdiaper.com/ Suprima&ProductLine=VinylPants 11 Call/Text: 443-742-0019 | [email protected] | www.dudleypt.com SCAN HERE WITH YOUR PHONE HELPFUL RESOURCES TO QUICKLY VISIT THESE LINKS
Product Companies (continued)
Tena www.tena.us
Threaded Armor – protective briefs threadedarmor.com/collections/protective-briefs
Tranquility tranquilityproducts.com/
Unique Wellness –offers product samples wellnessbriefs.com/
General UI Resources Multiple Sclerosis Resources
Charles Dudley – Peezing webinar session The Boster Center for Multiple Sclerosis facebook.com/watch/?v=387263682065536 bosterms.com/
Continence Product Advisor – Must Stop MS evidence-based product education www.facebook.com/MustStopMS www.continenceproductadvisor.org/ National Multiple Sclerosis Society International Consultation on Urologic www.nationalmssociety.org/ Diseases icud.info/
International Continence Society www.ics.org/
National Association for Continence www.nafc.org/
Reddit incontinence discussion group reddit.com/r/Incontinence/
12 Call/Text: 443-742-0019 | [email protected] | www.dudleypt.com OUR PARTING WORDS
Thanks for sticking with us! In short, incontinence affects a lot of people of all ages, sexes, races, and activity level. If you’re struggling with incontinence, we believe that you have a right to be treated with dignity, respect, and consideration for all of your needs, no matter what. It’s worth finding a practitioner that will work with you to meet YOUR goals without making you feel embarrassed or ashamed. Kaia and Kate at the end of their 10 week clinical training at Dudley Physical Therapy where they focused on pelvic health for cis men, cis women and transgendered.
Of course as pelvic floor physical therapists, we’d be remiss if we didn’t mention that pelvic health physical therapy could potentially help with your incontinence. (Pelvic physical therapy can also help with sexual dysfunction, back pain, as well as orthopedic issues like low back pain to boot!) If you’ve gotten this far, and you’re still looking to know more, please contact Charles today! He’s always happy to consult on pelvic issues, and will ALWAYS put your concerns first.
Charles Dudley, PT MPT COMP Dudley Physical Therapy
1559 Hyde Park Road Essex, MD 21221 Phone: (443) 742-0019 [email protected]
*Please note that many of these resources are for commercial use. The creators of this document do not endorse the use of any one product listed in this document and have not received any compensation by any of the companies listed herein, nor can we assume any responsibility for . The views within this document are the participants’ own; the authors have endeavored to refrain from editorializing whenever possible.
STUDY CITED: Gray M, Kent D, Erner-Seltun J, et. al. Assessment, Selection, Use, and Evaluation of Body-worn Absorbent Products for Adults with Incontinence: A WOCN Society Consensus Conference. J Wound Ostomy Continence Nurs. 2018;45(3):243-264.
13 Call/Text: 443-742-0019 | [email protected] | www.dudleypt.com WHO IS CHARLES DUDLEY? And how can pelvic physical therapy help you? • The quick version of who I am is…..I am one of you! I was diagnosed with neurogenic bladder with retention in early 2013 and have had many of the same tests you have, from multiple MRI to cystoscopes and urodynamic studies. I understand the fear and trepidation of going to the doctors in order to find out what is causing our issues. I have used a wide array of incontinence products and bladder management strategies and have lived through their failures and celebrated when they worked. I have also been through pelvic physical therapy which lead me to become a pelvic physical therapist in order to bridge the gap that exists due to the sparceness of therapists in this highly specialized field, especially those who work with men who are just now starting to come out of what I call the “pelvic closet” by providing information and a safe space for honest conversations about your issues, your needs, and how pelvic physical therapy can help. Are you ready to come out of the pelvic closet?
• I refer to pelvic physical therapist as the unicorns of physical therapy, both rare and magical in what we do! But what do we do that is different from other physical therapy? Can’t any therapist work on the pelvis? In a word, no, they cannot. We are trained to examine the pelvic floor muscles externally as well as internally, yes this means vaginally and/or rectally so we can treat the areas that can only be accessed internally. I also use biofeedback to help train the muscles to work better, whether they need to get stronger or need to relax more. Manual therapy is another tool I use where I am making the skeletal adjustments to the pelvis as well as the muscles and fascia in order to allow them to unwind so they can work correctly. I also help you understand your body which empowers you to take more control.
• If you would like a free 30 minute consultation to further discuss your issues, your needs, and how pelvic physical therapy may be able to help, contact me at the information below and just mention this guide book, “Incontinence Products Guide”
Charles Dudley, PT MPT COMP Dudley Physical Therapy
1559 Hyde Park Road Essex, MD 21221 Phone: (443) 742-0019 [email protected]
14 Call/Text: 443-742-0019 | [email protected] | www.dudleypt.com TESTIMONIAL
“I feel now I have greater insight on my Pelvic Floor Health”
Prior to seeing Mr. Charles Dudley, PT in clinic I suffered from bowel and bladder incontinence due to complications of Multiple Sclerosis (MS). My current treatment for my neurogenic bladder consisted in part of wearing adult diapers, taking medication, getting Botox in my bladder and self-catheterization several times daily. I had investigated using the Physical l Therapy as a modality for many years. My urologist suggested I see Mr. Dudley a few years ago. Recently, I reconnected with him to discuss potential treatments for my incontinence issues. During the first tele- med appointment I was put at ease as great professionalism was encountered. Once I attended clinic for treatment, I was made aware of every step of the process. Never once did I feel exposed. Pelvic Floor Health is not always the easiest to talk about, but Mr. Dudley addressed all of my issues. I was very impressed with the great attention given to my “bladder logs.” In the middle of a Multiple Sclerosis (MS) Flare, regular contact was made with me to see how I was doing. Mr. Dudley should be considered a respected resource for incontinence products. Through the course of the first few visits he identify other types of incontinence products that could potentially aid me, and then connected me to appropriate companies.
I feel now I have greater insight on my Pelvic Floor Health. I can more easily interpret signals from my muscles and have an overall awareness of ways to prevent bowel and bladder leakage. I learned how to manage the urgency signals to much higher degree, thus keeping me more dry.
In closing, Mr. Charles Dudley is a well-educated, patient focused, caring Pelvic Floor Physical Therapist. I have recommend and will continue to do so to those I know.
Shawn Duffy
15 Call/Text: 443-742-0019 | [email protected] | www.dudleypt.com