Wednesday, April 30, 2014

The Elephant in the Room: Incontinence in Young Adults

You had to have known this post was going to happen, right?

Or maybe it's one more medical or "special need" self care item I am soley responsible for taking on, given that I am capable of doing so when not in hospital, and let's be frankly honest:

A lot of you just really don't want to know.

That being said, if you don't want to read this post, here's your exit door. You're not going to hurt my feelings ;)

I'm writing this because this is something that is happening now to several others with similar diagnoses as mine. That, and the fact that no one else has yet written a review on incontinence care items targeted at those who are from the ages of 14-30 something ish.


Alrighty. I believe I have tried multiple products to give good review for several products as for as protective briefs or pull ons are concerned. These are products I chose based on my body type (which is long and narrow), so for each item reviewed, I will also give equivalent product by the same company in more typical sizes.

Here are the products I have tried that are still in my apartment. I will break these down in "pull on" styles first and some tips on travel, public restrooms, disposal, and pros and cons.

Pull On Styles

(Top left: Huggies Goodnights boxer style pull on in size XL. Top right, Prevail protective underwear in size Youth/Small Adult. Bottom left: Pampers Underjams in size L/XL unisex. Bottom right: Tranquility Night Time pull on in size small). 

Huggies Goodnights Boxer Style Pull On

I did a product review on these last fall, I believe. Could have even been last summer, I'm not sure. Looking at these, they seem appealing. Boxer style for bedtime, you need only to wear this product and have no spills with an intact product that doesn't make for awkward disposal in the morning...

Yeah, good luck with that.

As you can see, the material is very cheap. The price isn't. Some would say this is a gimmick or marketing ploy, and this is half true. The target group this product is for is older children to young adolescents. The explanation on the the packaging boasts that this will reduce embarrassment at sleep overs for kids dealing with "nocturnal enuresis" or -- simply -- bed wetting, which is involuntary void while the person is asleep.

the shape of this is very narrow...which makes sense. This is made for younger girls who typically are prepubescent. When it's put on, the cloth is very noisy, as if you are wearing wrapping paper or another paper product that crinkles with movement. I did not find that the function was especially just wasn't all that great, either. These do fit me, but if you aren't careful (like, in a hurry)  or even if you are just putting the product on, this tends to happen:

Ok. If I were a ten year old at a sleep over, I don't think I would be equipped to explain how my boxer seemingly..."broke". Or the fact that if a rip occurs, you can plainly see the padding. Worst of all, a rip can happen while sleeping, Again, this is a product that fits me well. That isn't the issue. I'm not the only person who has experienced this. If you search this on Amazon, read the reviews. A bunch of unhappy campers :(

Absorption: urine only
Practicality: not practical for daytime use
Pricing: too high for the quality of the product
Overall Satisfaction: mixed. I use occasionally in warm weather
Recommendation Of Product: Fairly dissatisfied. Will never purchase again.

Prevail Pull On

This is, bar none, the absolute worst brand name incontinence pull on. It just is. And let me show you why:

This is what is on the inside. The blue strip is coarse, and the package claims of "quick whick" technology (like...intergalactic pull ups?) in that blue strip to keep moisture away from the skin.

What they fail to mention is that rough material does not lock out moisture at all! And worse, these leak. All the time. Now, it could very well be that this product is actually too large for me. I had this bag donated to me when I had nothing at all last fall, and I was grateful for the kindness in sharing, but pretty upset that I wouldn't notice embarrassing leaks after what had to have been a few hours (lack on sensation means you go by the clock. And going by the clock with this product meant also changing pants)

The surrounding material is thin and cheap. Again, the price is way too high (retail) for its lack of function, and for caregivers who are very stressed may have a mini breakdown if attempting to use these for their loved one.
Absorption: urine only, poor performance
Practicality: impractical due to leakage from every pull on used
Pricing: I'm thankful these were free. The price is way too high for this worthless product
Overall Satisfaction: very, very dissatisfied, very upsetting and just a negative experience
Recommendation Of Product: NO WAY. If I knew of someone that could only get these I would GLADLY give them a better equivalent product for free.

Pampers Underjams

This is the most astounding product if you also have a long and narrow build, or smaller hips. I debating on whether or not to include this, since there is only a small population of young adults that can wear these...but decided to anyway. This is the only pull on the market has to offer me that actually works and works very well.

This is a big box of forty pull ons, and runs about $18 after taxes in Missouri. This type here is unisex, and looks impossibly tiny. They do stretch a bit, but if this rips down the seam this product will be too small for your body type.

This is my favorite pull on, and keep it in the house. The fabric is silent. For young adults, it's lowrise. It's a very slim product, so bring on the leggings. Easy to put on (especially in a wheelchair) and easy to dispose of. It holds very well and does a great job of keeping fluid away from skin.

The downsides are a little more twisted, however. I'm in and out of the ER, and always admitted to the floor. I commonly get CT scans (I've had two this month alone), and they always ask you to wear a gown. I routinely  have to self catheterize because I am not able to initiate or void everything in my bladder, so they always insert an indwelling Foley catheter as well. On seeing this product on me, there have been younger nurses and techs who have given me the strangest looks, knowing that there's an internet fetish about diapers and behaving like an infant. It's totally disgusting and morally corrupt, almost like inviting abuse of children. But hey, what do I know?

They say to always make sure you have clean underwear on jokingly in case of an emergency and an ambulance trip to the hospital. Well, my equivalent is making sure I don't show up in these.

Absorption: urine and occasional small amounts of runny bowel content
Practicality: very practical, easy to keep in a knapsack, easy to pull on and take off
Pricing: almost feel guilty for paying so little for such a helpful product with many per pack
Overall Satisfaction: Very pleased. Literally no complaints
Recommendation Of Product: absolutely for anyone that this product will fit.

Tranquility Overnight Pull On

Product Details
(image property of Amazon

This and the Daytime version are the most practical of the pull ons that I have tried...and also the most expensive. The pricing issue is easy to get around, however, but you're still going to pay more overall. However, you also are not going to go through so many pull ons since they hold like a beast.

I know this looks very similar to the Prevail pull on, but it's worth so much more than that. Here's a few reasons:

Automatically, you see that you are dealing with a larger fluid whicking core. Looking almost like cotton batting, fluid does NOT push back up, and the only reason I knew was because when I was trying this product out, I didn't develop skin break down. It also has odor control (thank God) and holds just about anything.

This is unique to Tranquility pull ons: the fluid containment panels. This is to make sure that the fluid is gathered in the center before reaching outward...but the outward fabric is ALSO very effective for preventing leaks of urine or stool.

Kuffguards: these are like the last resistance wall for soaking up bodily fluid. They do work, and one appreciates even more when laying down and asleep. This pull on is worth every penny, and sadly it is most likely you will have to purchase these out of pocket. The only product you may be able to get through insurance is the Prevail pull on...which we've gone over: the quality is very poor.

These pull ons are awkward to pull on, especially since I bought them too large. They are also very bulky, to warn. I'm sure the Daytime version is much slimmer and can fit under clothing less obviously.

Absorption: urine and bowel content. Extremely absorbant.
Practicality: I would only use these at night, honestly. If you put out more fluid than pull ons can handle, you may want to try the tabbed briefs.
Pricing: Not a small expense. I have found ways to find these at reduced costs, but they are still pretty pricey. It does even out, since you won't be tossing these out every other hour.
Overall Satisfaction: I do like these. My only problem with these is the weird fit. I'm sure if I'd gone a size down I would be extolling the virtues of these pull ons as well
Recommendation of Product: Absolutely for overnight, especially those who have no sensation or is developmentally delayed in that potty training isn't possible. I don't recommend for daytime use.

Tabbed Briefs:

(Top right: Tranquility Slimline: size small, Middle: Prevail Youth: 16-21 inch waist, Tranquility Slimline: size extra small)

Prevail Size Youth

Not all Prevail products are created equal. This is a tabbed brief that serves as a bridge: kids that are too large for baby/toddler products, and too small for adult products. Or, they just have unique anatomy. However the case, despite my dissatisfaction with the pull on that was supposed to be in my size range, I do like the tabbed brief in the Youth size (16-21 inch waist).

My personal preference, for any pull on or tabbed incontinent item, is a thinner item with quick absorbency. Thinner items don't hold as much fluid overall, but a single product isn't meant to be worn for long periods at a time.

Or, at least that's my logic

You'll need to measure, and I'm going to further emphasize this further down, but with an item meant to fit a 16-21 inch waist, we aren't talking Old Navy jeans size measuring chart 21 inch. We're talking your ACTUAL waist circumference. A popular complaint for all products is "true to size". Hate to say, but vanity sizing (like when you go to Abercrombie and fit a 00, you usually aren't able to fit a little kid's size 10) has skewed in the way we measure.

Here's the product when laying it flat. When putting a brief on yourself (again, this post is directed toward the young adult population...and I do put these on myself, in a wheelchair nonetheless) or with help you need the padding of the brief to surround your waist. As you can see here, the unpadded areas are very, very thin. wrap tissue paper thin.

And thin coverage/incomplete coverage = fail.
Leaks are a great way of starting or finishing a crazy day.

Come on. We're touching on a sensitive topic. Sometimes, you've just gotta laugh.

Back to the point on hand:

The best thing this brief has going for it is the price. It's very affordable, I believe for 90 briefs it's a total of around $30-35, and in a lot of cases, depending on the diagnosis, insurance will cover these. This close up shows some of the elastic. It's pretty rigid, so not too forgiving with movement. These were the first tabbed items I tried, and since I don't have much in the way of sensation, I didn't notice until, by observation of a nurse in hospital, noticed red marks. I hadn't gotten the hang of doing this at that point, so all I had to do was fix the position and method of taping. The issue resolved within a month.

You can see the thin material at the edge. For this not to become soggy, you need to count on the padding fitting properly. The edges in the front and back need to overlap, and taped down.

I didn't get a picture, so I apologize, but the tape tabs are two on each side, about an inch lies between the ones on top and bottom. I know many parents who use these end up only being able to get the top tab on comfortably, and I have found this to be true as well. YES, it will still work just fin, and doesn't pose any threat to the performance of the brief.

Here's the product after taping. If it looks small...that's because it is.

Absorbency: Not so "quick-whick", but does a decent job. I have these on hand always too, in case I run out of the product I use daily. Useful for both bowel and bladder incontinence.
Practicality: My experience: most tabbed briefs are very practical. Pretty self explanatory, and if you've ever babysat or had a younger sibling you pretty much already know how to put them on.
Pricing: These are very, very affordable. And the performance is good as well, so it's not a matter of finding something cheap and being perpetually frustrated. These also are covered items of Medicaid and Medicare.
Overall Satisfaction: These get the job done, while they have weak points it's still a very good product. On that note, none of these are perfect items. However, the performance combined with the price if paying out of pocket is very satisfactory.
Recommendation: Absolutely. Especially to needy families with poor insurance, or for the broke college student

Other Prevail Specialty Briefs Include: Prevail Per-Fit (average w/ bariatric sizes), Prevail Nu-Fit (average sizing, no bariatric sizes), and Prevail Breezers, which is most popular (average sizing, no bariatric sizes)

Tranquility Slimline: Small and X-Small

(small on the left, x-small on the right)

Oh, Tranquility. These are the gold standard for leak protection, skin integrity, comfort and ease of close to perfection as you're gonna get. I find I am not alone in this opinion.

Downside: $$$

Of course. There just HAS to be a catch. But it makes sense, sort of like the difference between ground and whole bean coffee. On is affordable and perfectly fine, the other fairly more expensive but also a more pleasant experience.

Let's look at both viewed flat.



Significant difference. Initially I went by the small. I was stupid and read the Amazon reviews about "my six year old child" for the x-small (with the label of Youth) and "my elderly mother" for the smalls.

Dude, really, I'm just trying to save you from all the fails that I made.

I was used to mainly either the Prevail Youth briefs or the Pampers Underjams, so when I got this from a vendor on Amazon, I wasn't expecting what I saw:

Down the middle we again run into a soft, absorbent core, but look at the side panels. This slim product (and it really is quite slim. Like, I don't have to wear looser jeans AND I do wear leggings with these on) is able to be this way due to the side panels redirecting the fluid path to not spread (which is the natural pattern) to first go in center and THEN cover area as the middle cannot hold anymore.

Quick word for those who are also unable to really feel for when to change: these very rarely leak when using the correct size. They also don't expand noticeably. Be sure to check the clock or even set a timer, otherwise you may end up with some skin breakdown, the nemesis of anyone in a wheelchair.

Easy way to check? Look at this:

The yellow lines turn blue! Which I think is pretty cool, as it's a very quick indicator of when to change.

(I don't think it's cool in that I will be showing all my friends. Mt friends and I are quirky and weird, but none of us are...quite that messed up)

Yay for elastic! Elastic around the legs is not only more comfortable, it's more healthy for the skin and allows for more freedom of movement, even if you cannot move too much. You can see the Kuffguard around as well, and the tabs are solid. I have never had one rip, while the Prevail does rip on occasion.

The tabs hold well, and can be repositioned and taped again as many times as is necessary.

Currently I am using the Tranquility Slimline Youth XS tabbed brief most of the time. When I'm not using that, I use Pampers Underjams. The Underjams are actually what I prefer when asleep, as it is a closer fit for me and no leakage when laying down, while the Slimline does.

Absorbency: Very absorbent, yet it manages to stay so thin (that was a late '90's phrase women used because that was the boon of diet shakes and stupid crap like that). Useful for both bladder and bowel incontinence. This product I recommend over all reviewed items for bowel incontinence.
Pricing: Ok, more likely than not, your insurance will not cover these. I get a lot of my needs on Amazon. The price reduction is amazing, and if you have Prime free two day shipping. Sites like Healthykin and others cannot match that.

However, one of the vendors contacted me personally to ask my view on this item. It was after my first order, which was too large. The vendor's name is Quality Homecare, which we set up a monthly delivery, which give me 5% off every order. The shipping is 1-3 days, and doesn't cost anything. They are also great about answering questions.

Practicality: About as practical as it gets. Again, very straightforward.
Overall Satisfaction: Couldn't be more satisfied. 
Recommend To Others: Oh yes. I have and I do.

Other Tranquility Products: Tranquility All Through the Night (ATN) Briefs: super thick and absorbent for overnight. Tranquility Wipes: adult sized and more sturdy wipes, for those of us that don't make ours ourself at home.

Tips and Experiences:

  • MEASURE BEFORE ORDERING: This makes all the difference in how a product functions. The wrong size can result in some exhausting disasters of mass destruction. Too tight is more dangerous than too loose, as soiled content so close to the skin can cause some nasty bacteria to grow.
  • Be Prepared: Use a backpack. Just because you're using incontinence items doesn't mean you have to run out and find a knapsack. Most people aren't going to notice too much, not anymore in these times. Many people aren't too observant. Keep whatever wipes you have with you, a couple of products in case you need to change, and small bags to bring out to toss out the waste. There really is no need to pack more than that...but along with being prepared, don't focus on it so much as it ruins times out with friends or family.
  • No Shame. No Blame: Please don't stew in blame and/or shame about the situation you find yourself in. This isn't something we see as common, and as those in our late teens to early thirties the prospect of being in the minority in this avenue can seem painfully humiliating. There is  nothing that is accomplished from mulling this over and over in your mind. Please don't hole up in your house being miserable, and don't feel like you HAVE to let your friends know. That's a very personal choice. I have let people know and it doesn't bother me, or my friends.
  • The Skin You're In: Take care of it! Using a moist product will be less irritating. Bathe or shower regularly.
  • Desitin Or Not: If your skin is fine, there is no need to spend a lot of money on creams. Save that just in case something changes, but there is no need to use when there isn't a problem.
  • Under Pads: Or "Chux" pads. It's a broad term for an item that will protect your bed or other surfaces in the case of leaks. They are a good idea, and they will cost money. I personally have one that is washable and reusable. Also hundreds more comfortable than what's at the hospital, and MUCH more comfortable than the disposable ones, which crinkle and sticky. They're more convenient. That's about all the disposable Chux have going for them.
  • Clothing Concerns: OK, not gonna lie:  you will need to go through your jeans, pants, and -- if female -- your short shorts. Short shorts gotta go. The just do. Those are typically tighter by nature, and if you're using a tabbed brief, a tab can show. If using a pull on...those cover a broud area, and very well could hang lower than the shorts themselves. Don't wear anything overly tight. Not only is it not comfortable, but -- again -- wetness against skin can cause skin breakdown. How I have come to wearing what I already own is this: I can use either the Slimline or Underjams under leggings. But my leggings aren't skin tight. If yours are, try something like wearing a skirt over the leggings or wearing a larger shirt belted at the waist to cover noticeable bulk. I have not needed to buy new jeans since this has happened, but there were some stuff I couldn't wear anymore. But hey, this could be a good reason to find a new style...I don't follow trends all that much. Try making something uniquely you.
Most aren't flawed, nor should you harbor shame or self loathing. Go through the process if this becomes something that lasts for long periods of time, find a way to cope. This doesn't make you inadequate, childish, or less than.

When we say we're all different, we usually do not include the fact that some of us have no control over their bowels or bladder. However, it falls under that umbrella, and there is no reason to think it's a topic that cannot be talked about.

I just wrote a whole blog post about it.

No blame -- no shame

1 comment:

  1. Yes. I highly recommend Quality Homecare ( for the most reasonable prices. I will ask to please refrain from self advertising in the comments section. Thank you.