There is some imprecision in defining what is incontinence. From puberty until my accident I wore paper towels in my underwear to soak up any dribbles after peeing and leaks of semen. I did not think of myself as being incontinent. (This was long before a spinal injury made me doubly incontinent in 2013.) How much dribbling makes someone incontinent? How often must a considerable accident have to occur for someone to be incontinent?
Many kinds of normal underwear, both male and female, have a double layer or gusset where there is likely to be a small amount of leakage.
Protective wear for those more heavily incontinent seem to fall within five types:
1 Adapted pants and knickers
There are many kinds of underwear on the market adapted for heavier leakage and marketed as incontinence wear: there are many brands of washable or disposable pants and knickers adapted to take pads or with absorbent areas. Most seem to be single-sex. The pads when sold separately can be single- or unisex.
2 Fixation pants
non-absorbent, used only to hold a pad in place; unisex - no front exit for men; nurses and carers usually refer to mine as knickers, pants or nets. The manufacturers often just refer to them by their brand name chosen to give a hint of what they are, with a pictogram to give a further clue, announcing that they are fixation pants for incontinence pads in microscopic print in 20+ languages on the back of the packet.
Another minute pictogram showing how to determine your size shows a figure of indeterminate gender, leaving the sex of the intended user equally uncertain.
They are more stretchy than is usual for ordinary underwear and so can be expected to take a pad more readily. The pad can be unisex or single sex. It is to be expected that the difference would be in the length at the front. To take an erection, my pads have to be pulled up as far as they will go. The packet does not clear up the mystery of the gender of the intended user.
3 Pull-ups:
an expression used in the USA for both children's and adult products; similar to normal underwear but with pad fixed inside and are made of waterproof material. They can be unisex or single-sex.
4 Diapers:
can open out flat; large absorbent pad to cover area likely to be affected by urine or faeces; plastic sides with one or two adhesive tabs on each side to hold them securely around the body between the groin and the waist. A term used in the USA for both children's and adult products. These too can be unisex or single-sex.
5 Cloth diapers (USA)/nappies (UK):
square, absorbent, washable material held in place by safety pins or something more modern. There are many brands of cloth diapers/nappies shaped like plastic ones with fastening studs at each side. Occasionally they are referred to as 'napkins' but in the UK this is more usual for smaller squares of lighter material used at the dinner table to clear up stray bits of food from around the mouth or fingers or to prevent the soiling of clothes - similar in purpose to nappies but at the other end of the alimentary canal.
Pants made of plastic, rubber or other waterproof material can be worn over any of these types of incontinence wear for extra protection.
Diapers, pull-ups, fixation pants, nets or knickers with many brand names are really all variations of ways to hold a pad of absorbent material in place and to be able to get access to it as needed. The differences between the variety of incontinence wear amount to a few features:
amount of absorbency;
whether they open with tapes or studs (diapers), usually at the sides or whether they are sufficiently stretchy so that no opening is needed (pull-ups or fixation pants);
material used: waterproof (usually plastic or rubber) or textile.
washable or disposable. This is likely to affect cost. My washable fixation pants cost very little. I use only about six per year. The last pack I bought cost £6 for 25. I use one disposable pad per day costing around 30-35p.
Whether the pad is fixed to the pants, such as in a pocket, or just covered by them might be significant for those who have an active lifestyle. Some fixation pants, including mine, allow the pad to be moved in them.
Gender: neither the pads or pants that I use indicate on the packets which gender they are intended for; presumably they are for both. This seems to be quite common. The difference in position of the urethra perhaps makes that surprising. My pads are long enough to reach past the entry point of my suprapubic catheter if not placed too high at the back. Some brands of pad are clearly female.
So how can we find what incontinence wear suits us best or at least well enough? A good starting point would be an estimate of urine leakage, and if applicable, faecal leakage, per day. This will set limits on what would work, frequency of changing and whether disposable or washable would affect the cost. Having a suprapubic catheter reduces the capacity needed for my pad a great deal. Bowel evacuations result in faecal leakage being unusual for me.
Some of the advertisements for branded incontinence wear give quite good guidance on questions such as level of absorbency, method of opening, material used whether washable or not and other issues raised here.
