Bedwetting and Maintaining Appropriate Hygiene

When one talks about bed-wetting and what type of garments to manage it,there is an undue emphasis on the image of the garments. The key evidence of this is how the products are marketed. For example disposable diapers for older children,adolescents,teenagers,and adults are called "disposable briefs". As mentioned in a previous article these garments have the same design,fit,and style as baby diapers. The reason they call them disposable briefs is because if f they called these garments diapers no one would buy them. Another way that the stigma surrounding incontinence garments(particularly diapers) drives what products will be made,sold,and marketed is the prevalence in the market for products that are underwear like in design and appearance. For adults these garments are known as "protective underwear" and for older children,adolescents,and teenagers they're called "pull-ups" and "Goodnites" I have mentioned in a prior article that although these seem to be the most popular forms of protection, garments such as diapers actually appear to be the most effective form of protection to manage heavy incontinence such as bed-wetting. In general,bed-wetters lose a large volume of urine at night and in some cases they can wet more than once at night. With this in mind,it would be prudent for parents of bed-wetters to consider using diapers to deal with the bed-wetting.

There is debate among people about whether or not parents should require their older child,adolescent,or teenager to wear diapers to bed. I have addressed this issue in previous articles. Most people feel that the choice of what type of protective garments to wear to bed should be left up to the individual,or they feel that if the person that wets the bed chooses not to wear protective garments at night(whether diapers or other forms of protection), that's okay as long as he or she takes care of the wet clothing and bedding. I feel that there is a central issue that doesn't seem to be addressed in this context and I believe that our attitudes in this area need to be reexamined. I also feel that this issue doesn't seem to be considered in general by most people or if it is considered it takes a back seat in the decision making process about what type of items to wear for bed-wetting. The issue I'm talking about is hygiene. From what I can tell,most people would rather wear a garment that is less stigmatizing or none at all. However,as I discuss in this article this emphasis on image versus effective protection is misguided and could have detrimental effects. This article talks about the negative effects that urine can have on the skin and why it's necessary to maintain appropriate hygiene when you're incontinent. To that end, it's a good idea to wear the most effective type of protection for bed-wetting if that means diapers,then diapers should be worn. It's much more prudent to wear a garment that provides adequate protection(and therefore offers suitable skin care and comfort) then to wear something that leaves the person and bedding wet thereby increasing the risk for skin problems.

There are a number of articles that discuss the importance of skin care when you're incontinent. National Incontinence,a company that sells incontinence products and is run by a nurse who specializes in incontinence, has an article on their website which mentions several problems that could result from exposure to urine:1.)Maceration which means becoming soaked or "waterlogged". National Incontinence has this to say regarding maceration- "This added fragility puts the skin at greater risk for damage caused by friction,shear,and pressure." 2.)Incontinence dermatitis also known as perineal dermatitis or diaper rash is the second problem that this article talks about. The article describes perineal dermatitis this way- "Perineal dermatitis involves the irritation and breakdown of the skin as a result of over-exposure to moisture and chemicals in urine and feces." 3.)Bacterial infection-resulting from exposure to urine. This can be particularly detrimental for elderly patients because their skin tends to be more dry. Because of this dryness cracks can appear in the skin and the bacteria can be absorbed in these cracks 4.)Exposure to caustic agents-Ammonia is one of the caustic agents found in urine and this can irritate the skin and can contribute to the growth of microorganisms. 5.)Fungal infection- To quote the article- "The damp,warm skin environment generally associated with incontinence is ideal for the proliferation of pathogenic fungi." Some of the steps they mention to reduce the likelihood of skin problems resulting from incontinence are the following: 1.)Prevent excessive skin wetness 2.)Maintain the skin at its natural pH range(between 4 and 7) 3.)Minimize direct contact with urine and feces and 4.)Cleanse gently to avoid friction One of the articles the National Incontinence website references is "Skin Protection for those Dealing with Incontinence." Some of the things they say in the article are the following: "Health care professionals agree that prompt,proper,consistent perineal care is essential in dealing with incontinence" and "The best prevention against skin damage caused by incontinence is to keep the skin dry" Two of the steps they mention-minimizing direct contact with urine and preventing excessive skin wetness, go directly against the prevailing thinking on this issue espoused by many people who believe that it's okay if a youngster chooses not to wear protection to bed. A large number of people feel that as long as the youngster takes a shower in the morning,it's okay if he or she doesn't wear diapers to bed,but the points brought up in this article on the National Incontinence website suggests that not wearing the most effective protection to bed(and not just the form of protection that is most socially acceptable) or wearing none at all is contraindicated. Other medical professionals also emphasize the importance of proper skin care when incontinent. Lying all night in wet bedding and clothing for several hours a night does not "prevent excessive skin wetness" or "minimize direct contact with urine and feces" as the article on skin care from National Incontinence suggests.

As I point out below,many bed-wetters feel that garments such as pin-on diapers covered with plastic pants and disposable tape tab briefs offer more effective protection than underwear and pull up style products for the management of heavy incontinence such as bed-wetting. I'm not suggesting that pin-on diapers covered with plastic pants and disposable tape on diapers are the best choice for everybody that wets the bed. I'm also not suggesting that reusable or disposable pull-ups don't work for some people that wet the bed. In general,though,as I mentioned at the beginning of this article,bed-wetters lose a large volume of urine during the night and with some people the pull-ups aren't absorbent enough. As I have also brought up at the start of this article, some bed-wetters wet multiple times during the night and might require more than one pull-up. Individuals like these lose a large volume of urine throughout the night and the fact that they go through several pull-ups per night can be very expensive. In a situation such as this, instead of using a less absorbent product (which causes the person to get up several times during the night to change one's self,thereby preventing him or her from getting a full nights sleep) it would be best for the individual to wear a garment that provides better protection. This can be especially important if the bed-wetting persists into adulthood. At this point I'd like to digress for a moment and talk about this delicate issue. There are a couple of reasons why you need to carefully consider what type of product to wear to bed if you're an adult with a bed-wetting problem. Both of these reasons pertain to relationships and out of consideration for the person sharing the bed with you,certain precautions should be taken. First and foremost you don't want to pee on your partner!(I hope that didn't sound impertinent-I meant this in a completely lighthearted way. I feel it's good to have some sense of humor about these types of things) Second, you don't want to disturb him or her by having to get up several times during the night to change yourself if you wear a product that isn't absorbent enough. With these points in mind I thought I'd discuss other options. There seems to be certain advantages with garments such as pin-on cloth diapers and disposable briefs for the management of bed-wetting and it might be good for some bed-wetters to wear these to bed instead. What I'm suggesting is that a person should consider using pin-on diapers and plastic pants or disposable briefs if they have tried the pull-ups and find that they don't offer effective protection. There are also cases of people who use both pin-on diapers and disposable tape on diapers. Some people find that the pin-on diapers and plastic pants are too hot to wear in summertime and only wear them during the cooler months of the year. During the summer months they switch to disposable tape tab briefs.

The bottom line is that a person should use the most effective method to manage their bed-wetting. If a person finds the pin-on diapers and plastic pants or disposable tape on diapers are more absorbent than underwear like products(thereby providing them better protection,comfort,and security),they should switch to these products,after all, it's important for the bed-wetter to maintain appropriate skin hygiene.

Some people suffering from incontinence have said that wearing diapers has caused them skin problems. While it is certainly true that wearing diapers can cause some skin problems,it must be stressed that this most likely occurs if the person does not adhere to a regimen designed to promote and maintain healthy skin while using these garments. This has been pointed out repeatedly by many medical professionals when using incontinence garments. In addition,many pediatricians and parenting articles talk about the precautions that parents must take to make sure their infants don't get rashes and other skin problems from wearing diapers. It's also possible that the person might have sensitive skin that makes them susceptible to developing skin problems from wearing diapers,but this can most likely be minimized by talking to either a urologist to help them decide on an appropriate product to wear,or by talking to a customer service representative from the company they purchase incontinence products from. They should be able to recommend a garment that will help in this regard,or recommend certain skin care products that are especially designed for people with sensitive skin. Other medical professional who deal with incontinence and what steps to take to manage are wound,ostomy,and continence nurse,also known as a wocn nurses. They can suggest measures you can take to deal with skin problems resulting from incontinence. You might want to check with your local hospital or primary care physician to see if they can put you in contact with a wocn nurse. In addition your pharmacist might have suggestions on skin care products designed to prevent any problems that may result from wearing diapers.

A common problem that parents experience with their babies is diaper rash. This can also happen as well with other age groups who use diapers to deal with incontinence. Products to deal with this issue are found in food stores, stores such as Walmart and Target,and pharmacies such as Rite Aid, CVS,Walgreens,and similar stores. These products include diaper rash ointment such as Desitin, A&D ointment, Balmex,and other brands, baby wipes, powder, and related products. You can find these items in the infant section in the stores just mentioned. I think it would be a good idea to look into buying some of these products in order to prevent your youngster from developing any skin problems that might result from wearing diapers for the bed-wetting. In addition places such as HDIS(Home Delivery Incontinence Supplies), Continence Connection,and National Incontinence sell skin care products for incontinence.

Finally,if the person does not use diapers for the bed-wetting,they're just exposing more areas of the skin to detrimental effects. At this point I'd like to get back to the suggestion by most people that a bed-wetter will not suffer negative health effects if they don't wear diapers to bed as long as they take a shower in the morning. In my opinion this is a case of locking the barn after the horse is out. It is true that it would be advisable for a person to take a shower in the morning if they choose not to wear diapers to bed,if only to clean one's self and to eliminate the tell tale odors of urine before changing into the clothes the person is going to wear for the day. However, as pointed out earlier,the person's skin is still exposed to urine for several hours per night,thereby increasing the risks that some type of skin problems could occur. In this case,wearing diapers to bed is a preventative measure designed to minimize the risks of developing skin problems down the road. Another thing that should be kept in mind is the following possibility. During the winter time there is the potential for catching a chill if the person lies all night in wet sheets and clothing. By catching a chill the person is at risk for catching a cold if the person's immune system is weak for whatever reason. This is a point that doesn't seem to be considered by people who tend to downplay the negative effects of lying all night in a wet bed and although this risk might be negligible,it is something that shouldn't necessarily be discounted. Furthermore,wearing diapers to bed would cut down on the time needed to get ready in the morning-instead of having to take a shower in the morning,all the person has to do is clean around the diaper area. Using diapers to manage the bed-wetting would also cut down on the amount of laundry one has to take care of,allowing the person opportunities to take care of other things. In today's day and age when people are trying to compress more and more activities into a shorter time period, time is a precious commodity and anything that might help in this regard should be considered.

I hope this article gets people to reconsider their thinking in this area. Although there is a tremendous amount of stigma surrounding using diapers,in the end it makes more sense to use whatever means are necessary to mange this problem in a way that both makes the person suffering from bed-wetting more comfortable and provides better hygiene.