Diapers and Dignity

One of the things that seems to be mentioned frequently when discussing the use of diapers to manage bedwetting (as well as other forms of incontinence) is the concept of dignity.  A large number of individuals feel embarrassed about wearing diapers and think that wearing them is “undignified.” I think these people are missing the mark in a significant way. One of the ways people feel a sense of worth and self-esteem is by having a sense of control over their lives, by having the capabilities and resources to handle challenges we encounter throughout our lives, and by taking the appropriate measures to deal with those challenges when they arise.    

The authors of the article “The Concept of Dignity and Its Use in End-of-Life Debates in England and France” from the Cambridge Quarterly of Healthcare Ethics cite a 2002 report from the Nuffield Council on Bioethics regarding the concept of dignity. According to the report “an essential ingredient in the conception of human dignity is the presumption that one is a person whose actions, thoughts, and concerns are worthy of intrinsic respect, because they have been chosen, organized, and guided in a way which makes sense from a distinctly individual point of view.” The journal made the following comment regarding this concept of dignity: “According to this definition, a person’s intrinsic worth, and hence dignity, stems from his or her capacity for autonomy and self-determination.” Merriam Webster defines self-determination as “the freedom to make your own choices.” 

Psychology Today has an insightful article about dignity entitled “What Is the Real Meaning of Dignity?” Here are some quotes from the article: 

• “Dignity is our inherent value and worth as human beings; everyone is born with it.”
• “The glue that holds all our relationships together is the mutual recognition of the desire to be seen, heard, listened to, and treated fairly; to be recognized, understood, and to feel safe in the world. When our identity is accepted and we feel included, we are granted a sense of freedom and independence and a life filled with hope and possibility.” 

If we examine the comments from both of the articles cited above we come to the following conclusions. First, there’s the idea that autonomy and self-determination play a critical role in the concept of dignity. How this ties in with the use of diapers to manage bedwetting is this: our choice to use diapers to manage our bedwetting is a manifestation of both autonomy and self-determination (the ability to make our own choices). As people who wet the bed, by choosing to wear diapers to manage our bedwetting regardless of the stigma surrounding using diapers, we are exercising both autonomy and self-determination. Hence, we are acting in a dignified manner. 

Now let’s look at some of the comments from the Psychology Today article. According to the definition of dignity in that article, our value and worth as human beings are not diminished by what health problems we have or how we manage them. We don’t feel that an individual that has to use insulin for diabetes lacks dignity; we don’t feel that a person who has to use a wheelchair due to various diseases lacks dignity; we don’t feel that a person who has to use a pacemaker lacks dignity; we don’t feel that a person who has to wear glasses lacks dignity. These are all health problems that need to be managed by using the appropriate equipment and have nothing to do with a person’s inherent sense of self-worth. In my opinion the same reasoning should be applied to a person who needs to wear a diaper to manage their bedwetting.

That said, I think it’s important to return to the second quote from the Psychology Today article. People who use diapers for bedwetting are treated in an undignified manner. They are not “seen, heard, listened to, and treated fairly;” they are not “recognized, understood;” they are not able “to feel safe in the world.” Their identity is not “accepted” and they do not feel “included.” It’s my hope that people will reevaluate their preconceived notions in this area so we can get to a point where this is no longer the case.

Health problems are one of the things that people have to contend with in the course of their lives. Different problems require different solutions. In the case of problems such as bedwetting, there are a multitude of reasons a person may wet the bed. The National Association of Continence (NAFC)  has this to say regarding the various causes for bedwetting: “People struggle with this condition for all sorts of reasons ‒ spinal cord injuries, neurological diseases, and even stress can cause bedwetting.”     

According to Web MD, sleep apnea, deformities of the bladder or urinary tract, diabetes and urinary tract infections, can also cause bedwetting. Some people have been cured of their bedwetting using  surgical interventions, medication, bedwetting alarms, and other methods. Unfortunately, there are some people who wet the bed their entire lives. In a situation like that, the prudent thing to do is wear some form of protection to bed, and diapers tend to be the most effective form of protection to manage heavy forms of urinary incontinence such as bedwetting.

As mentioned, having a sense of control over your life tends to give you a sense of dignity. Using the appropriate medical equipment in certain circumstances provides that control. In the case of bedwetting, diapers are the form of medical equipment that is necessary in some circumstances. I wear both adult size cloth diapers fastened with diaper pins and covered with a pair of adult size pull-on plastic pants (or “rubber pants”) as well as disposable tape tab style diapers, and even though most people feel these products are “undignified,” they are the products that work best for me. Many other individuals also find these products very effective for managing heavier forms of incontinence such as bedwetting. 

Unfortunately, our society is very image conscious – we are constantly being bombarded by ads and other media telling us how to “be and look cool” and how to be and look “glamorous.” Whether it's celebrities on the red carpet, television and movie stars, musicians, or ads for makeup, clothing, and perfume, we are consumed with this idea. We are constantly being bombarded by messages from celebrities suggesting “if we wear this” or “listen to that,” we're “cool.” Social media is also a culprit in this area. What it boils down to is this: bedwetting and diapers are not something that are talked about by most celebrities and media figures because they're not glamorous things to talk about. They're not “sexy.” Sarah Silverman is one brave soul who was upfront about her bedwetting and how she had to wear diapers to bed as late as 13 years old. Hopefully this will open the door for other people (including celebrities) to have the courage to be more upfront about this topic.      

As a society we're too focused on image, and while I'm not against glamour and beauty per se, I think we let these factors drive our thinking way too much. Who cares if diapers aren't “sexy,” “cool,” or “glamorous”? If you wet the bed, you should use them, because it's much less “glamorous” and “sexy” (not to mention uncomfortable) waking up in urine-soaked nightclothes and bedding. And if you have a partner, you want to show consideration for them by wearing a diaper to bed so they don't suffer collateral damage from your bedwetting. After all, I'm sure they won't find it “sexy” or “glamorous” to wake up wet either. 

I think we need to be more upfront about this topic and have a sense of humor about it. This will go a long way to alleviating (and hopefully eliminating it entirely) the stigma of an older child, teenager, and adult wearing a diaper to bed.