The Stigma Surrounding Wearing Diapers for Bedwetting - Further Thoughts

The stigma surrounding older children and adolescents wearing diapers to manage their bedwetting also carries over to adults that experience nighttime accidents. I have several theories about why there’s so much shame attached to older children, teenagers, and adults wearing diapers to manage their bedwetting. What's puzzling to me is that it seems that most medical professionals and the public seem to have no issue with the use of diapers with special needs children, developmentally delayed children and adults, the elderly, and patients suffering from neurodegenerative disorders such as Alzheimer's, multiple sclerosis, dementia, cerebral palsy, spina bifida, Parkinson's, and similar diseases, but discourage the use of diapers among bedwetting children past the age of 4. I have a theory as to why this might be the case: individuals in the aforementioned groups typically have severely diminished cognitive and physical capacities, which can render them helpless just like an infant in some instances. 

I've worked with special ed children in the school system and many of these children are cognitively and physically at the level of an infant. Since these groups of patients and students are at that stage, it's considered socially acceptable for them to wear a diaper. On the other hand, it is strongly felt that children, teenagers, and adults who wet the bed, and do not have severe mental and/or physical handicaps should only wear underwear style products such as “Goodnites” instead. I'm not against parents using this style of protective garment on their bedwetting children, and if they work for them that's great. But they don't work for everybody. For some individuals, pull-ups such as “Goodnites” do not provide adequate protection, and parents should be informed of the other options available to protect their children at night.

So the question remains, where did this stigma originate? I suspect more than likely it stems from parents' attitudes during the potty training stage. This tends to be a frustrating time for many parents, and there are some parents who try to transition their child out of diapers by shaming them into using the potty. They do this by saying things such as “Don't you want to wear big boy/girl pants like Mom or Dad?”, or “Only babies wear diapers.” Personally, I find this practice reprehensible.

Then there’s the commercial for Huggies pull-ups whose tagline is “I’m a big kid now.” The implication is that only babies wear diapers. As with other things, we're programmed to believe this and this follows us throughout our lives. Even if we need these products when we're an older child, teenager, or adult, we remember this programming and we feel “babyish” wearing these garments, even though deep down inside we know we're only wearing them because we have a medical problem and using them is not a reflection of our maturity. 

In fact, it could be argued that we're acting more mature by wearing diapers to bed because we're taking responsibility for managing the problem, which is what adults do. In my opinion our attitudes in this area is a perfect example of what the philosopher John Stuart Mill calls “the tyranny of opinion.”

Another theory I have for why parents cast aspersions on those individuals that need or choose to wear diapers to manage their bedwetting is that the parents themselves may feel embarrassed about it. It's such a competitive world out there and parents feel pressured to do anything they can to help their child get a leg up on the competition. Having a child or adolescent in diapers may make them feel the child or teen is not “up to snuff." These parents may then feel ashamed:  “What would my neighbors or friends think if they find out my teenager still needs to wear diapers to bed? I hope I don't forget to take the plastic pants down from the clothesline before they come over! So much for going to Harvard!”       

Custom and fashion also influence our choice of how we manage incontinence. Custom and fashion are key factors in our lives ‒ they dictate a lot of our behaviors. For example, there was an old-fashioned custom that said that it's inappropriate to wear white clothing after labor day. The author Stanley Schmidt talks about the influence of custom and fashion in an editorial of his called “Signs of Respect.”  In this editorial he discussed something he calls “phantom tyrants." According to Schmidt, “These are impersonal forces that presumably originate with identifiable actions by individual people but then take on a life of their own and continue to dictate people's behavior whether or not any individual would independently choose them. We commonly know them by such names as “custom” or “fashion.” One example of a “phantom tyrant” he mentions is the custom of men taking off their hats upon entering a building. I feel that the expectation that people are supposed to stop wearing diapers for bedwetting after the age of 4 is a perfect example of a “phantom tyrant.”      

In tandem with custom and fashion there are ingrained attitudes about various milestones (both cognitive and physical) in a person's life. We tend to have certain preconceived notions about our child's growth process, and if they deviate from that in the slightest we become alarmed. For example, children should talk by a certain age, they should read by a certain age, they should walk by a certain age. While it is true that we should have reasonable parameters established for these situations in order to rule out the possibility of cognitive and/or physical problems, the same reasoning shouldn't be applied in my opinion to the use of  pin-on cloth diapers covered with plastic pants or disposable diapers with tape tabs for the management of bedwetting in older children, teenagers, and adults.  

Besides cognitive and physical milestones there are also numerous social milestones in a person's life. Most cultures have certain expectations of when we're supposed to achieve certain things: we're supposed to get a driver's license by a certain age,  or we're supposed to graduate from high school by a certain age. Nowhere are our cultural expectations more entrenched than with bedwetting and diaper use, and if a person needs diapers past the age that is considered socially acceptable by most people, we instill in them the idea that they should feel ashamed.       

It's very puzzling to me how we are inundated with the most shocking and outrageous stuff on daytime talk shows and news programs and don't bat an eye. Plus, as a society we've become more tolerant in many ways and have broken many taboos, but for some reason an older child, teenager, or adult that needs to wear a diaper for bedwetting is appalling to most people.        

One way we can alleviate or eliminate the stigma surrounding wearing diapers for bedwetting is to change the definition of diaper: an absorbent, waterproof, protective undergarment made of either reusable or disposable material that is drawn up between the legs and fastened at the waist by tape tabs, diaper pins, or other methods. It is designed to be used for several purposes: for managing episodes of incontinence experienced by babies and young children before they are potty trained; for providing protection for children, teenagers, and adults that suffer from incontinence due to various medical conditions; as well as providing protection for children, teenagers, and adults that wet the bed.

Another way to accomplish this is to have celebrities and talk show hosts discuss this. This would be a perfect topic to have Oprah talk about. Comedians are well known for breaking taboos and Sarah Silverman did this with bedwetting with her book The Bedwetter: Stories of Courage, Redemption, and Pee. In fact, in one section of the book she mentions that she had to wear diapers to bed on a camping trip when she was 13 years old. Another comedian who I think would do a good job discussing this issue is Rita Rudner. In her book, I Still Have It...I Just Can't Remember Where I Put It: Confessions of a Fiftysomething, she talks about the various issues people deal with in their fifties. As the Amazon description says: “Rudner tackles body issues, style, and technology, and looks at the wonders and surprises of life on the dark side of 50.” With her intelligence, wit, and grace, she would be the perfect person to talk about this in a funny, warm-hearted manner.                

The bottom line is this: We need to be more pragmatic about this whole issue. This means we should stop hiding from the reality of the situation and refrain from manufacturing and marketing incontinence products that look “cool," “aesthetically pleasing," or “fashionable.” One way this manifests itself is the design of some of the products manufactured for older children that wet the bed – for example in the stores they have “Goodnites” with superheroes on them, and one company now makes adult size diapers in “bold blue, dynamic green, and soft purple.” One person in an ad for “Always Discreet Boutique Underwear” has the following to say: “I never thought I'd say this, but I found bladder leak underwear that's actually pretty.” By trying to gussy up these products it sends the message that bedwetting and other types of urinary incontinence are something to be ashamed of.          

I think the chief reason for manufacturing these products is to make the user feel “dignified.” Personally, I don't care how the products look or if people consider them “undignified” as long as I get a good night's sleep. In my opinion, it's more “undignified” (not to mention uncomfortable) waking up in urine-soaked nightclothes and bedding. In my case, going to bed all diapered up is the most practical solution.

I find pin-on style prefold cloth diapers with plastic pants (or “rubber pants”) worn over top as well as disposable diapers with tape tabs to be the most effective methods for keeping my bed dry. We should focus on how well the products are at providing protection, instead of making the products “socially acceptable.” I feel it's high time we be more sensible and realistic about this whole situation and view diapers no differently than other forms of medical equipment such as eyeglasses, hearing aids, wheelchairs, asthma inhalers, or insulin pumps.

As a society we've become more tolerant and accepting of a wide variety of health problems and other issues, and celebrities such as Oprah talk about many taboo topics and bring them to light so people will be more accepting of them. For some reason though, the public just can't or won't come to terms with an older child, teenager, or adult wearing a diaper to manage their bedwetting. I think it's heartbreaking that the public has this attitude because it causes undue suffering for those who wet the bed. Because of the stigma attached to wearing diapers, many people are reluctant to wear garments that can provide comfort for them as well as make cleanup a lot easier for everyone concerned.       

I've read scores of childcare books, newspaper columns and articles, as well as online articles for over 30 years on this topic, and can probably count on one hand the number of medical professionals who feel it's okay to use diapers to manage an older child, teen, or adult's bedwetting. Since these people are the “gatekeepers” for the dissemination of this information, I think they need to take a more balanced view of this matter. I also think that it's shameful that so many parenting experts and medical professionals proselytize the viewpoint that “only babies wear diapers.”  These people should know better in my opinion; it does a great disservice to those whose only option is to wear diapers to bed, and is very demoralizing and disheartening to denigrate them in this fashion.  And of course the public latches on to this view, the result being they also perpetuate the idea that diapers are “babyish.”  T. Berry Brazelton is one pediatrician who has taken a more relaxed view of this situation and here's what he told one reader who wrote in about this topic: “I've had many  children in my practice who were enuretic (bedwetters) and needed to wear diapers.”     

I hope my thoughts in this area help those children, teenagers, and adults who may be having a difficult time coping with their bedwetting and help them realize that there's no shame in wearing “big boy” or “big girl” diapers to deal with the issue. I also think it's important to have a sense of humor about it. For instance, if you wear cloth diapers and plastic pants to manage your bedwetting, one way you can find the situation amusing is by looking at your night gear and saying to yourself: “These look just like Paul Bunyan's baby clothes; here's his diapers and here's his baby pants!” You can use the same joke if you're wearing adult size disposable diapers: “These look just like the Pampers Paul Bunyan would wear!”

I hope this post has been informative and has cheered up those people who may feel depressed and ashamed about having to wear diapers to bed. Just remember there are plenty of us in the same leaky boat, and diapers are the best way to patch the boat up and keep it from sinking!