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!

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.                

How to Tell Your Partner You Wet the Bed

         

Most adults with bedwetting problems wear protection at night to maintain comfort, hygiene, and make cleanup easier. Some of these individuals feel ashamed about having to wear adult diapers to bed. This can be particularly embarrassing for those who wear disposable tape tab style diapers as they have to deal with the tell-tale crinkling sound the diaper makes as they move around, caused by the plastic outer cover of the diaper. The embarrassment of wearing diapers to manage bedwetting, however, can be overcome with the support and understanding of loved ones, and using the tips mentioned in this post can help with gaining their support.   

Many adults in these circumstances are reluctant to get intimate with their significant other for fear their partner will reject them when they find out they wet the bed and have to wear protection every night. This can be a nerve-racking prospect for most people, but there are ways to make it easier to have a conversation about it. 

I’m offering some suggestions for some things you can say to your partner to break the news of your bedwetting and the use of protection in a playful, lighthearted way. Before saying these things to your loved one it's good to lay some groundwork – this includes setting aside an appropriate amount of time to discuss the issue with them as well as having an icebreaker to start the conversation. 

You might begin the conversation by saying, “We've been seeing each other for a long time and I care for you very much. There's something I need to tell you and I was wondering if we could sit down and talk for a bit. I wanted to talk about this many times before but felt too embarrassed to bring it up. This is very difficult to talk about so bear with me. I have a health problem that I've been dealing with since I was a child and I'd like to discuss it with you.” 

If these preliminary remarks land well with your partner, you can follow them by saying something like what I’ve provided below. 

• “I have a medical condition called nocturnal enuresis, which is the clinical term for bedwetting. I manage it by wearing adult size diapers to bed every night. It's like having a rainstorm in my bed every night – in fact I predict there's going to be flash floods tonight so I better put on my diapers before going to bed. As you can see I've managed to keep my sense of humor about it and I hope this doesn't affect your feelings toward me.”
  
  

• “I wanted to let you know that I wet the bed every night. To manage it I wear adult diapers to bed – it's either that or wear a raincoat to bed.
  
  

• “Every night I have a problem with wetting the bed. As a result, I'm in the wetness protection program – I wear diapers and plastic pants every night to protect the bed.
  
  

• “I wet the bed every night and wear adult size disposable diapers to manage it. This is the best way to deal with the issue ‒ the only alternative is to buy flood insurance. The nighttime attire I have to wear to bed are adult size versions of the Pampers the babies wear – the reason I'm mentioning this is that I wanted to give you an idea of what the products look like beforehand so you're not surprised.”

I realize that you probably feel terrified at the thought of divulging this secret, but if you and your loved one have a strong relationship and if the person is a loving, caring person, more than likely it will not affect their feelings for you.        

As you can see from my suggestions above, I’m recommending you use some amount of humor to address the situation. But before you decide on that approach, you should consider your personal style and that of your partner. Do what makes you (and them!) comfortable.