INCONTIENCE
By John W.

Howdy,

I don't usually post because I can almost always rely on someone else better expressing the same things I would say, often before I would get a chance to say them. (grin) Still, since the issue of incontinence came up, and it's one of the "sorer" (literally and figuratively) spots of my CES experience, I wanted to add my two cents to the discussion.

Like others, I choose to wear diapers to handle my incontinence when I'm out and about (most of the time). I've tried many of the other "solutions" and after numerous bad experiences, I finally decided on diapers as the most effective, reliable and comfortable way to deal with the problem. I'd like a chance to describe some of my experiences with the other solutions, in order to clarify my position, and perhaps by echoing some experiences other men on the list are going through, provide them with options.

First of all, let me describe some specifics of how my incontinence "works" (or doesn't work, as it were) to provide a background. After a gazillion urodynamics tests and so on, my urologist finally came to the conclusion (which I'd been telling him from the start) that I cannot sense fullness in my bladder at all. At best, I get a momentary sense of pressure right before an accident from my "final" sphincter, but by then it's usually to late to make it to the bathroom.

My internal sphincter seems to vary behavior in a somewhat cyclic manner, which seems to be related to a bunch of things like how much stress I'm putting on my back, etc. It tends to be "stuck" either open or closed. When it's stuck "closed", I can only barely initiate a stream, and full voiding requires cathing. When it's stuck open, I tend to have frequent accidents involving significant amounts, often when sitting down or standing up, or just shifting around.

As for my bowels, because of the pain medications I'm on, constipation to the point of requiring laxative suppositories or enemas to initiate a bowel movement is usually the rule. Unfortunately, the occasional upset stomach can cause me to have bowel accidents, since I also have little to no sense of pressure or ability to control that sphincter either. Luckily, those are pretty rare, with the more common headache being of the "Out! Out! Damn you, get out!" variety.

So in terms of the products I've tried and use, most of the variety comes in terms of handling urine accidents. As a guy, this gives me only three really practical options, discussed in turn below.

1. Caths

Obviously, when ye olde sphincter is stuck shut, I wind up relying on cathing. The "stuck closed" phases vary in length a bit, with the longest I've seen being just over a month, and the shortest being a day or two. During those periods, I usually wind up cathing several times a day. Often, this will really starts to irritate my urethra, so after about five days to a week of constant cathing, I'll sometimes switch to a Foley just to relieve some of the irritation caused by the whole "insertion/removal" process. Unfortunately, Foleys tend to give me UTIs. Also, while relieving the irritation of the "internal" section of my urethra, they often make the irritation of the "external" stretch of it worse, due to the shifting around of my penis during normal activity. All in all, I'm not fond of intermittants, and like Foleys even less. I've actually discussed getting a urinary sphincter "stent" to eliminate the "stuck shut" problem more or less permanently. Which would of course just increase my need for a solution to the "stuck open" situation, whose solutions I'm getting to next...

2. External/Condom Caths

Whomever came up with these things deserves to be shot, in my opinion. I've tried them over and over, and never had a really decent experience with them. My problems with them tend to fall into a couple of related issues. The first is the "fit" issue. It's hard to describe this "delicately" so I'm not going to bother. My apologies if this part offends anyone. Simply put, here's a substantial "size difference" between when my penis is erect, and when it isn't. I can still get erections, although I don't have very much sensation in my "gear". The problem is that the stimulation of handling my penis to put on a condom cath often causes me to get some level of an erection. Condom caths which fit fine in that state don't fit very well after the erection's gone away.

So I get left with two situations: either I use a tighter smaller size, which makes erections in general really uncomfortable (and also because of the tight fit, often causes them), or I use a larger size, which then frequently "blows off" during heavier voiding. In general, it's been my experience that I'll get blow-offs (and subsequent pant-wettings) a couple of times a week at least with condom caths. In my opinion, that's just not acceptable for a "solution" designed specifically to avoid that happening.

The third thing which bothers me about condom and foley caths is my "appearance" when using them. I don't particularly like (okay, I hate) having tubes running around strapped to my body. Having a frequently-sloshing bag of pee strapped to my leg doesn't make things better. When I get undressed around my partner it makes me very self-conscious and aware of my condition, and hurts my self-esteem. I just don't need that kind of hassle.

3. Diapers/Pads/etc.

Diapers really get a bad rap as an incontinence solution. My experiences with them have been very positive. For one thing, even when they leak, it tends to be minimal and results in just wet spots on my pants occasionally. I find that FAR better than the full "wet crotch and legs" result of a condom cath blow-off.

With good, absorbant disposables, even the wet spots are only a very rare occurrance. I will stress the importance of getting "good" diapers (for example, I prefer Molicares, but Tranquility is pretty good as well, as are Tena). The crappy drugstore brand products, and unfortunately also the Depends products, are NOT good diapers, in my experience. Diapers also are the only solution which really can handle bowel accidents, that I've seen, although I guess some of the pads products would also do a good job there.

Another big plus for me is that diapers fit more or less like underwear, and don't cause me the discomfort issues when I get an erection that condom caths always do. Finally, I find them much easier on my "body image" since I can just take them off like underwear, no straps, adhesive removal, etc. necessary. I appear to have pretty good luck when it comes to diaper rash, since I've only had really irritated cases a couple of times. Both times appear to have been related to bowel accidents, so I'm not particularly surprised.

I think part of the bad rap of adult diapers is actually displacement of the general stigma of incontinence. They do most graphically relate to the "toilet training programming" which is a strong influence on the stigma, certainly. In that sense, they are a direct counter to what most people have been programmed to think regarding toilet training, having been encouraged/rewarded/not punished for getting "out" of diapers. But SO WHAT? The stigma is silly, and we all know it.

Incontinence is a medical problem, and the products we choose are a direct treatment of that problem. I find the notion of not using what is for me the most viable solution simply because we were told as children that "big kids don't wear diapers" is ridiculous. That we, as incontinent people, should chose less comfortable or less effective solutions because of some silly social stigma is totally counterproductive. The stigma won't go away as long as we "hide ourselves away" and prevent others from confronting the stupidity of the stigma.

Anyway, this has turned into a book, and I'd better stop now. I just wanted to describe my situation, and explain the reason I too choose diapers. Folks might want to take a look at a wonderful web site at www.incontinencesupport.org to read more on the general issues I've touched on.

Have a great weekend, all. -----