Finding the Right Fit: Why Size Matters With Incontinence Products

The following transcript was generated electronically. Please let us know if you see any transcribing errors and we’ll get them corrected immediately. 

Bruce Kassover: When it comes to choosing an absorbent product that works for you, there are a lot of factors that need to be considered. You have to look at things like the amount of volume that it can hold, whether or not you want to use tabs or pull-ups or any of the other different styles that are out there. But one of the things that’s often overlooked is fit. The quality of the fit is probably as important, if not more important, than any other factor out there, and it’s especially difficult if you happen to be a plus size person. Join us today to learn about finding the right fit to get a product that helps you live a life without leaks.

Welcome to Life Without Leaks, a podcast by the National Association for Continence. NAFC is America’s leading advocate for people with bladder and bowel conditions, with resources, connections to doctors, and a welcoming community of patients, physicians, and caregivers. All available at nafc.org. 

Welcome to another episode of Life Without Leaks. I’m your host, Bruce Kassover, and joining us as always is Sarah Jenkins, the executive director for the National Association for Continence. Welcome, Sarah. 

Sarah Jenkins: Thanks, Bruce. 

Bruce Kassover: Excellent. Today we have a guest. It’s Brooke Schmidt. She is a registered nurse. She has more than 10 years of experience in things like pediatrics and adult health and geriatrics and case management, community health and wound care. So many things. However, She has a very interesting focus nowadays. She’s currently working as a freelance nurse writer, where she collaborates with clients to provide them, you know, high-quality content and, things that are just professional, medically correct, and compelling for an audience. So welcome, Brooke. Thank you for joining us today. 

Brooke Schmidt: Yeah. Thanks so much for having me. 

Bruce Kassover: So you are a nurse writer. That is not a job description that we hear very often. I’m wondering, maybe you could tell us a little bit about your path to becoming a nurse writer. How did you get to, to be on the podcast today?

Brooke Schmidt: Yeah. My nursing career started pretty traditional. I spent 10 plus years working in home and community health, mostly for a PACE organization, which stands for Program of All-Inclusive Care of the Elderly. It’s Medicare, Medicaid funded program for people 55 and older who are generally considered somewhat medically complex.

And, during my experience with that, I worked with people with all sorts of health conditions, and as we know, as people age, incontinence becomes more prevalent. That’s why I ended up here today as part of it. But it also segued into becoming a nurse writer when I had kids.

I needed to have some more flexibility and spend some more time at home, so I decided to channel my clinical expertise and use it to continue helping people by making sure there’s good, evidence-based materials on the internet for people to find the same information I would give them if I was seeing them in person providing more clinical care.

Bruce Kassover: That sounds like it’s incredibly important because nowadays people go on the internet, and there’s so much information out there that is absolutely total baloney. Yes. And it sounds very compelling. Most people, or I shouldn’t say most people, but many people really don’t have the skill set that allows them to evaluate and understand the difference between quality, real, evidence-based information and stuff that’s just, coming out of some guru’s mouth.

So just tell me about what is the landscape like now for information online, and what can people do to make sure that they’re getting quality information? 

Brooke Schmidt: Yeah, it’s a great question. I think of two things. I think of health literacy, and we know that is not always something the average person has. And as a nurse, I have to remind myself of that all the time, even when talking with my own family. And I think also the age of AI, it’s really easy to fall in the trap that you search into the search bar, like, how much urine leakage is too much? And it’s gonna give you an AI summary of a bunch of websites.

But what people don’t do is go look at the sources that were used for that AI summary, and I don’t have a statistic for you, but a lot of times those are not evidence-based websites they’re pulling the information from. And it’s not to say that the information they’re giving you is always wrong, but it’s really not the best way to get your medical information.

So it’s using websites that have the little signature saying, “This article was medically reviewed,” by a doctor, a nurse, a pharmacist, and using credible websites that I’m thinking of Mayo Clinic or the Cleveland Clinic. Places that are sourcing their information from research and journal articles, not from people’s opinions. 

Bruce Kassover: That makes perfect sense, and I understand that you write for a number of websites yourself, and you provide that sort of, vetted quality information. Where can people find more of your own writing if they wanted to see what you have to say?

Brooke Schmidt: Yeah. One of the companies I’m working with that ties us into the podcast today is LivDry, who’s a producer of incontinence products, and they have a whole adult resource section on their website that’s dedicated just to information about incontinence. And I write a good number of articles from them.

And every time, when I write something, if I’m stating a statistic or a fact, it’s… There’s a little link you can click that’ll take you back to the source it came from. And so that’s a good place to find me right now. 

Bruce Kassover: That’s very good. And we’ll make sure to put links to LivDry, also to your own website in the show notes. But let’s talk a little bit about incontinence and the sort of subject matter you’ve been focusing on, because one of the things I think that’s really important that we want to talk with you about specifically today is fit.

Here at the NAFC, we give lots of guidance for people to help them choose products that work as well as possible for them. And there are things like absorbency and different styles of products, all of which are incredibly important. But one of the things that I think is not always as appreciated as it should be is fit itself. People think that sort of if it’s around my body, it’s fine. But that’s not really what matters, is it? 

Brooke Schmidt: Not at all. Yeah, fit is incredibly important when we’re talking about minimizing leaks and also protecting our skin. Incontinence products, just like clothing, are not a one-size-fits-all, and every brand is gonna have a slightly different size and fit.

And so there’s just really not an off-the-shelf solution for a lot of people. It’s great if there are. But when I… in my clinical practice, every new patient who came into our clinic was basically given this comprehensive assessment, and part of that was managing their incontinence products.

So we would start by measuring, which is probably something that a majority of people wearing incontinence products don’t do, just like we don’t often measure ourselves before necessarily ordering our own clothes.

So incontinence products on the package, the brand website, even the Amazon little description down below should give some sort of size chart, and typically that comes with a waist measurement.

So that’s measuring… I wouldn’t focus so much on worrying about ‘where’s my waist.’ What you’re wanting to measure is where typically your underwear would sit, which is where an incontinent product would sit. So we’re getting that measurement, and it’ll fit you into a range for the size. The sort of caveat with that is again, it’s a range.

I get a lot of questions about what happens if I’m the number in between the two sizes, and there’s not a lot of resources out there to help people with that. And it’s a big topic, but there’s also, based on the style of product, the fit is a lot different.

So the waist measurement is great for what we consider a pull-up style product. It’s also important when we’re looking at a tabbed brief. But neither of these products are taking into consideration someone’s stomach or abdomen size, which varies a lot by person, or the width around their leg where the seam sits.

And we also sometimes use the term ‘gluteal cleft,’ which is again, where the… where your underwear sits as it goes under that curve, which is the same place where an incontinent product will sit. And so measuring those areas and taking into consider- consideration each person’s body size is how I would fit a product on somebody, and that’s not a service that, the average person looking for these is gonna have.

Bruce Kassover: You just mentioned something that really is like an added dimension. When people are thinking of regular clothes, normally they think about things like you said, like your waist. And that alone has all sorts of weird issues because if you’re a man, you’re used to just inches, right?

You’re, you’re- … 36 inches, you’re 42 inches. You’re whatever you are. If you’re a woman you have, you’re an eight, you’re a 16, you’re a two. And an eight from one manufacturer is very different than an eight from another one. Women’s sizing of just regular clothes is always an issue. So the waist, I w- I’m wondering, how are they typically measured from a waist perspective or do they vary from manufacturer to manufacturer ? 

Brooke Schmidt: It’s typically, so when we’re talking about a brief or a pull-up, obviously it doesn’t apply to a insert pad. They’re done based off of the waist measurement.

Bruce Kassover: Okay. So that’s, I guess that simplifies things, but then you added that other complication, which is you have to look around your thigh as well, where your thigh meets your groin area, which is not something that most people think of when they’re shopping for clothes, is it?

Brooke Schmidt: Yes. Yeah. And the big issue to show why that’s important is a well-fitting incontinent product is sitting flat on your waist with no big gaping or being too tight, and then you’re having a similar fit around your leg, and you want the product to run again, a similar spot that the underwear would.

So it runs along the line of the groin and under the gluteal cleft, ’cause these are the biggest areas we know where we have leaks, are typically around the legs and at the stomach. And so finding the fit for each body, even though you measure your waist and you compare it to this chart, it might still not work for you and cause leaks.

Bruce Kassover: Now I’m thinking that, it… Your, your idea is you don’t want to have a leak, right? So I would imagine you just want it to be as snug as possible. Is that correct? Or can it be too snug? 

Brooke Schmidt: It can be too snug, because if we’re digging into the skin it’s potentially causing little pouches where, like, where urine could come out , and it’s also then gets into the risk of damaging your skin.

So we want it to be you think… I would say you can comfortably fit two fingers in it. Like, It should be snug, but it shouldn’t be leaving deep red marks. A little bit of a line you get from your sock, totally fine if it goes away in a couple minutes. But if you’re taking it off and there’s a deep indent, then it’s definitely too tight.

Bruce Kassover: Okay. That makes sense also. But now you also brought up something else, which is we’re talking about, the function of it, and absorbency and skin issues. I think that skin issues is something that really isn’t appreciated nearly as much, and you have moisture in the area and that can cause things. What sort of skin issues are common for people to maybe encounter and what can they do to help minimize the chance of them developing them ? 

Brooke Schmidt: Yeah skin issues are, were my bread and butter when I was working in the clinical setting, and unfortunately they become much more prevalent any time we have moisture on our skin.

I think mobility and incontinence are two of the biggest risk factors for skin issues, and they do end up going hand-in-hand because mobility can cause incontinence if you can’t make it to the toilet, and it can also inhibit how you care for yourself. Because if you can’t reach certain areas, you’re not going to be able to change your product or clean yourself.

But then because of those common skin issues with incontinence, a big one is incontinence dermatitis. Dermatitis is a fancy word for basically a rash. And you can have contact dermatitis, which is your body’s reaction to urine or feces on the skin, or you can have allergic dermatitis, which would be more from a reaction to the incontinence product itself, like some ingredient in it that you’re allergic to.

They’re treated differently. Incontinent dermatitis for contact with urine is, removing the urine from your skin will generally resolve the issue, which is hard to do when you have incontinence. But it can mean changing products more frequently, using a product that wicks moisture away from your skin better, and then also using barrier products which comes in typically a wipe or a cream form, which basically forms a layer over your skin to try to prevent the urine from soaking in and having more direct contact with it.

Bruce Kassover: Yeah, that sounds like maybe not a catch-22, but a problem. Imagine that if you’re wearing these products and you develop dermatitis, you have a rash now that you have to deal with, but you can’t not continue using the products, right? So your suggestion is things like a barrier cream or, just try and change products, maybe find something that’s more absorbent. Is that the right approach in the, in those sorts of situations? 

Brooke Schmidt: Yeah. Yeah, and sometimes it’s also using the wrong product. There’s a lot of misinformation about some types of products. So when you’re using like a pull-up, for example, people tend to layer more products inside of it thinking it’ll be more absorbent. But what pad you’re using makes a big difference because there’s some pads that are meant to be called like a flow-through liner, meaning the urine will flow through the pad once it’s full and then collect in the pull-up. But some pads have a plastic backing that are meant to be used alone so that urine doesn’t leak through them, and when you put that on top of your pull-up, you’re now just trapping in this like soggy pad that’s gonna cause leaks and have more urine on your skin.

So some amount of it is also using the right product for your situation, ’cause the wrong product can give you the rash or the dermatitis. 

Bruce Kassover: I’m with you. Whenever I hear somebody talking about pads in association with incontinence, one of my concerns is that we also have a lot of people who wind up just using menstrual pads rather than things that have been developed specifically for urine and incontinence conditions. What are your thoughts on that? 

Brooke Schmidt: Yeah. I actually think that’s become more common recently ’cause they have products now, for periods and incontinence, like washable underwear, and they actually market them for both situations. I haven’t actually done the research enough to know that those are… I don’t know that they’ve been clinically tested to show if a menstrual pad or underwear has the same absorbency.

And they’re also, a menstrual pad is only touching part of your body, whereas incontinence products usually cover a larger surface area. I wouldn’t use them interchangeably personally, ’cause I think they’re formulated for different uses.

Bruce Kassover: Yeah, I think that’s probably the pretty standard guidance is that, if it’s something that’s actually been manufactured specifically to handle incontinence, leaks, that sort of volume. And so we’re talking about very different fluid volumes, so that makes a lot of sense.

But you talked about surface area, and that brings up another issue I really wanted to get your thoughts on, which is, we talked about sizing, but we haven’t talked about plus sizes for people who are themselves larger. What sort of challenges does that present when it comes to finding an incontinence product that works?

Brooke Schmidt: Yeah. So I think one of the biggest factors for that is, I’ve done my own, I’ll call it market research… you go to the grocery store aisle and typically the largest size of incontinent product you can find at your typical store is an extra large.

And we know that especially, in the United States, a large population, a large part of our population is overweight or obese, which means that a good majority of people shopping for these products aren’t gonna find something at the store, and unfortunately may mean that they’re squeezing into a smaller size that’s causing leaks.

And often for people who are plus size, they’re gonna have to use online resources. And we talked about them before, but LivDry, for example, has a pretty large selection of extended sizes. They go all the way up to a 3X, and that’s gonna give people the same quality absorbent product, just in a larger size, which becomes even more important when we’re talking about being plus size ’cause they’re, it comes with more folds, more moisture, more heat on the body, and it can also make dealing with skin issues a lot harder. So it’s even more important for these people to have high quality products. 

Bruce Kassover: I’m with you. Now, you mentioned LivDry, and I’m certainly not ashamed of promoting them a little bit if they do make products that fit this audience. So maybe you could tell us how could you find LivDry online? 

Brooke Schmidt: Yeah. So they currently have an Amazon storefront, which I, as someone who’s worked with many older adults and also my own family members, if you’re an adult child buying incontinence products for your family, anything you could do on Amazon, incontinence products or not even Amazon, but any website that offers a subscribe and save option, because you can just automatically have these products delivered to your loved one, even if you’re not close to them. They do also have a website, but currently most of their storefront is just through Amazon. 

Bruce Kassover: Okay. That makes sense. So what we’ll do is we’ll put a link there for anybody who’s interested in going and learning more about them.

Brooke Schmidt: There’s also a big cost aspect to it because the products all come in packages of, 20-plus things and so you buy it and you try it and it doesn’t fit.

Not everyone has the money to keep going out and trying them until they find the right thing. And so I think that’s where measuring is a really big part of, like, where you should at least start so you’re in the right ballpark when you’re trying products. 

Sarah Jenkins: Yes, absolutely. And even just getting the help of one of the consultants on the phone to walk you through where to measure, if you have questions. I think that’s just so helpful. 

Brooke Schmidt: Yeah. That’s a great point. I think it’s also not ever trying to feel like you have to figure it out on your own because there are consultants through the products, through the companies and there’s, depending on your healthcare provider, nurses or aides can help you with measuring if you can’t reach yourself or you don’t have family or a caregiver who can help you.

And I think we know that there’s a lot of shame and dignity issues that come with incontinence, and I just always really like to encourage people that it’s not something you have to face by yourself. And us in healthcare, it is something we deal with all day every day and it is… I would rather somebody come and say, “Hey, I’m having a hard time finding a product,” than having to help them heal the skin issue or get treatment for the urinary tract infection because they couldn’t find the right product to help them manage their symptoms. 

Sarah Jenkins: Absolutely. 

Bruce Kassover: We really appreciate all of this insight. It’s really helpful, and I certainly know that there are so many people out there who are struggling to try and find products that make sense. So with any luck, this is really gonna make a difference for them.

However, this is Life Without Leaks. And one of the things we always like to do before we leave is give our guests one little hint, tip, strategy, bit of advice to help them live a life without leaks. So I’m wondering if you might have one today. 

Brooke Schmidt: Yeah. I think it’s a, almost a summary of what we talked about. But I think that my most important tip is we should always address the root cause of incontinence and not just assume that it’s happening for no reason. But even despite when we do that, most people are still gonna have some amount of symptoms and incontinence they’re dealing with every day, and it’s finding the approach that works for each person, which is gonna be different.

But in my experience, the biggest thing is the right size and fit of the product combined with the right sort of toileting plan, to combine those things that you’re not missing out on your life. Because my biggest tip is finding, I guess in summary, is finding the solution that makes it so you can do what you want to do every day. ‘Cause quality of life is really important and something that I’d wish for anybody dealing with incontinence. 

Bruce Kassover: I don’t think there’s anything more important than that, so I appreciate it. So thank you for sharing that. Thank you for joining us today. 

Brooke Schmidt: Yeah. Thanks for having me. 

Bruce Kassover: Life Without Leaks has been brought to you by the National Association for Continence. Our music is Rainbows by Kevin McLeod. More information about NAFC is available online at nafc.org.