Read more from Slate's Geezers issue.
Aging can be a cruel process. You get liver spots. You slow down. You start hurting everywhere. You take more pills than Janis Joplin in her prime.
But it's not just the physical aches and pains that get to you. Your dignity can begin to evaporate as well. There's the patronizing look from the waiter as you struggle to read a menu. The inability to perform simple tasks that were once executed with ease. The subtle erosion of your independence.
All of these problems are exacerbated when you start urinating in your pants.
The reality of the age-related regression to a state resembling infancy is never clearer than when you lose control of your bladder. You start buying clothes not so much for style or comfort as for how well they hide a telltale stain. At social events, you chart bathroom routes and exit strategies. Every long car ride becomes a chore, every airplane ride a potential disaster, every happy hour a decidedly unhappy hour.
According to the National Association for Continence, more than 25 million Americans suffer from incontinence or other bladder-control problems. (Nearly 50 percent of nursing-home residents are incontinent.) There are two types: stress incontinence and urge incontinence. People who are stress incontinent leak urine while coughing, sneezing, laughing, or lifting heavy objects. People who are urge incontinent have what is commonly known as an overactive bladder. For the urge incontinent, the need to void one's bladder—which can hold about 24 ounces of urine at its top capacity—can come suddenly and uncontrollably.
Wearing adult diapers is one of the few medication-free ways that incontinent people can feel comfortable going out in public. Adult diapers are exactly what they sound like—padded, disposable cotton briefs similar to those worn by infants. There are two layers to most well-made adult diapers. The inside is composed of hydrophilic material that attracts liquid, while the outside is composed of hydrophobic material, which prevents the liquid from seeping through. "You don't want that clamminess on your skin," said Gary Evans, owner of incontinence supply house XP Medical.
A couple of months ago, Slate asked me to field-test various adult diapers for its "Geezers" issue. In many ways, I was an unlikely choice—I am a 27-year-old male, and incontinence primarily afflicts women and the elderly. Then again, I am prone to back pain, influenza, sinusitis, digestive malfunctions, and swollen fingertips; I eat poorly, exercise infrequently, drink heavily, and never sit if I can slouch. If there is anybody who is due for a painful and unhappy old age, it is me.
There are several Web sites, like the Incontinence Resource Center, that rank adult diapers from best to worst. As for my experiment, my methodology was simple. I was testing for wearability, for absorbency, for longevity, and for style. I rated the diapers in each category on a 5-point scale for a total of 20 possible points.
Wearability(5 possible points)
While you will never really feel comfortable in an adult diaper, some are more wearable than others. Several criteria are encompassed in this metric. Does the diaper fit? Does it feel like genuine cotton underwear, or does it feel like you're wearing a stack of paper towels? Does it provoke scratching and crotch-adjusting to the point at which it would be noticeable in public? Can you wear the diaper for extended periods without feeling like Baby Huey? Do you ever forget that it's there?
Absorbency(5 possible points)
This, of course, is the big one. A good diaper should be able to absorb as much liquid as a brimming bladder can expel. How much liquid can the diaper hold, and how much can it hold comfortably? How well does it absorb that liquid? Does it keep you dry? Is it prone to leaks? At what point does the diaper start feeling like a used sponge? At what point does it start feeling like a swimming pool?
Longevity(5 possible points)
"You're relying on the product to perform the process that your bladder's not—storing urine," said Gary Evans. Thus, it's important that an adult diaper be wearable even after it has been soiled. Besides, spare diapers are like spare tires: You can't really bring either to a cocktail party. How long can a used diaper be worn comfortably? At what point does a quick-change act become necessary?
Style(5 possible points)
Diaper style doesn't matter so much for babies, who don't know any better and who cry all the time, anyway. But it's important for adults. If you are a slender, incontinent man, will the diaper ruin your silhouette? Does it make it difficult to fit into pants? Can you wear an adult diaper and still feel sexy?
I chose six brands of diapers—all the "superabsorbent" kind—and put them through a rigorous, three-prong testing process. First, I subjected them to clinical and scientific wetness testing. (I poured water on them from a measuring cup and watched for sogginess.) Next, I wore them dry as I went about my daily routine—to work, on the subway, to the low joints that I frequent at night. Finally, I wore them wet. With my own urine. (Ah, the things that we do for science, and money.)
Store Brands For the sad soul who is both incontinent and destitute, and for nobody else. Conventional wisdom says that any savings that may result from using generic personal-hygiene products are subsumed by the discomfort that users must endure. This is doubly true for generic adult diapers. Unless you are impoverished, or a masochist, there is no reason to go generic. The savings are minimal, and so is the quality.
I tested three different store brands: Target (Affirm), Walgreens (Certainty), and Kroger (Kroger), all of which were similar in price (low) and quality (low). The simple verdict: Don't use the store brand if you have any plans at all to do anything that day besides change your adult diaper.
My experience with Kroger was particularly memorable, which isn't a good thing when it comes to diapers. They were about as absorbent as a drainpipe, sagging under the weight of the water and leaking like Daniel Ellsberg. These pull-on-style diapers went on easily and didn't actually feel too bad when I wore them dry, but years of using my congenitally cheap roommate's Rite-Aid-brand toilet paper has steeled me for discomfort.
Eventually I consumed enough liquor to muster the courage to wear them wet. Unfortunately, consuming all that liquor also mustered enough urine to make the testing process one of the more unpleasant experiences of my life. The diaper swelled until it could swell no more, at which point streams of urine began running down the sides of my legs. Even though I had locked myself in a bathroom to perform the test, I still feel unaccountably ashamed, as if God were laughing at me—a feeling made worse by my inability to exit the diaper. The Kroger diaper features quick-release strips on its sides so that wearers can rip the sides for a quick and easy exit. But the strips didn't immediately rip, and I just stood there stymied for a few seconds, tugging ineffectively at a wet adult diaper and feeling as if there must be easier ways to make a living.
Afterward, I headed directly to the shower.
Depend Super Plus Absorbency Adjustable Underwear Perhaps the best-known brand of adult diaper, thanks to the long-running commercials featuring Little Women star June Allyson. Many of the adult diapers I came across boasted soothing and gentle names like Depend or Affirm. This makes sense—people want to trust their adult diapers. A product with a name like Mystique probably wouldn't sell very well.
I tested the Super Plus Absorbency Adjustable Underwear variety (now with worry-free odor control!), which looked and felt like a cut-rate codpiece. While it was comfortable and largely itch-free, the main problem was that the garment didn't fit. It is undoubtedly difficult to make a one-size-fits-all adult diaper, but I fell squarely inside the L/XL size according to the chart on the box, and I could have fit another person in these briefs. (This is speculation: I did not attempt this.)
As absorbency goes, Depend is adequate at best. While much better than the Kroger diaper, Depend still had trouble comfortably holding more than a pint's worth of liquid. When I wore it wet, the poor fit really became a problem—it felt like a damp, loose towel was wrapped around my waist. When it comes to "rewet absorbency" (how much liquid an already wet diaper will absorb), Depend does not perform well; it's necessary to change diapers if you're planning to double dip.
One final note: Depend claims that you can change these diapers without having to remove your clothes. I tried this several times, and am pretty sure that this is false. Maybe it's a practice-makes-perfect thing, but it was essentially impossible to change these diapers while still wearing my pants. Impossible and disgusting—it always felt like the urine was going to brush up against the inside of my jeans, leaving me with stink-thigh. And besides, you'll have to remove your clothes to don a new diaper, so it's not really a significant time savings.
Attends Underwear Super Plus Absorbency With Leak Barriers The word Attends sounds a lot like the word Depend, and, indeed, the two brands are similar—similar in their mediocrity, that is. Like Depend, Attends was functional, but its performance certainly wasn't great. None of the American diapers was that great, actually. There is an economic reason for this. The vast majority of American-made adult diapers are purchased by hospitals, Medicare, and Medicaid. These institutional purchasers are mostly interested in saving money, so diaper manufacturers tailor their products to their buyers' demands, producing diapers that are, essentially, cheap and cheaply made.
Attends fit a little bit better than Depend, although I would not recommend wearing either of them underneath tight pants. ("Relaxed fit" is the phrase to remember when it comes to buying diaper-friendly trousers.) It was the most comfortable domestic diaper when it came to long-term wear, but that's sort of like saying that first-degree burns are the best kind of burn. While, like a Depend, it held about 16 ounces of liquid before structural integrity was breached, it certainly did not live up to its expected absorbency.
A basic Attends brief promises to hold about 15 ounces of liquid; you would expect that the Super Plus Absorbency variety would exceed that capacity. It did not, which is no big surprise, according to diaper guru Gary Evans, who explained how manufacturers test their product absorbency: "They dunk the entire product, leave it there for a certain amount of time, allow the surface liquid to drain off, and weigh the product to see how much liquid it absorbs. I find that, realistically, you'd be lucky to get half of [the advertised absorbency]." I found that, realistically, American adult-diaper manufacturers are sort of bastards.
Of course, for many people, incontinence is manifested not in sudden, game-changing urinary explosions but in the small and steady drips characteristic of stress incontinence. I therefore subjected all of the diapers to the "drip test," dousing myself periodically with small amounts of liquid over the span of a few hours. (It is extremely hard for a strong-bladdered man to simulate stress incontinence, so I did this by pouring water into my crotch.) I can say that Attends is perfectly fine when it comes to catching drips. Just don't ask it to soak up a gusher.
Molicare Super Plus Adult Diapers
Like chocolate, beer, and jewel thieves, the best adult diapers come from Europe. This is not coincidental. European manufacturers don't have to cater to institutional purchasers' demands, so they're more likely to sell on quality rather than cost.
The top-of-the-line European diapers are made by a company called Abena; their diapers boast a ridiculous 4,100-milliliter absorbency (more than a gallon). Sadly, I had trouble tracking these down stateside. European diapers typically aren't sold in drugstores and have to be purchased from specialty retailers or online merchants. I did, however, get to test-drive the awesome Molicare Super Plus. If Abena is the Mercedes of adult diapers, then Molicare is at least comparable to a Volvo. Bulkier than its domestic counterparts, the Molicare is nonetheless a more wearable product, thanks to its superior fit, which envelops your netherlands snugly and completely. It felt like I was wearing one of those portable seat cushions that people bring to high-school football games. Frankly, I felt voluptuous.
The European advantage was most evident when the Molicare got wet. Orders of magnitude more absorbent than Depends, Attends, or Kroger, the Super Plus never leaked, not even after two rewettings. My legs were never clammy while wearing it wet; indeed, I felt as comfortable as one can probably feel after having urinated in one's pants. When my bladder finally starts down the road to unreliability, I'm going European.