Incontinence can be hard enough to manage on its own, but when you don’t fit into traditional sizing, it can be even more complicated. Addressing incontinence with specialized plus-size leak protection requires special considerations, especially since not all brands offer larger sizes. There can also be issues with fit, leaks, and skin concerns, which can be hard to navigate.
As an experienced nurse who has spent countless hours troubleshooting incontinence and working with plus-size patients, I have learned things that work and don’t work. Here, we discuss the parts of incontinence in plus-size care that no one talks about and what to do about it.
The Disconnect with Incontinence Care and Plus-size Bodies
People who are considered plus-size have been known to delay or avoid seeking healthcare due to their fear or concern of how healthcare providers will treat them. Incontinence concerns are no different and can result in prolonged issues that go unmanaged.
Family members, friends, caregivers, and even healthcare professionals may feel uncomfortable addressing fit issues with someone who wears plus-sized clothing or products. They do not want to draw attention to their size or make them feel bad, or, on the flip side, they will assume all of the issues are because of their weight and suggest weight loss as the only solution. The lack of support and ability to have open-minded conversations can inhibit access to products and health care services.
As an experienced nurse, my focus is to help individuals with plus-size bodies and their caregivers navigate the stigma and be able to find practical support and respect regarding their incontinence care. This is best done through education to ensure they know how to access and use products that work for their body.
Plus-size Incontinence Products Sizing and Fit
Sizing is a big issue; plus-size people often have fewer options when it comes to clothing, underwear, and incontinence products. It is not always feasible to go shopping at the store to try different sizes and find what fits their bodies. They are left guessing and often wearing the wrong size. Measuring yourself or asking someone else to measure you may be embarrassing and a barrier to finding the right incontinence product. This is something I always address with every patient, of any size, and explain that taking measurements is not for weight or size tracking but simply to find the best fit that provides them with a comfortable, well-functioning product.
Typical incontinence products will start with standard sizing, such as small, medium, and large. Some brands stick to traditional sizing, while others may offer expanded options, including those considered plus-size. One example is LivDry, which manufactures products in sizes beyond the standard, including 2XL and 3XL. These products can accommodate hip sizes up to 92” and offer leak protection for larger bodies. You want to make sure you find a product designed for larger body types, as it will help minimize leaks and be more comfortable.
With plus-size incontinence care, another issue I have encountered frequently is that people struggle with absorbent pull-up underwear rolling around the waist or hips. This is usually due to a product that is the wrong size (often too small) or the wrong fit for your body type (it may fit the legs and abdomen but be too tight around the waist, causing it to roll down). When pull-ups roll, they can be harder to conceal under clothing, be uncomfortable, and put extra pressure on the skin, which can cause breakdown. Choosing a product that is not only the right size but also features contoured, higher-waist side panels can give you a more customized fit that reduces rolling.
Another thing people don’t talk about is how varied all of our bodies can be. Being plus-sized does not automatically mean your weight is carried in one area of your body. Whether extra weight is carried in your abdomen, hips, or legs will affect the fit of incontinence products. Your hips may indicate one size, while your waist and/or legs indicate another. If you find that the measurements of different body parts differ significantly, you may be better off trying adjustable adult briefs that allow for more customized adjustments around the legs and hips, rather than a pull-up.
Skin and Hygiene Issues That Can Arise
Any time you are dealing with incontinence, it is important to thoroughly cleanse the skin after any contact with feces or urine. This helps maintain the skin’s natural balance and prevents issues such as rashes, moisture-related damage, and open wounds. Taking a shower or bath is not always possible multiple times each day. I recommend using gentle adult cleansing wipes or no-rinse foaming cleansers formulated to be gentle on the skin.
The ability to reach and complete hygiene can sometimes be difficult. There are adaptive tools available, such as long stick-type devices that you can attach toilet paper or a wipe to, to help ensure good hygiene. If you or someone you are caring for is struggling with hygiene, it can be helpful to meet with an occupational therapist (OT).
You may also need to work with your health care provider and begin using products such as barrier creams to protect the skin from moisture and other medicated topical treatments for rashes, wounds, or yeast infections, all of which are common when managing incontinence (always consult with your medical provider for treatment advice when experiencing skin issues).
Problem Solving Real-Life Issues
Beyond finding the right size and fit and addressing hygiene, it can be helpful to talk through real-life scenarios I have encountered. While the exact situation may not apply, it gives helpful hints and ways to think through problem-solving if you experience something similar.
A patient who stands out to me is one who struggled with incontinence for many years. This patient was plus-sized and was struggling with frequent daytime leaks, overnight wetness, and had several associated skin issues. I measured this patient myself and ordered them a 3XL pull-up for daytime and the same size brief for overnight. While their hip measurement put them in this size, I found out during a follow-up phone call weeks later that none of their issues had resolved.
To better problem solve, I met with the patient and had them try on the products. The pull-up fit well around their waist, with no gaps, and wasn’t too tight. The issue was that the gusset around the legs, which is supposed to sit below the buttocks in the gluteal fold (the area where the buttocks meet the upper thigh), was actually becoming trapped in skin folds of the upper thighs. The product was not positioned close enough to the urethra, where urine exits the body, to absorb urine before it accumulated against the leg bands and leaked with any movement or pressure.
In this scenario, I educated the patient and their caregiver on proper product placement. The size was right, but the placement was not. I taught them to feel with their hand to ensure the leg gussets were sitting in the crease between the buttock and thigh, or to use a hand mirror for a better view to check the fit. While the product should not feel tight, it should sit close to the skin to maximize absorption. Once the product worked properly and had a good fit, we could focus on healing her skin, which had been damaged by frequent contact with urine. By allowing the product to absorb urine and wick it away from the skin, it reduces the risk of maceration (when skin absorbs too much moisture and becomes soft and fragile), which can lead to open wounds and infection.
Another situation I have seen is with a patient who was struggling to change incontinence products by themselves. Due to their body size and physical limitations, repeatedly changing their pull-up throughout the day was causing fatigue and preventing them from participating in other physical and social activities. They were attempting to avoid frequent changes by just adding booster pads on top of the wet pull-up. This would result in multiple booster pads layered in the pull-up by the end of the day. It was still resulting in leaks but had also caused incontinence-associated dermatitis (IAD), which occurs when urine remains on the skin, and a rash develops. IAD is also referred to as diaper rash, and the skin can appear bright red and shiny. It can be painful and difficult to heal once it occurs.
In this situation, I had to first focus on healing the skin. This usually includes leaving the skin open to air to allow it time to heal, using barrier creams, and promptly removing any urine or wet products. If redness, rashes, or pain develop in any areas, you need to see your medical provider for an accurate diagnosis and treatment. Once the skin had healed, we were able to develop a new, more sustainable plan. This included using an easy-on/off pull-up style product with tear-away sides for easier removal. I also taught the patient how to change her pull-up without removing her pants completely. This technique involves placing the pull-up over one foot and pulling the entire product up through the pants. You then loop the other open leg hole down through the other pant leg, hook it over the foot, and then pull it up and through. This helped conserve energy while still allowing for frequent changes. In addition, we used flow-through booster pads that could be removed and replaced if the pull-up below was still dry, and that also kept moisture away from the skin.
Key Takeways
Incontinence care for plus-size individuals can come with a lot of stigma. Learning practical solutions and finding trusted caregivers or healthcare providers to discuss incontinence with can help prevent frustrating issues such as leaking and skin damage. When incontinence is addressed and a management plan is in place, it helps improve quality of life.
