Pull-Ups or Briefs: Choosing the Right Product

What each product is

Pull-up pants (protective underwear). Absorbent pants worn like underwear, pulled up and down over the legs. They have an elastic waist and leg cuffs, and some have tear-open sides so that they can be removed without taking off trousers. They look and feel like normal underwear and let a mobile person manage independently.

Tab-style briefs (adult diapers). An absorbent garment fastened at the sides with adhesive or refastenable tabs. They open flat, so they can be put on and taken off while the person is lying down or when standing is difficult. They usually carry higher absorbency and adjustable fit.

Shaped pads and liners. Smaller absorbent pads worn inside normal underwear or fixed with netting pants, for light to moderate leakage. See choosing incontinence products by situation.

Underpads. Flat sheets placed under the person in bed or on a chair, as protection; see underpads: disposable and washable options.

Who suits pull-ups

• People who are mobile and can stand to dress, and who want independence and a discreet product.
• Moderate leakage from stress or urge incontinence, or occasional bowel leakage.
• Those who go to the toilet themselves and need pants that can be pulled down quickly.
• People who are sensitive about "diapers" and prefer something that looks like underwear.
• Daytime use and outings.
• Carers who can help the person stand to change.

Limits: pull-ups are harder to put on a person who cannot stand or who is in bed, since the legs have to be threaded through. They may be hard to remove after a bowel movement without soiling clothes unless they have tear-away sides. Sizing is less adjustable, so gaps at the legs can cause leaks.

Who suits tab-style briefs

• People who are bedridden, weak or unable to stand, or who are changed lying down.
• Heavy leakage, night use, or large volumes.
• Bowel incontinence, since the sides can be opened and the garment wrapped away without dragging soiling down the legs.
• People with swollen legs, large thighs, hip fractures, casts or contractures, where legs cannot be threaded easily.
• Carers who need quick, controlled changes, including two-person turns. See how to change an adult diaper in bed.
• Those who need an adjustable fit, since tabs can be tightened and loosened.

Limits: briefs can look and feel more like a baby's diaper, which may offend some people. Poor fastening can lead to gaps or sagging. Plastic-backed briefs may trap heat and moisture, so skin care matters.

Comparing products: what to look at

Absorbency. Products are rated by capacity, using symbols or drops on the pack, or by terms such as light, moderate, heavy, extra and overnight. The more absorbent, the thicker and more expensive. Choose the lowest absorbency that stays dry for the intended time. A product that is too thin leaks; one that is too thick is bulky and hot.

Size and fit. The product must fit the waist and hips. Too large gapes and leaks; too small digs in and rubs. See how to measure for adult diapers and pull-ups.

Leg cuffs and barriers. Gathered, soft cuffs around the legs prevent side leaks. Check that they are not cutting into the skin.

Wetness indicator. A line that changes colour when wet helps carers know when to change, especially in dementia or bedbound care.

Breathability. Cloth-like, breathable outer layers allow air to reach the skin and reduce rashes and odour, which is particularly useful in hot, humid climates. Plastic-feel outers trap heat.

Odour control and fastening. Some contain materials that lock in moisture and reduce smell. Refastenable tabs allow adjustments and checks without discarding.

Softness and skin comfort. A soft, non-scratchy inner layer, free of fragrance and lotions that may irritate sensitive skin.

Gender and shape: products shaped for men and women exist, with absorbent material positioned differently; many unisex ones work well.

Ease of use: for people with arthritis or tremor, easy-grip tear sides or large tabs help.

Cost and availability: costs vary widely. Compare the cost per piece, not per pack, and consider availability of the same size and brand over months. See an incontinence products budget: what a month costs.

Quality and authenticity: buy from reputable pharmacies and check manufacture dates and packaging; see spotting fake or poor-quality care products.

How to use them properly

Putting on pull-ups (standing): 1. Wash hands, and explain what you are doing. 2. Have the person sit or hold a support; help to step into the product, one leg at a time. 3. Pull up to the waist, adjusting so that the leg cuffs fit snugly, and the waistband is flat. 4. Smooth out creases, particularly at the groin.

Putting on briefs (lying): 1. Prepare supplies and wash hands; see how to change an adult diaper in bed. 2. Roll the person to one side, place the brief flat with the back panel centred under the hips, tuck the rolled edge, roll back, and bring the front panel up between the legs. 3. Fasten the lower tabs upward and the upper tabs downward (or as the maker shows), snug but with room for two fingers at the waist. 4. Check that the leg gathers are pulled out, not tucked in.

Changing frequency. - Change when wet or soiled, and at least every three to four hours in the day for people who leak often, unless the wetness indicator shows otherwise. Heavy products at night may stay on longer if the skin is healthy, but change promptly after a bowel movement. - Do not wait for the product to be "full". Prolonged contact with urine and stool damages skin; see incontinence-associated skin damage: prevention and care. - Check the skin at each change and clean gently; see wipes and perineal hygiene done gently. - Use a thin layer of barrier cream if advised; see barrier creams and skin care under pads.

Common mistakes

• Buying the wrong size, the most frequent cause of leaks.
• Using a product that is too thin or too absorbent for the need.
• Doubling up pads inside briefs, which causes bulk, leaks and skin pressure, and blocks absorption. Use a single appropriate product, or a booster pad designed for it, as advised.
• Cutting or altering the product.
• Not changing often enough to save money.
• Using a pad only, when a brief or a more absorbent product is needed.
• Fastening too tightly, causing marks, or too loosely, causing gaps.
• Not pulling out the leg gathers.
• Using talcum powder, which can cake and irritate; avoid unless the nurse advises.
• Using plastic sheets directly under the person; see mattress protectors for incontinence.
• Using products as a substitute for toileting when the person could go to the toilet with help; see bladder training and timed toileting.
• Flushing used products or throwing them loose in the bin; see disposal, laundry and odour control.

Mixed approaches

Many families use a combination: pull-ups by day for a mobile parent, briefs at night or when unwell, underpads on the bed and a waterproof mattress cover, a urinal at the bedside and a commode for the night; see urinals for men and women: bedside use and managing incontinence at night. The right mix changes as health changes.

Dignity and choice

Let your parent take part in choosing, within safety, and try different styles. Many people are more willing to accept a product that looks like underwear. Keep supplies out of public view and speak respectfully; see dignity in intimate care: words, privacy and consent and talking about incontinence with a parent without shame.

When to ask a professional

Ask a continence nurse, pharmacist or doctor to recommend a product and show how to fit it. Ask a nurse to check the skin if there is redness, soreness, blisters or broken skin. See a doctor about the cause of incontinence, since products manage but do not treat it. Seek urgent help for fever with confusion, blood in urine, inability to pass urine, severe pain or open sores that are spreading.