Anniversary

    This month marks 10 consecutive years in diapers for me.

    This is not

  • 10 years in diapers 24/7 (which will be December 2022 or January 2023, depending on your definition)
  • 10 years officially needing diapers (July 2023)
  • 10 years in uninterrupted diapers (also July 2023 or alternatively January 2026, depending on your definition)
  • Rather, this is 10 years of being routinely in diapers, i.e., always being in diapers to the exclusion of underwear during at least some scheduled periods of time and/or under at least some circumstances. This is "being in diapers" in the most basic sense, namely spending too much time in diapers to be considered undiapered.

    The reason it started in June is because in late May 2012 I had a scare where I unexpectedly couldn't access a toilet for 2-odd hours and thought my bladder control was going to fail (it did, but not completely or dramatically, just a few spots). Consequently, I started wearing protection, initially whenever I thought I might not be able to access a toilet for more than about 1 hour. The rest is history.

    anonymous

    Hello! I saw your post on the different kinds of…incontinent Abdls and seeing your thoughts on the “URPI” folks (Abdls with mild incontinence issues that refuse to use diapers for them) it broke my brain a little. in a good way! I related a bit to the hyper qualification of need you described, since I deal with high frequency and dribbles, wo untraining. Do you think normal folks with issues who assess the need for protection have a similar reluctance to protection? Thank you for your content!

    Hello!

    Hi anon!

    in a good way!

    I'm glad to hear that! lol

    I related a bit to the hyper qualification of need you described, since I deal with high frequency and dribbles, wo untraining

    There sure are quite a few of us.

    Do you think normal folks with issues who assess the need for protection have a similar reluctance to protection?

    My general experience is that they do experience reluctance which is similar in terms of impact and some aspects of its construction, but which is fundamentally different in rationale.

    Both groups make assessments of their need with respect to some threshold, but:

  • AB/DLs tend to construct their arguments with explicit reference to social responsibility (e.g., invoking their responsibility not to wear diapers) whereas non-AB/DLs tend to construct their arguments around a more abstract and impersonal concept of medical need (e.g., asserting that their own need does not qualify)
  • AB/DLs tend to construct their arguments as a matter of balancing needs ("my need to wear diapers [does not exist and therefore] does not outweigh my responsibility not to") whereas non-AB/DLs tend to construct their arguments as failure of a single variable to exceed a specific minimum ("I may or may not have issues, but not enough to need to wear diapers")
  • Thank you for your content!

    No worries!

    anonymous

    Is there any evidence that untraining/bowel incontinence increases the speed of metabolism/digestive processes, or is the shorter duration between eating and messing just confirmational bias?

    I can't see why it would do that. I would guess that the shorter duration, if any, between eating and messing would result from the fact that it's no longer possible to hold without consciously noticing you're doing it, and possibly from the fact that there is less likely to be anything already in the bowels.

    anonymous

    Could you possibly go through the steps of what it might look like for someone who only meant to untrain to being a bedwetter, but eventually accidentally lost all control?

    Could you possibly go through the steps of what it might look like for someone who only meant to untrain to being a bedwetter, but eventually accidentally lost all control?

    Sure. As you might know from following my blog, the typical path to bedwetting entails first going through daytime untraining. However, I'm going to be a hyper-pedantic literalist and assume you mean that our hero meant to untrain to only being a bedwetter — that is, without developing loss of daytime control first — because I think it's more productive in terms of answering your question. I'm also going to describe this hypothetical someone with second-person ("you") pronouns, because I tried drafting this post with third-person ("them", "this person") pronouns and it didn't flow.

    An additional note: In conceiving this scenario, the specific chains of events I picked were chosen on the basis that they effectively made my point, not that they were the experiences most likely to be representative of how this would actually happen.

    However, they do share mechanisms with the versions of these events that are likely to actually happen. In effect, I chose the implementation of those mechanisms which was most likely to lead to a continence-degrading outcome 100% of the time. In reality, until quite late in the process, it will virtually always be the case that continence-degrading outcomes happen in circumstances where with a little bit of luck they could have been avoided and you simply ... didn't get lucky.

    So you only want to develop bedwetting. In this scenario, you've tried hypnosis before and you know it works for you, so you decide to use hypnosis. You find an existing file that works for you, or you commission a file — in this instance it doesn't particularly matter which, as long as it works for you. It's a curse file, because you don't want it to be able to be reversed (and because that makes this hypothetical simpler to lay out, neither do I!). After applying it for some time, it works; you start wetting the bed. It intensifies over several months; at first it happens every so often, then an average of 1 night per week, then 3, then 5, then 6, then 7. You rejoice, very pleased with your brilliant success.

    Of course, this has consequences. The muscles which directly block the outflow of urine are the external and internal urethral sphincter (EUS and IUS respectively). What those two muscles have in common is that they're evolved to be contracted for all but a few minutes a day, because hey, toilet training per se might be an invention of agricultural civilisation, but the tactical utility of continence has been a fact for long enough that the capacity for it is now permanently baked in.

    These contraction-oriented muscles are now not tightly contracted while you're asleep. Since you, or the version of you which I've constructed or sculpted for this hypothetical, get the 7–9 hours of sleep which is recommended (Hirshkowitz et al., 2015), your contraction-oriented bladder muscles are now relatively or absolutely relaxed for an average 8 hours out of every 24, 8 hours more than the average adult.

    Similarly, the pelvic floor is integral to continence because it is designed to support, among other things, the urethral sphincters. It is designed to do that 24 hours a day. It is sensitive enough to demand that relatively minor changes in bladder habits in a context of otherwise full continence can affect its functioning (Golen & Ricciotti, 2022). Under your enlightened administration it is doing it 16 hours a day. The results are predictable.

    Consequently, your secondary nocturnal enuresis (SNE) — adult-onset bedwetting — starts to be compounded by urinary incontinence (UI), specifically stress UI. One of the functions of your bladder control system is to prevent urine from unexpectedly exiting the bladder when you experience an increase in intra-abdominal pressure (IAP) — that is, when your control muscles come under increased stress. Stress UI happens when your control muscles are no longer strong enough to hold up to the highest level of pressure achieved within your abdomen under ordinary circumstances.

    You find you start wetting a little bit when you cough, exercise, laugh, sneeze, or do various other things that raise the pressure within your abdomen. You may be an AB/DL and therefore able to deal with pee as an occupational hazard, but you are not particularly enamoured of the idea of wetting your pants, so even though you have no intention of losing further control, for practical reasons you define conditions additional to your already-existing overnight diapering under which you would be willing to wear diapers.

    You happen to have a regular exercise routine (sleep, regular exercise — why are you here?) and so you start wearing pull-ups when you're jogging, because you're not tremendously enamoured of the idea of wetting your pants while you're out round your neighbourhood, with people who might not know you but could still very well recognise your face.

    Then you get COVID. You don't have to worry about exercising for the moment — if you've got COVID, you absolutely shouldn't (Walsh, 2022), and you shouldn't try to get back in the saddle too fast, either (Tang, 2022) — but you have a racking cough for a two-week acute phase, and a lingering dry cough for at least six weeks afterward. Technically the acute phase isn't too big of an issue, because you're spending most of it in bed feeling like you're being kicked to death by an angry Clydesdale, and you already have a mattress protector on it, so you only have to change the sheets. After the 7th time you realise you don't want to keep changing the sheets and grudgingly admit it would probably be appropriate to wear diapers during the day, just in the interim.

    After the first week, things seem to level out and you're not coughing quite so much, so you stop wearing d— sike, COVID is biphasic (Chen et al., 2020), you got punked. You're back in bed for another week, sore, weary, and fed up. You hit the end of the acute phase and the coughing seems to tail off, but it takes weeks for it to feel quite gone enough for you to feel safe out of diapers. By that point, you just don't quite trust your bladder and have adopted the habit of wearing diapers in situations where you think it probably won't come under any intense stress, but where you don't feel like you can be sure.

    Then spring comes along. Lingering immune system dysregulation from COVID (Ryan et al., 2022) means you now have a pollen allergy that even a dangerous dose of loratadine can't put down. You are sneezing all the time, and losing confidence in your bladder accordingly. You add another entry to your list of circumstances under which you are willing to wear diapers for safety's sake.

    And so on and so on — gradually, over time, the pencilled-in blocks of time during which you are willing to wear diapers expand to cover most of your day. Even though you're not deliberately trying to lose any bladder control, all the genuinely unintentional accidents are subconsciously normalising it, teaching your brain that maintaining bladder control isn't that important because the vast majority of the time, if you don't manage, the worst that will come of it is a wet diaper.

    And, of course, the organic foundations of your control are also being eaten away. While the changes initiated by your bedwetting have certainly reached the point where they're perceptibly having an effect on your daytime control, that does not by any metric mean that they've reached their maximum. Hell no. No sirree. You're beginning to notice that you're wet even when you know very well that you haven't done anything that causes that to happen, but of course at first it's a difficult and ambiguous call to make — you were already in a wet diaper, how do you know it's gotten wetter? And by the time it's clear and unambiguous, this phenomenon has advanced to the point where it's an independent and impossible-to-ignore threat to your continence on its own.

    Now, you don't want to lose additional bladder control, but two other things are also true. The first is that you don't want to experience your current level of loss of bladder control in such a way that you get hurt, embarrassed or humiliated by it. The second is that you're an AB/DL; whether or not you particularly enjoy being incontinent, you know how to deal well with diapers and you have no intention to slum it, nor any reason to do so. This is your game and you intend to win.

    Consequently, you start slowly adapting your conditions of living to how much you're wearing diapers. You stock up on waterproof pants, bodysuits, adaptive clothing. Of the dozens to hundreds of purchases you make, each one makes you incrementally safer and more comfortable in your diapers, and, while it also makes it incrementally slower and more inconvenient to use the toilet, it doesn't stop you doing so. (But that increment is still there.) You are resolved to fight the further dissolution of your continence in a sensible and stylish manner even if it does make it slightly harder, because you know you have the strength and motivation to do it nonetheless. (You think, anyway.)

    Then 2022 hits. Cost of living is skyrocketing (Konish, 2022), crypto is crashing (Hern, 2022), US$44 billion can't buy the microblogging network favoured by the woman who stole your wife (Graves, 2022) like it could back in grandpappy's day (Mukul, 2022). In the interests of economic pragmatism, frugality, and not wanting to start fouling perfectly good pants the day the supply chain breaks down, you decide to integrate cloth diapers into your diapering stock. In particular, you decide to supplement your overnight diapers with them, because you weren't a complete babe in the woods before you went in and you intend to be a bedwetter for the rest of your life, so cloth diapers are a good long-term investment.

    You buy half [insert your favourite Velcro-on brand here] and half pin-ons, because you have a nagging feeling the Velcro might go too and you want to be adept enough with pin-ons that you don't accidentally die of tetanus after medical science ceases to exist. And you do get good with them! It still takes about a minute to get them on and off, but hey, they're for overnight so you should never need to change them that quickly.

    The thing is, of course, that the pelvic floor muscles — whose tone you either haven't succeeded in maintaining or haven't meaningfully tried to — are also implicated in bowel control. Relaxation of the levator ani group in particular makes it much harder to avoid messing, and since relaxing that group is part of relaxing the pelvic floor, it's also spending 8 hours a night relaxed. Your #2 control is basically being held together by chewing gum and chicken wire.

    A some point your digestive system eventually decides to file a formal grievance over your distinct lack of fibre intake. You wake in the middle of the night, hurriedly lever yourself out of bed, and sortie toward your residential amenities with the greatest possible degree of expediency. Unfortunately, you are wearing pin-on cloth diapers which require dexterity and time to remove, it's the middle of the night, and you just woke up. You don't quite make it.

    You are not extraordinarily distressed because this isn't the first time you've filled your diapers; you have previously experimented with doing it before, voluntarily, because you are a brave explorer of boundaries. You are a little stressed because you didn't want this to happen, but you wave it off and move past it. Unbeknownst to you, however, you have experienced a very considerable psychological change.

    In particular, your bowel control has been running — like your bladder control, and perhaps even more justifiably — on the unspoken, visceral learning that if you lose bowel control the universe will end. What you have just learned and can't unlearn is that it will not. If you lose control and you are in diapers you will be in a messy diaper. It will take a moment to clean it up.

    A couple of months later you eat at a taquería which accidentally gives you the order of the performatively masochistic late-20s cis guy in the snapback who ordered the Spicy heat level and all the relatively-high-Scoville extra ingredients. It is otherwise the same as your order, which is why they mistakenly gave it to you, and why you meekly eat it, thinking it must be your order and there must have been a mistake.

    Two and a half hours later, on your way home, you are feeling a sense of deep regret. Your stomach is making a soundscape of noises you've never heard before and clenching at random intervals. Out of an abundance of caution, you press home your pursuit of the blue line on your GPS with a replenished and renewed degree of urgency.

    Unfortunately, your body still remembers. It remembers that if you mess your diapers, the universe will not end; you will simply experience 10 minutes of inconvenience and annoyance. What it is experiencing right now is a degree of irritation and pain which, from the point of view of your underlying autonomic systems, feels like it will never end. As you get inside your front door, the threshold for action markedly drops because both your overworked body and the overstressed subconscious-associative layer of your mind agree: this is somewhere you can void. Again, you don't quite make it. Things proceed in this fashion with the kind of inevitability usually reserved for physics alone.

    tl;dr —

    • Bedwetting entails some loss of bladder control through weakening the relevant muscles to below-normal strength.
    • That loss of bladder control entails further loss of bladder control through the same mechanism, actuated by the measures taken to respond to the initial loss of bladder control.
    • The organic loss of bladder control, its exacerbation by responding to the logistical requirements it imposes, and the positive feedback loop between them, eventually lead to loss of bowel control.

    References

    Chen, J., Qi, T., Liu, L., Ling, Y., Qian, Z., ... & Lu, H. (2020, March 11). Clinical progression of patients with COVID-19 in Shanghai, China. Journal of Infection, 80(5), E1–E6. doi:10.1016/j.jinf.2020.03.004. Retrieved 15 June 2022.

    Golen, T., & Ricciotti, H. (2022, April 1). Why do I need to urinate right when I get home?. Harvard Health Publishing. Retrieved 15 June 2022.

    Graves, W. (2022, March 16). Elon Musk shares transphobic meme following report of Grimes dating Chelsea Manning. Consequence (Consequence Holdings, LLC). Retrieved 16 June 2022.

    Hirshkowitz, M., Whiton, K., Albert, S.M., Alessi, C., Bruni, O., ... & Adams Hillard, P.J. (2015, March). National Sleep Foundation's sleep time duration recommendations: methodology and results summary. Sleep Health, 1(1), 40–43. doi:10.1016/j.sleh.2014.12.010. Retrieved 15 June 2022.

    Konish, L. (2022, June 13). Hot inflation data points to a record-high Social Security cost-of-living adjustment in 2023. Some want to change how increases are measured. CNBC. Retrieved 15 June 2022.

    Hern, A. (2022, June 5). Crypto has crashed — can it bounce back?. The Observer (Guardian News & Media Ltd). Retrieved 16 June 2022.

    Mukul, P. (2022, May 14). Explained: Why has Elon Musk put the Twitter deal on hold?. The Indian Express (The Indian Express Pvt Ltd). Retrieved 16 June 2022.

    Ryan, F.J., Hope, C.M., Masavuli, M.G., Lynn, M.A., ... & Lynn, D.J. (2022, January 14). Long-term perturbation of the peripheral immune system months after SARS-CoV-2 infection. BMC Medicine, 20, 26. doi:10.1186/s12916-021-02228-6. Retrieved 16 June 2022.

    Tang, C. (2022, April 26). Regaining fitness after COVID infection can be hard. Here are 5 things to keep in mind before you start exercising again. The Conversation (The Conversation Australia and New Zealand). Retrieved 16 June 2022.

    Walsh, G. (2022, June 6). Can you exercise with Covid? What doctors recommend. GoodToKnow (Future plc). Retrieved 16 June 2022.

    anonymous

    How does add tend to affect the untraining process?

    I don't know. I'm not sure that it ... does, particularly. At most, it might slow it down because during hyperfocus a person might not remember to keep their muscles of control disengaged and might therefore unintentionally hold them. Apart from that I would think it would be more or less inconsequential.

    anonymous

    Which is better for the diaper area - an astringent soap on the basis that it helps to "dry out" the exposure to moisture and messes, OR a moisturising soap so that one doesn't strip away the body's natural oils and skin flora? I can't help thinking it's the latter because that is what is normally used for babies.

    Strongly agree — the latter. This is also basically the difference between baby powder and Sudocrem, and I use Sudocrem despite the eye-watering expense for the reasons you gave here.

    anonymous

    Hi Kali! Bit of an odd question, but wanted to know if you had any advice to help me. I been wearing diapers whenever I can for the better part of my adult life. Mostly just at night and into the morning because of sleep. I’m not looking to untrain myself to need my diapers, but I still want to be able to go 24/7 in diapers when it’s an option. My issue is I struggle though to keep the desire to be diapered through the daytime hours. Be it either only wetting a few times in a diaper over a few hours,just loosing interest during the day without even using my diaper, or becoming uncomfortable in them because of other stuff such as sweating to much in and around my diaper in the warmer half of the year. I just eventually give up and take it off and put normal underwear back on. Do you have any advice to help keep one’s self in their diapers for longer periods?

    Hi Kali!

    Hey anon!

    Bit of an odd question, but wanted to know if you had any advice to help me.

    I'm always a fan of odd questions.

    I’m not looking to untrain myself to need my diapers, but I still want to be able to go 24/7 in diapers when it’s an option.

    OK, but keep in mind that extended 24/7 is always associated with a risk of continence loss, however slight.

    Do you have any advice to help keep one’s self in their diapers for longer periods?

    The advice always varies on a case-by-case basis. Here's my best shot.

    The thing about wearing diapers consistently for any length of time is that it doesn't feel like casually and irregularly wearing them. Certainly if you find yourself actively wanting not to wear them then it's advisable to pay attention to that and figure out why, but over time, as you adjust, the sensation of actively wanting to wear them diminishes — they become a more comfortable, gratifying, and safe variation of underwear.

    The first thing that sticks out to me is that you've mentioned that you occasionally become physically uncomfortable in your diapers. This is absolutely going to be a barrier to consistent, concentrated diaper wear and it would be a good thing to address. It might be good to analyse the specific ways that you're uncomfortable, and see if you can figure out strategies to address them other than leaving diapers — if the issue is heat, for instance, you might consider switching your current outerwear choices for alternatives which cover less skin and are made of more breathable fabric.

    The second thing is that you mentioned you give up and go back to normal underwear. It might be good to get into the habit of not thinking of underwear as "normal" — consciously and actively resisting a norm takes effort, and the truth is there really don't need to be norms around underwear. There is definitely a lot of emotional, logistical, organisational and social pressure for adults to remain in underwear, though; that much is absolutely true.

    One thing you might consider doing is making it difficult to impossible to access your underwear. For untrainees, the advice for the snap 24/7 which has been traditional for untraining is that you actually destroy your underwear (e.g. alwaysdiapered, 2004, p. 6). I'm hesitant to recommend that here because you mentioned you don't want to untrain and I have no intention of pressuring you to.

    What you might do is consider buying a time-lock safe. When I helped people do this, I used a Kitchen Safe kSafe, which I learned about from some AB/DL video now lost to time: it's a tall box with a square footprint and a lid with an electronic lock that can be dialed up to 10 days.

    I picked the kSafe because it was in my price range, and because the base ("box") is deliberately designed to be both sturdy enough for virtually any normal use and capable of being broken in an emergency; since it was a matter of other people's consent I wanted something that had that kind of emergency escape hatch. Given you're self-managing, if you're particularly serious about it, you might try something like a Genie Hand Time Lock Countdown Safe, which is a couple of hundred bucks US, stainless steel, and can go up to 100 days.

    It's also worth looking at whether you're under certain kinds of pressure and how they can be remedied. Do your diapers sag? Consider buying onesies. Do your diapers and/or waterproof pants cut into you? Strongly consider re-measuring yourself and changing sizes. Do your clothes fit well over your underwear but too tightly over your diapers? Consider buying new clothes. Do you feel like your diaper hygiene routine isn't complete enough? Extend it. Do you feel like it's too inconvenient to carry around the stuff you need to look after your diaper hygiene? Look at ways to make it more convenient.

    The third thing is that you mentioned you already consistently wear diapers a portion of the time (at night and when sleeping) and that your main issue is maintaining interest during the day.

    You might like to take advantage of what Tommy Siegel of DPF termed the "black hole effect" (BitterGrey, 2022). Simply put, certain AB/DLs naturally tend toward more demanding and extended relationships with their kink over time. You might be running into problems if you try to accelerate rapidly toward 24/7; rather, tracing gently widening circles outward from your existing position might be the way to go.

    You could do this by setting certain times of day during which, or circumstances under which, you will wear diapers — or "allowing" yourself to wear diapers during those times. As you acclimatise to and normalise doing it at those times or under those circumstances, you could add more circumstances or times in which you will wear diapers. Over time, you could gradually expand to cover the whole day at the point in your self-development where you're genuinely fully ready to do so.

    I hope all of this has been some help!

    References

    alwaysdiapered (2004, June 18). The twelve month diaper-training program. Docdroid. Retrieved 8 June 2022.

    BitterGrey (2022, January 5). ABDL glossary and search. Understanding Infantilism. Retrieved 8 June 2022.

    anonymous

    Hi Kali,

    I am a closet DL for over 15 years now, have been reading your blog for a few weeks now and mustered the courage to also message you albeit as anonymous. I have had the binge/purge cycle quite a few times. Had some weird stuff hall I wanted to tell someone about and maybe find out why it happened. I don’t wear every day but now always have a good supply. Some times I will wear at night when I go to bed (since it’s the only true privacy time I get) and maybe wet a little before sleep but sometimes then I will wake up and be completely soaked without being aware until I woke up . Also had incidents not wearing where I’d wake saturated quite a few times and a sometimes semi conscious wet myself as I am waking up. Most nights I get up every hour to go to the bathroom even when I’ve had minimal fluids, daytime doesn’t have these issues but found myself needing to go every hour or so as well and if I hang on past 45 sec to 1 minute or so I will start leaking, is this something I should look into with a doctor? Kinda nervous to talk about such things to my family even though they would support me. Also the idea of going 24/7 intrigues me and I’d love to try it but for now due to privacy don’t think it’s possible but hope I could try it in the future.

    Hi Kali,

    Hi anon.

    I am a closet DL for over 15 years now, have been reading your blog for a few weeks now and mustered the courage to also message you albeit as anonymous.

    I'm glad you're here.

    is this something I should look into with a doctor?

    I would say so.

    I am assuming, I think reasonably enough, that you're not 24/7 at present. In that context:

    Some times I will wear at night when I go to bed (since it’s the only true privacy time I get) and maybe wet a little before sleep but sometimes then I will wake up and be completely soaked without being aware until I woke up . Also had incidents not wearing where I’d wake saturated quite a few times

    I'm going to start throwing around the medical terms at this point so a reminder that I am not a medical professional in case it was needed.

    This sounds like secondary nocturnal enuresis (SNE) — i.e., straight-up adult bedwetting. If you wear a lot and your control is exceptionally susceptible to being compromised by time spent wearing — and I mean exceptionally — there's a small chance that wearing diapers might have contributed. Otherwise, I don't have an explanation immediately to hand concerning why it's happened here.

    sometimes semi conscious wet myself as I am waking up.

    This isn't incredibly unusual in people who are very used to wearing diapers. Combined with the other things you've mentioned, though, it's a little bit 👀, Chris Voiceman (2021) areas.

    Most nights I get up every hour to go to the bathroom even when I’ve had minimal fluids

    This is nocturia. It's strictly defined as "having to wake one or more times per night to urinate" (van Kerrebroeck et al., 2002) but it mostly becomes clinically visible when it reaches the degree of severity typically classified as "severe," i.e., waking up 3+ times per night. It sounds like that's happening to you.

    Nocturia is identified by assessment of nocturnal urine volume (NUV). NUV can be increased by nocturnal polyuria (producing more urine during the night and less during the day) and by decreased nocturnal bladder capacity. Clinically significant nocturia can be induced by one or both.

    daytime doesn’t have these issues but found myself needing to go every hour or so as well and if I hang on past 45 sec to 1 minute or so I will start leaking, is this something I should look into with a doctor?

    I would say so. Based on how you described it:

  • I am guessing you need to pee 8+ times a day, which is clinically identifiable as urinary frequency (Gormley et al., 2014; Lightner et al., 2019).
  • I am inferring that you experience a "sudden, compelling desire to pass urine that is difficult to defer," which is clinically identifiable as urinary urgency per the 2002 International Continence Society definition (Wein, 2011).
  • Urinary frequency, urinary urgency, and nocturia are the cardinal symptoms of overactive bladder (OAB). The fact that you also experience involuntary loss of urine pushes this over the line into urge-type urinary incontinence (urge UI) — which is considered a subtype of OAB (Lightner et al., 2019), but in my experience, "OAB" alone typically connotes "not including urge UI".

    Also the idea of going 24/7 intrigues me and I’d love to try it but for now due to privacy don’t think it’s possible but hope I could try it in the future.

    I recently wrote a post about this, anon — concerning the way that in evaluating whether they need to wear diapers, AB/DLs, even AB/DLs dealing with IC, tend to sideline the question of whether they have a demonstrable physiological need to wear diapers in favour of prioritising the question of whether they would "need" to wear diapers if they had no physiological need at all, regardless of whether they do in fact have one.

    Someone previously quite rightly pointed out that I'm known to "encourage people to 'give into the void'," which I think is true, but is also largely coincidence. I have no intention of pressuring you to go 24/7 if you do not wish to do so or if you would feel uncomfortable.

    However, I implore you to consider that what you are reporting is clearly less than normal continence, whether or not there are ways to manage it other than diapers, and whether or not you choose to pursue those ways. I understand why "privacy" is a major variable in an AB/DL person's evaluation of whether they should go 24/7, but it sounds as if you also have a legitimate physiological need, and the solitary fact that you are AB/DL should not force that need onto the sidelines.

    I would strongly advise that you assess the degree to which wearing diapers would actually assist in managing your continence and helping you feel protected, and wear them to that degree, prioritising medical need over concerns about social acceptability at least on an interim basis until you can receive medical advice.

    References

    Chris Voiceman (2021, February 15). Sussus Amogus [video]. YouTube. Retrieved 2 June 2022.

    Gormley, E.A., Lightner, D.J., Burgio, K.L., Chai, T.C., Clemens, J.Q., ... & Vasavada, S.P. (2014, May). Diagnosis and treatment of overactive bladder (non-neurogenic) in adults: AUA/SUFU guideline. American Urological Association; Society of Urodynamics, Female Pelvic Medicine & Urogenital Reconstruction. Retrieved 2 June 2022.

    Lightner, D.J., Gomelsky, A., Souter, L., & Vasavada, S.P. (2019, September 1). Diagnosis and treatment of overactive bladder (non-neurogenic) in adults: AUA/SUFU guideline amendment 2019. Journal of Urology, 202(3), 558–563. doi:10.1097/JU.0000000000000309. Retrieved 2 June 2022.

    van Kerrebroeck, P., Abrams, P., Chaikin, D., Donovan, J., Fonda, D., ... & Weiss, J. (2002, February 8). The standardisation of terminology in nocturia: Report from the standardisation sub-committee of the International Continence Society. Neurourology and Urodynamics, 21(2), 179–183. doi:10.1002/nau.10053. Retrieved 2 June 2022.

    Wein, A. (2011, October). Symptom-based diagnosis of overactive bladder: an overview. Canadian Urological Association Journal, 5(5 Suppl 2), S135–S136. doi:10.5489/cuaj.11183. Retrieved 2 June 2022.

    anonymous

    (AFAB) How do I use more of the absorbency in the back of my diaper? I notice that my diapers tend to leak before the absorbency at the back is used. I would prefer not to use "medical" diapers because I need some "squish" to know that I need to change.

    That's a good question.

    Sorry to toss this back to you with what is basically another question, but this leads me to immediately wonder what your wetting pattern is like.

    Disposable diapers have what is called a distribution layer, which does what it says — distributes moisture across the diaper. It's good, but it's not 100% effective and it therefore relies on having available absorbency underlying it to pick up the bleed-off of moisture as it's distributed across the diaper. As the fraction of the diaper's total absorbency which is used increases, the effective mL/s the diaper can distribute through the distribution layer without leaking from saturation decreases.

    When you're peeing, you're by definition peeing into the wettest part of the diaper. If you're peeing like a normal person, i.e. at a relatively high rate of flow in mL/s, and your diaper is already fairly wet, you might be exceeding the diaper's capacity to absorb and distribute moisture. If you slow down and hold back a bit you might have a better time.

    anonymous

    I am the FNQer who messaged a few months back. My activity level and (in)continence meant that cloth diapers were ruled out, and cloth-backed diapers (alone) just sagged way too much (chafing from the front waistband; messing in an invariably wet diaper = blowouts) even with a bodysuit due to the lack of diaper structural rigidity. I tried PeekABU alone but leaked too often, so I had to resort to Tena Slip Plus (+Wartenburg wheel) + PeekABU + sleeveless bodysuit under whatever I was wearing.

    I am the FNQer who messaged a few months back.

    Hi again!

    My activity level and (in)continence meant that cloth diapers were ruled out,

    I get that. As an exceptionally sedentary person, I've had a pretty easy time, but there were times when cloth diapers didn't work even for me.

    cloth-backed diapers (alone) just sagged way too much (chafing from the front waistband; messing in an invariably wet diaper = blowouts) even with a bodysuit due to the lack of diaper structural rigidity.

    YEP. I think I tried my first cloth-backed diapers the better part of a decade ago (I don't remember a time before the divide between "plastic-backed" and "cloth-backed" existed, put it that way) and crap, they really are getting worse over time.

    I tried PeekABU alone but leaked too often, so I had to resort to Tena Slip Plus (+Wartenburg wheel) + PeekABU + sleeveless bodysuit under whatever I was wearing.

    Exhaustive but sensible.

    anonymous

    I am an Autistic person who untrained due to poor interoception and the stress/annoyance/anxiety of timed voiding. I finally understand what you mean when you say that after a while, being in a wet diaper becomes "background noise". Are there any semi-discreet ways to check for diaper leaks in public, or did I ust replace timed voiding with timed diaper changes? Fem-leaning non-binary if it matters.

    Hey anon.

    Are there any semi-discreet ways to check for diaper leaks in public, or did I ust replace timed voiding with timed diaper changes?

    My experience has been that the vast majority of diaper leaks are crescent leaks around the middle rear point of the leg band.

    I exploit the fact that women's jeans typically only have back pockets (if any) by storing things in my back pockets and using that as an excuse to pat my butt; leaks are typically located below and in the outside direction from the pocket.

    When I'm wearing skirts, I typically smooth them out of the way, so that I'm not sitting on a crumpled-up bundle of skirt and pressing creases into it. I do this because I don't like crumpling my skirts, but also because if I start significantly higher than I need to (e.g., at the top of my butt waist), I can run my hands over the spots where diaper leaks typically show up.

    Diaper leaks from the top back of the diaper are much rarer, but I can generally locate those by scratching my back if I suspect a leak might have happened.

    Diaper leaks at the front of the diaper are relatively rare and I don't have a specific tactic saved up for those.

    Unfortunately losses of mess containment are relatively hard to find other than by feeling them or otherwise becoming suddenly, unpleasantly aware of them.

    For the record, I do try to time my diaper changes, but the times don't have to be strictly adhered to and I don't see any reason that everyone should have to do it.

    Fem-leaning non-binary if it matters.

    I appreciate the additional information!

    anonymous

    RE: Getting E patches to stick better - diaper area, no real way. Other areas? Adhesive dressings over the top, or plastic-based surgical tape, but those don't really come cheaply. Recommend NOT to use paper-based medical tape because after some time it feels like an adhesive mess to the touch, but doesn't stick when you actually need it to.

    Oops, this is the first part of the previous answer lmao

    Thank you for this!

    anonymous

    RE: Getting E patches to stick better - inboxing you in a separate ask because this part reads like an advert, but I swear by Durapore or Transpore, although that stuff can be eye-wateringly expensive, and you'd probably need to find it at a specialist medical supply store. As mentioned, Micropore (or equivalent) NOT recommended.

    I really appreciate this. Thank you! <3

    (I was gonna answer this privately and then realised I didn't have that option lol)

    anonymous

    Hey kali love your blog. Long time lurker first time asker. A while back you answered a question about how not wearing 24/7 and actively untraining you can still lose partial continence. Ive noticed something similar. My last job was really stressful and so i wore literally every night and as much as i could on my days off. I also listened to babypants Daytime wetting hypnosis almost everyday, though that was more because it helped me get in a calmer headspace.. Well i ended up getting out of that job and ended up back in food service. I noticed after a few weeks that i couldnt go almost an entire shift without going to the restroom like i used to and i feel the need more more strongly than before. But on the flipside im consuming overall less fluids than i was at my last job. Is it possible i might reach a point of no return? I cant really use bedwetting as a reference point as ive always been a bedwetter.

    Hey kali love your blog.

    Hey anon. Thank you very much.

    Long time lurker first time asker.

    If you think about it, much more of my life is spent not answering questions on this blog than answering them, so I am also a long-time lurker.

    I also listened to babypants Daytime wetting hypnosis almost everyday, though that was more because it helped me get in a calmer headspace

    I'm sorry, but I do find this a little amusing, for Brennan (2013/2020) reasons. I absolutely get why you'd do it — hypnotic conditioning is probably one of the more relaxing experiences you can have, no matter what the conditioning is for — but there is, and I mean this in the most loving way possible, a touch of "Well, there's your problem," present here.

    I cant really use bedwetting as a reference point as ive always been a bedwetter.

    Ouch. Most of my assumptions are based on the idea that, in general, people aren't already consistent bedwetters when they start untraining, so I can see how inconvenient that must be when in fact you are.

    Is it possible i might reach a point of no return?

    It is possible. It's gonna be difficult to call it specifically because you are a bedwetter. Already being a bedwetter doesn't mean untraining can't make your bedwetting heavier or more frequent — it still can if there is room to do so, but going from 3 wet nights a week with light wetting to 5 wet nights a week with moderate wetting over the course of several months is a much less binary change than 'never wet the bed ever' to 'wet the bed once'.

    While anecdotally I get the vibe that bedwetters are somewhat more likely to be turn loss of continence around, at least in the early stages, equally for you it is going to be harder to know when those stages are because one of the major reference signals with respect to which they would traditionally be defined is, for you, lost in the noise.

    I can tell you that you could eventually reach a point of no return, but I will need you to ask me more questions on detail to be able to give you a more detailed answer.

    References

    Brennan, A. [amanda b.] (2020, September 6). I don't know what I expected [meme]. Know Your Meme (Literally Media). (Original post created 2 October 2013.) Retrieved 30 May 2022.

    anonymous

    Does weakened bowel control lead to difficulty with pushing as well? When I feel a slight urge, I run to the bathroom, so I can have a controlled bowel movement hopefully. But what I've started to experience recently is that if the urge subsides, no matter how hard I push, I feel powerless. It was not the case back then. After a failed attempt I have to accept the fact of a surprise but guaranteed accident later that day, when a stronger urge hits. Part of untraining coping with this? Thanks.

    Hey anon.

    Does weakened bowel control lead to difficulty with pushing as well?

    It... shouldn't do. Keep in mind that I am not a medical professional and my opinions about the physiology of untraining are wild guesses, but none of the key muscles which I believe are weakened by untraining — external anal sphincter and puborectalis in particular — are pushing muscles. Rather, they're blocking muscles.

    Pushing is primarily regulated by the lower abdominal muscles, and those should be fine.

    Part of untraining coping with this?

    I mean, in principle, sure — coping with and adapting to unexpected loss of control is a core competency of untraining. For instance, most people who successfully complete bladder-only untraining with no unintentional excess loss of bowel control eventually get to the point where they have to deal with irregular, infrequent loss of bowel control.

    This is because, while the muscles of bowel control remain competent to regulate messing in normal operations, successful untraining and physical weakening of the muscles of bladder control undermines the foundation they share with the muscles of bowel control, reducing the ability of the latter to be resilient to spikes in load that sometimes unpredictably occur in day-to-day life.

    However, in practice, I don't think most people have to cope with the same experience you do. I'm really sorry but I'm not sure what's happening there.

    anonymous

    Hi Kali, I personally want to untrain at least enough to experience at least a little while of genuine accidents. Approximately how long can someone experience the beginnings of unpotty training before things fall out of a salvageable state?

    Hi Kali, I personally want to untrain at least enough to experience at least a little while of genuine accidents. Approximately how long can someone experience the beginnings of unpotty training before things fall out of a salvageable state?

    Hi anon. This is a thorny one.

    "How long" is less important than "to what point", and "a salvageable state" is subjective and varies between people. Answering the question in its own terms, I would say 6–12 months, with a hard upper bound and a soft lower one. The reasoning is that in the middle case it will take you 3–6 months to start experiencing changes, and those changes will probably develop to a point where they may not be completely reversible within 3–6 months after that.

    The mechanistic explanation, which is probably more useful, is that your continence is likely to be fully to near-fully recoverable until bedwetting is established; that significantly alters your prospects.

    "Establishment" of bedwetting can be defined as reaching the point where it happens with a definable frequency above a given data-informed threshold; I'm conservative on this and favour 1+ wet night per week average as the threshold, although you could optimistically make a case for 2+. Once established, bedwetting seems to be irreversible in a strong majority of cases, and frequency tends to climb either linearly to 7 wet nights/week, or linearly to a certain point and then logarithmically to 7 wet nights/week.

    Established bedwetting seems to both undermine and destabilise daytime wetting control, limiting the residual optimal achievable continence experience to one which is notably shaky and often in need of support in any event.

    In the middle case, you can intervene in the onset of bedwetting and prevent it from becoming established by withdrawing from diapers as soon as practicable, ideally immediately, after the first incident of bedwetting you experience.

    However, the middle case makes a number of assumptions which may or may not apply to you:

    You can reacclimatise. If you've experienced any degree of subjective loss of control, even if it doesn't reflect an underlying erosion of objective control, and you leave diapers, you will probably find you will have a short adjustment period. This might only be a week or so, but if you don't have a week free to do it you could find yourself in a bad spot.

    You don't spiral. Spiralling is a form of sudden-onset, rapidly-progressing loss of continence during untraining. Anecdotally, it seems to be virtually impossible to recover continence lost to spiralling, even when the same degree of continence loss achieved without spiralling would typically be recoverable.

    If you are predisposed to it — which I still do not have a statistically powerful way of predicting, after almost a decade of running this blog, coining the term, and having incidents of it reported to me — it can kick in earlier than 3 months, which would normally be the absolute minimum to notice any changes.

    You have a normal experience of untraining. My predictions and descriptions of untraining are based on what seems to be the aggregate median experience. There are always outliers.

    For instance, for the vast majority of people, bedwetting hasn't become established until after it's happened a number of times. For a small group of people who've written to me, it's become established after one incident. For 2 people who've written to me, it's become established before it occurred (i.e., they both left diapers before experiencing bedwetting and began to experience it a week or two later in any case).

    In another instance, some untrainees leave diapers before experiencing bedwetting, but after experiencing subjective loss of daytime wetting control severe enough that they don't feel safe out of diapers, and find that the daytime wetting control, which should be easy to immediately start recovering ... isn't, and they're not able to make any headway, eventually forcing them to return to diapers.

    You haven't locked yourself in. Because the exit strategy here is rapidly and completely leaving diapers, it might be hindered if your ability to wear diapers in your social context is secured by a backstory which would make rapidly and completely leaving diapers impossible.

    For example, if you're sharing a bed with someone, and you got them to be OK with you wearing diapers to bed at night by giving them the impression you were already having trouble staying dry, when bedwetting first occurs you may find that you are not able to withdraw from diapers quickly enough to prevent it from becoming established.

    Ultimately, my advice would probably be as follows

    Set a specific time limit for yourself. I would recommend 6 months, but no more than 9.

    Devise a set of criteria which would lead you to immediately withdraw from untraining if they were met before the time limit.

    Accept on at least an abstract level that even though you intend to stop untraining, you may not be able to do that. You don't under any circumstances have to accept that it "will" happen, but you do have to accept that it might.

    Prepare very well, as if you were actually going into diapers permanently. Worst case you will have a very comfortable and convenient stay in diapers; best case you will not have to ad lib under awkward circumstances if things go pear-shaped.

    When stocking up on diapers, buy one extra month's worth so that if you reach the end of your planned stay in diapers and find yourself physically unable to leave them, you are not then immediately clotheslined by having run out of diapers. The extra month's worth are not supposed to be used if you don't need them; if you do need them, they will give you time to plan and pivot.

    Question: diapers and HRT

    CW: genital mention.

    This is a question for any transfem AB/DL on feminising hormone replacement therapy. Putting it out there because I can't solve it on my own.

    I've had to experiment with different ways of taking my estrogen over the last year or so. My original dose–ROA–API combination was 4mg/day sublingual estradiol valerate/Progynova (see also note 1), but I had to stop because for some reason my body tears through it insanely fast, so I was basically perimenopausal and nonfunctional for the back half of every day.

    I switched to 2 × 100µg/day transdermal estradiol patch/Estradot, which produced much more even and predictable serum levels. Unfortunately, using 2 patches and placing them in the areas directed by the leaflet (buttocks and lower tummy) isn't working for me — it's delivering intolerably low serum estradiol levels of about 200–250 nmol/L (see note 2), well below the Endocrine Society minimum of approx. 370 nmol/L (Hembree et al., 2017, § 3.0).

    I stuck the patches in the area where the literature suggests they have the best bioavailability (W., 2019/2022) — directly below my penis, on the skin over my testes. They work fantastically well there; I've felt better in the last couple of weeks than I had in the six months prior.

    Unfortunately they still have their problems. Namely, they unstick. Fully continent transfem friends have informed me this is also a problem for them; patches adhere best on skin that doesn't move or distort and doesn't sweat overmuch, and between the legs is ... neither of those. However, I get the definite sense that being in diapers is exacerbating the problem. These patches are supposed to be used for 3–4 days under optimal conditions, non-diapered friends who have them in the same area are reporting 2–3, and I'm managing barely 1–1.5.

    I'm wondering if one of the various substances involved with diapers is the problem — I'm thinking pee and poop, yes, but also baby powder, Sudocrem, and potentially chemicals in the diaper itself. Unfortunately, because whatever it is seems to be chemically interfering with the adhesion, and my understanding is estrogen patch adhesive is literally just transdermal estradiol gel, I assume just actually using estradiol gel/Estrogel is also out of the question.

    I really would rather not switch to injections, not because they're not good, but because they're not approved by the Australian Therapeutic Goods Administration (Cheung et al., 2019), and a lack of TGA approval means they're extremely difficult to get and can't be subsidised under the Australian Pharmaceutical Benefits Scheme, or PBS ("TGA and PBAC," 2021). I'm on a moderately tight budget, and without PBS subsidy, I think injections are going to be difficult for me to financially sustain.

    So:

    • Is there any way for me to make estrogen patches stick better, or to firmly hold them down?
    • Is there another route of administration I can use that isn't pills and doesn't have this problem?

    Notes

    • There was a shortage for a while in 2021 ("Substitution instrument," 2021), during which I used estradiol hemihydrate/Estrofem/Zumenon at the same dosage.
    • These are the correct figures. The number given is larger than some readers might be expecting, because the measurement unit is nanomoles per litre (nmol/L), which is standard where I live, rather than nanograms per decilitre (ng/dL), which I understand is standard in the United States.

    References

    Cheung, A.S., Wynne, K., Erasmus, J., Murray, S., & Zajac, J.D. (2019, August 5). Position statement on the hormonal management of adult transgender and gender diverse individuals. Medical Journal of Australia, 211(3), 127–133. doi:10.5694/mja2.50259. Retrieved 25 May 2022.

    Hembree, W.C., Cohen-Kettenis, P.T., Gooren, L., Hannema, S.E., Meyer, W.J., ... & T'Sjoen, G.G. (2017, September 13). Endocrine treatment of gender-dysphoric/gender-incongruent persons: An Endocrine Society clinical practice guideline. Journal of Clinical Endocrinology & Metabolism, 102(11), 3869–3903. doi:10.1210/jc.2017-01658. Retrieved 25 May 2022.

    Substitution instrument to address shortage of PROGYNOVA estradiol valerate tablets (multiple strengths) (2021, August 12). Therapeutic Goods Administration (Australian Government Department of Health). Retrieved 25 May 2022.

    TGA and PBAC parallel process and requirements (2021, September 22). Pharmaceutical Benefits Scheme (Australian Government Department of Health). Retrieved 25 May 2022.

    W., A. (2022, April 27). Genital application via the scrotum and neolabia for greatly enhanced absorption of transdermal estradiol in transfeminine people. Transfeminine Science. (Original article published 29 March 2019.) Retrieved 25 May 2022.