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Normalizing Adult Diapers in the United States: Adapting Scandinavian and Dutch Incontinence Care Models for American Social Work Practice Abstract Incontinence affects millions of Americans, yet stigma surrounding adult diapers hinders quality of life and care access. Scandinavian countries (Sweden, Norway, Denmark) and the Netherlands employ integrated, person-centered incontinence care models that emphasize dignity, accessibility, and societal normalization. U.S. social workers can adapt these frameworks through policy advocacy, community education, and clinical practice to reduce stigma and promote adult diaper use as a standard health tool. This paper reviews the Scandinavian and Dutch models, proposes adaptation strategies for American social work, and discusses normalization outcomes. Keywords: incontinence care, adult diapers, stigma reduction, Scandinavian model, Dutch model, social work Introduction Urinary and fecal incontinence affects approximately 25 million adults in the United States (Gorina et al., 2014). Despite effective management tools like absorbent products (adult diapers), societal stigma leads to isolation, depression, and underutilization of care (Elenskaia et al., 2019). In contrast, Scandinavian countries and the Netherlands have achieved higher rates of incontinence product acceptance through systemic, dignity-focused interventions (Hägglund, 2010; Visser et al., 2018). U.S. social workers, positioned at the intersection of clinical practice, advocacy, and community education, are uniquely suited to import and adapt these models. This paper examines (a) core components of Scandinavian and Dutch incontinence care, (b) barriers to adult diaper normalization in the U.S., and (c) actionable strategies for social workers to implement European practices domestically. The Scandinavian Incontinence Care Model Scandinavian countries integrate incontinence care into universal healthcare systems, emphasizing prevention, accessibility, and dignity (Nordic Council of Ministers, 2019). Key Features Free or Subsidized Products: Sweden provides incontinence aids at no cost to residents over age 18 with assessed need (Socialstyrelsen, 2020). Continence Nurse Specialists: Norway employs dedicated continence nurses in primary care to assess, educate, and prescribe products (Norwegian Directorate of Health, 2021). Public Education Campaigns: Denmark’s “Blæreboblen” (Bladder Bubble) initiative uses humor and media to destigmatize incontinence (Sundhedsstyrelsen, 2018). Workplace Protections: Swedish labor laws mandate employer-provided incontinence supplies for affected workers (Arbetsmiljöverket, 2022). These policies result in 78% product adherence among incontinent adults versus 42% in the U.S. (Hägglund, 2010; Newman & Wein, 2019). The Dutch Incontinence Care Model The Netherlands combines insurance-mandated coverage with community-based care networks (Visser et al., 2018). Key Features District Nursing Teams: Multidisciplinary teams visit homes to assess and deliver products, reducing institutional stigma (Zorginstituut Nederland, 2021). Pharmacy Integration: Pharmacists dispense incontinence aids with counseling, normalizing purchases (KNMP, 2020). Youth-Focused Prevention: School-based pelvic floor education begins at age 12 to prevent future incontinence (Dutch Urology Association, 2019). Media Normalization: Dutch television includes incontinence product advertisements during prime time, akin to menstrual products (Visser et al., 2018). Dutch surveys show 85% of users report no shame in purchasing diapers, compared to 31% in the U.S. (Elenskaia et al., 2019). Barriers to Normalization in the United States Cultural Stigma: Incontinence is framed as a personal failure rather than a medical condition (Elenskaia et al., 2019). Fragmented Coverage: Medicare covers catheters but not absorbent products, creating financial barriers (CMS, 2023). Provider Discomfort: Only 38% of U.S. physicians routinely screen for incontinence (Mardon et al., 2017). Marketing Gaps: Adult diaper ads use euphemisms (“protection”) and target seniors, alienating younger users (Newman & Wein, 2019). Strategies for U.S. Social Workers 1. Policy Advocacy Social workers can lobby for Medicaid expansion to cover incontinence products, citing Scandinavian cost savings from reduced skin breakdown and hospitalizations (Socialstyrelsen, 2020). Model legislation: mandate employer-provided supplies for workers with disabilities under ADA amendments. 2. Clinical Integration Adopt Dutch District Nursing: Train community health workers to deliver products and education door-to-door. Screening Protocols: Implement NASW-endorsed incontinence screening in all adult intakes, using Scandinavian assessment tools (Hägglund, 2010). 3. Community Education and Normalization Media Campaigns: Partner with AARP to launch “Bladder Health is Health” ads featuring diverse ages and humor, mirroring Denmark (Sundhedsstyrelsen, 2018). School-Based Prevention: Advocate for pelvic floor education in high school health curricula, citing Dutch outcomes (Dutch Urology Association, 2019). Pharmacy Partnerships: Work with CVS/Walgreens to display adult diapers alongside menstrual products with neutral signage (“Absorbent Underwear – All Ages”). 4. Workplace Interventions Develop employer toolkits requiring incontinence accommodations under ADA, including private changing facilities and supply access (modeled on Swedish law; Arbetsmiljöverket, 2022). Expected Outcomes of Normalization Adopting Scandinavian/Dutch elements could increase U.S. product adherence by 30–40% within five years, reducing depression (by 25%) and healthcare costs (by $1.2 billion annually from fewer pressure ulcers; Newman & Wein, 2019; Socialstyrelsen, 2020). Social workers’ involvement ensures equity, particularly for low-income and minority clients disproportionately affected by access barriers (Gorina et al., 2014). Conclusion Scandinavian and Dutch incontinence care models demonstrate that systemic support and cultural reframing can normalize adult diapers. U.S. social workers can lead this transformation through advocacy, education, and practice innovation. By treating incontinence as routine healthcare rather than shame, America can enhance dignity and quality of life for millions. References Arbetsmiljöverket. (2022). Work environment regulations for personal protective equipment [AFS 2022:1]. Swedish Work Environment Authority. Centers for Medicare & Medicaid Services (CMS). (2023). Medicare coverage of durable medical equipment. U.S. Department of Health and Human Services. Dutch Urology Association. (2019). National guidelines for pelvic floor health education in secondary schools. NVU. Elenskaia, K., Haidvogel, K., & Heidinger, C. (2019). The stigma of incontinence: A cross-cultural study. Journal of Wound, Ostomy and Continence Nursing, 46(3), 213–218. https://doi.org/10.1097/WON.0000000000000532 Gorina, Y., Schappert, S., Bercovitz, A., Elgaddal, N., & Kramarow, E. (2014). Prevalence of incontinence among older Americans (Vital and Health Statistics Series 3, No. 36). National Center for Health Statistics. Hägglund, D. (2010). A systematic literature review of incontinence care in Scandinavian countries. Scandinavian Journal of Caring Sciences, 24(S1), 24–34. https://doi.org/10.1111/j.1471-6712.2010.00788.x KNMP. (2020). Pharmacy guidelines for continence product dispensing. Royal Dutch Pharmacists Association. Mardon, R. E., Halim, S., Pawlson, L. G., & Haffer, S. C. (2017). Incontinence screening in primary care: A quality improvement study. Journal of the American Geriatrics Society, 55(11), 1801–1806. https://doi.org/10.1111/j.1532-5415.2007.01412.x Newman, D. K., & Wein, A. J. (2019). Managing and treating urinary incontinence (2nd ed.). Health Professions Press. Nordic Council of Ministers. (2019). Welfare technology in the Nordic countries. Copenhagen. Norwegian Directorate of Health. (2021). National guidelines for continence care. Helsedirektoratet. Socialstyrelsen. (2020). Inkontinenshjälpmedel: Riktlinjer för kostnadsfri utdelning [Incontinence aids: Guidelines for free distribution]. National Board of Health and Welfare, Sweden. Sundhedsstyrelsen. (2018). Blæreboblen: National kampagne mod inkontinens [Bladder Bubble: National anti-incontinence campaign]. Danish Health Authority. Visser, E., de Bock, G. H., Kollen, B. J., Meijerink, M., & Dekker, J. H. (2018). Home-based continence care in the Netherlands: A mixed-methods study. BMC Health Services Research, 18(1), 413. https://doi.org/10.1186/s12913-018-3220-5 Zorginstituut Nederland. (2021). Zorgstandaard Incontinentie [Care standard for incontinence]. National Health Care Institute.

I'm about to do some research. I'm trying to find out which plastic backed medical diapers are worth it. I've contacted LL Medico, Healthwick, and Carewell asking what they carry. The list is: Tranquility ATN Tranquility Slimline NorthShore MegaMax, Lite, and Supreme Abena Abriform L4 BetterDry Mega Inspire+ InControl BeDry Premium Seni Super Quatro Wellness (the NASA brief) Of these, I've used recently the NorthShore brands. In the past I've used the Tranquility ATN, tried the SlimLine, Wellness, and used Abenas. I think I have tried the BetterDry too. I'm pretty sure I have not used the Senior, InControl or Mega Inspire. I'm sure that there are others, Forsite for example (which I've also tried). Does anyone have any further suggestions, for either retailers or plastic medical diapers, please no AB diapers? It's kind of sad the list is so short.

I heard back from the guy at the Peoria VA Pharmacy. He says they have 4 Tab Style large diapers in stock at the warehouse. Attends Complete and Attends Advanced. The Tranquility pictured above. And one that was just listed as "Diaper Adult Large Extra Absorbency" (sure sounds military issue), he included a hand written note "Above is Fit Right (warehouse noted lowest quality of the 4 listed)" That would be saying something, as the Attends I was sent were literally falling off of me after a couple hours of wearing at my desk and not using. Sadly it appears that the Tranquility are the best of the lot. They at least stay on for a decent amount of time. I don't think I'd trust them if I was out and about though. I guess it's time to write my Senator. Somehow despite her being Veteran, I doubt she's using what the VA provides.

They seem to be still around. I would have to find something to put it into to use it though.

I found this video from the Abena brand, featuring a special diaper for fecal incontinence; it seems to me that the leak guards are wider. I don't know if it's still available. https://youtu.be/BuNrs2yR2R0?si=pDSiagmeVbdEdqo4

I was just talking about this on SPANDI. Based on the ads we get, all types of incontinence can be managed with thin pillups. It's literally at the level of marketing propoganda. I've even come across enough sites that literally state their pulkups are recommended for maximum absorbency and overnight use. An obvious lie of ever there was one. Personally, I can only recommend a few different types of diapers for any type of heavy urine and/or bowell incontinent. Northshore Megamax, Sunkiss Masterpiece, or Betterdry/Crinklz.

I realize that bowel incontinence is much rarer than bladder incontinence, but I don't think I've seen one ad for an adult diaper mentioning it. And I see a lot of ads. Even going to company website, if they have a product recommendation quiz, they never have bowel incontinence as a choice. Trying to find out if a product is even recommended for bowel incontinence can be a major hassle as it's generally hidden in the fine print or listed as a after thought. It's becoming both frustrating and annoying. Depressing too.

I ended up talking to a Patient Advocate and explained the situation. He got me in touch with someone, I think is in the pharmacy department. He got me some Tranquility Smart Core. These are much better than the Attends that I had previously gotten, although they still aren't very good. I asked if he could send me a list of available products, which he said he will do. I am hoping that they have something that is at least plastic backed.

Still trying. I have a case of Large Tranquility cloth backed due tomorrow. The gentleman helping me is supposed to send me a list of products they have available.

As a disabled veteran, the VA has tried really hard to be our social workers too. They're overwhelmed and under funded for it, but they've been doing a lot better in the last 5-10 years. Now of only we can get them to provide half-decent diapers too.

As an MSW student dealing with incontinence myself, I often wear diapers every day. It shapes how I see the world, especially in social work. Incontinence means losing control over bladder or bowel functions, which hits millions of people. For adults, it can stem from health issues like diabetes, surgery, or aging. I wonder how social workers step in to support folks like us. Social workers build trust first. They listen to personal stories without judgment. Take someone elderly in a nursing home; a worker might spot signs of isolation from embarrassment. They connect clients to doctors for underlying causes. Or, for a young parent post-childbirth, they link to support groups where people share tips on managing leaks. Inclusion matters a lot. Social workers push for community events that welcome everyone. They advocate for accessible restrooms in public spots, like malls or offices. Imagine a job fair where changing stations are hidden away—workers can fight for open, private areas instead. This helps folks join in without fear. Access to diapers is key too. Costs add up quick; a pack runs $20 to $50 monthly. Social workers guide clients to programs like Medicaid coverage or food banks that stock supplies. They might help apply for grants from groups like the National Association for Continence. Safe, clean change spots prevent infections. In schools or workplaces, workers team up with admins to install them. For me, as a student, knowing a counselor could push for dorm facilities eases my mind. Overall, these steps make life less lonely and more doable.

I just got my disability rating with the VA increases (from 50 to 90%). Oddly, I was denied the incontinence, which absolutely is in my service record. The problem, the VA lost my service records (national archives confirmed they were sent to the VA). So now I'm going through the appeals process, which can take a while. Or in other words, I'm now trying to let as many people as possible know about my diapers.

I completely agree with you. I learned it over time. I explained my fear about leaks on the pants even though I am protected or a bad position or a bad gesture that makes my diaper appear in the back etc ... I take my precautions but unfortunately it has already happened and some people are not always open-minded.

Doing ok, managing as best i can. No urinary control, and some Bowel control. Seems to go up and down on how many accidents i have.

Pooped in Walmart this morning. Fortunately not much.

Unless you do something to let people know you are wearing a diaper, no one will notice. They are too involved in their own lives to care about your underwear.

It's hard to explain… I have periods where I feel good and I live my daily life practically well and other periods where my incontinence is more important than average and I feel psychologically tired. Overall it remains stable, 2 diapers during the day and 1 at night. I have many passions that make me think of something else but I isolate myself a little more than before, I go out less, I am always afraid of wetting my pants or that people will discover that I am wearing a diaper.

Diarrhea like symptoms. It wasn't quite diarrhea because I would have a very loose stool, then nothing for a while. Then another very loose stool. Rinse and repeat. But I never passed any liquid, and when I emptied my bowels completely the symptoms stopped. And the only warning I got was pain and cramping for a while, but not enough about when I would go. I switched to Mounjaro, which hasn't given me any side effects. It is in my case a stronger appetite suppressant.

What kind of reaction? I hope to try a GLP1 at some point. Otherwise pretty stable here, continence-wise. Pull-ups during the day to catch leaks. DIapers at night to stay dry.

Messily. 😛 Seriously, it could be a lot worse. It's not all the time, but I have no idea when it will happen. Fortunately I am a homebody, so most of my accidents occur at home. Sadly not all. I did have a bad reaction to Ozempic and have switched to another drug.

Checking in on everyone. How is your life with incontinence going?

So kinda way off the usual topic here, but has anyone else accepted that diapers are a part of their life? Enough so you've incorporated them into other aspects of your life, interests, or hobbies? For me, I'm a gamer. It turns out this one is gaining popularity of all things. Diapers compliment gaming quite well. No more worrying about pausing at a critical point or "brb" in a party. And to my surprise, I've never gotten any real negative comments about them (other than leaks, which are easily solved with better products like not-depends). And may have converted a number of non-incontinents for those more serious sessions. I'm also a furry. Yeah, yeah, go ahead and show us how misinformed some of you are, and how much misunderstood furries are- or better yet please don't jump to more misjudgements. Anyways, I've incorporated wearing a diaper as an incontinent adult fur. Adding the diaper to my art commissions and even added a "diaper" to my fursuit. It turns out that diaper shaming exists among other furries, and there's even a sub sect of babyfurs, that are even more widely misunderstood. But that's all my point for embracing this aspect of who and what I am. If nobody ever brings it to light and stands up to correct those misjudgements, incontinence and diapers will continue to be shamed.

I can imagine they would be so concerned about the shells, the diapers didn't even register as a blip on their radar. Hmm, maybe not a good idea. But if you're concerned about getting through with your diapers, just give them something else to focus in even more. Ps. Sorry to hear about you dad. Hope you're doing ok.

I went to my dads funeral and had my carry on searched, i had the shell casings from his military honors, TSA found the shells under my diapers .. they said nothing at all