I flat out refuse to adult today.

As your legal caregiver has exercised Substituted Consent for the SecuStent™ device to be fitted, Implant recipients may have questions or concerns about the installation and adjustment to usage of the device. In most cases, this guide is provided during an information and disclosure session immediately prior to the procedure, so it may be the first time you are being informed of your SecuStent™ treatment plan. This guide will explain your upcoming procedure, what to expect following the procedure, as well as sensations to expect and adjust to as a person with incontinence. 

Remember that if you do not know the meaning of a word or sentence, you can ask your doctor or caregiver to explain it to you at any time.

Why implant a SecuStent™ device?

SecuStent™ implantation is an elective treatment intended as a support for holistic Psychoregressive (PR) therapy plans coordinated between a patient’s legal caregiver and medical service provider. PR therapy seeks to render a patient permanently psychologically regressed and dependant on their caregiver or institutional supervision. Holistic PR treatments utilise direct medical interventions to support and reinforce the process of Psychoregressive therapy. According to the aims of the Psychoregressive therapy plan, the patient’s mental ability is reduced to anywhere between the pre-vocal and prepubescent stages, although a degree of loss to urinary control is always expected and encouraged.

Examples of Holistic Psychoregressive interventions include usage of muscle relaxants such as Diazepam in suppository form to relax the pelvic floor and encourage loss of muscle tone, topical injection of Botulinum Toxin to weaken or paralyse fine and gross muscle control, treatment with Anaphrodisiac drugs such as Depot Medroxyprogesterone Acetate (DMPA) to decrease and eliminate libido, usage of Diuretics and Laxatives to encourage and enforce involuntary toileting, and prescription of Psychiatric Medications such as Anxiolytics, Dissociatives, and/or Deliriants to increase compliance and reduce cognitive independence. SecuStent™ may be used alongside any combination of these interventions.

The usage of a SecuStent™ device is recommended as a replacement treatment in situations where typical hypnotherapeutic or behavioural therapies become ineffective at achieving total urinary incontinence. A patient may have already undergone a period of therapeutic conditioning to eliminate or reduce bladder control, but latent muscle mass or psychological resistance may prevent total elimination of urinary continence. In some cases, a temporary period of therapeutic conditioning is planned to allow a patient to adjust to light incontinence management before total incontinence is induced.

Usage of devices such as the SecuStent™ to induce permanent and total urinary incontinence have been shown to be an extremely effective technique to reinforce and achieve key goals such as reduced independence, infantilised self-image, and compliance with behavioural and psychological PR therapies. Some therapy plans incorporate the implantation of a SecuStent™ device as the primary treatment to induce urinary incontinence, often on the first day of Psychoregressive treatment, in order to create an immediate dependence on incontinence management products and to reduce the illusion that a patient may return to their original lives unaltered by PR therapy. This guide’s sensory section aims to explain the sensations of incontinence for those with limited prior experience in order to support adjustment and acceptance.

How does the procedure work?

The procedure to affix a SecuStent™ device is quick, easy, and painless. After application of topical numbing agents, The SecuStent™ device is slid directly into the urethra on the end of a lubricated catheter, guided by the doctor with an ultrasound transducer. The catheter is held in place for a period of 10 minutes to allow the heat reactive bimetallic inner structure of the device to expand into place, fixing the bioadhesive gently against the mucous membranes of the sphincter and releasing topical muscle relaxants into the bladder walls. Once the device is confirmed to have affixed correctly, the catheter is slid out of the urethra. After this, the bladder will typically empty its contents onto the absorbent padding prepared beneath the patient, before slowing into a slight but constant dribble. At this point, the patient is typically taped into a high absorbency diaper and moved for post-operative checks and testing. 

In cases where the patient is uncooperative or unwilling, they may be sedated and/or physically restrained during the procedure. What will it be like to be incontinent? The sensory guide.

You may have already undergone a degree of therapeutic conditioning to weaken bladder control, induce nocturnal enuresis (bedwetting), and/or psychosomatic incontinence in reaction to specific emotional or psychological triggers. Alternatively, implantation of the SecuStent™ may be your first experience with any degree of induced incontinence. Whether you are coming from a background of total continence or light-to-medium incontinence, adjusting to total incontinence will be a big change. In order to help prepare for, adjust to and accept your new state, this section of the guide will outline the facts, feelings and sensations you can expect from total urinary incontinence and 24/7 diaper dependancy.

You will be dribbling at all times…

You will feel a constant sensation of matriculation at the end of your urethra before the wetness is absorbed by your diaper. Whenever you sit, stand, bend, lie, cough, laugh, sneeze, or exert yourself physically, you will experience a small volume of urine being squeezed from your urethra into your padding. In situations where you are un-diapered, such as during changes or washes, you will continue to dribble urine from your urethra directly onto the surface you are sat or stood above. 

… But you will be protected at all times.

It will no longer be your responsibility to manage or control your bladder or protection. Your caregiver will assume all responsibility for managing, checking, and changing your diapers. With the usage of products with sufficient capacity, can rest assured that your diapers will absorb all fluid released into them. Many report that after the initial period of adjustment to incontinence, no longer having to manage their own toileting becomes a comforting and relaxing experience: a stressor is completely removed from the patient’s life.

What does wearing diapers feel like?

If you have only ever worn light incontinence management products such as pads or pull-ups, then it may be hard to imagine the experience of wearing a heavy incontinence management product such as a diaper. Likewise, implantation of the SecuStent™ may be your first experience with any form of continence loss. For some people, adjustment to life in diapers is intimidating, difficult or embarrassing. However, Flowly™ research has shown that most patients come to accept their diapers as a positive and comforting aspect of their life within 12 to 18 months.

A diaper is taped onto the wearer by a caregiver, and feels like a bulky mass between the legs. Many describe the experience of wearing a diaper as “soft”, “poofy”, or “thick”. Within the first ten minutes of being changed into a dry diaper, the wearer may feel a slight dampness as their bladder leaks into it. While most people imagine that diapers will feel constantly wet as they absorb urine, the reality is that heavier diapers feel very dry until they near capacity. Diapers with plastic backing may produce a slight noise when a patient moves, often described as a “rustling” or “crinkling”similar to that of a plastic bag. 

As the diaper is used, it becomes warmer, thicker, heavier, bulkier, and swollen. Over time, your body may begin to ignore the sensation of urination. Signs that you are urinating include a feeling of blooming warmth against your groin. Many diapers incorporate wetness indicators in their prints to signal when it is time for a change, but many caretakers will choose to inspect the diaper physically or visually. Diaper designs range from purely medical to ones decorated with colourful patterns and characters. Once it has reached capacity, the diaper is changed at the caregiver’s discretion.

Most PR patients are discouraged from touching or adjusting their diaper in any way, and many are not allowed to ask for changes or comment on the state of their diaper. This is intended to make consciousness of the diaper as secondary as possible for the wearer, and increase the responsibility of the caregiver for checking and changing the patient. Instances of leakage may occur during the adjustment period, but it is important to remember that this is your caregiver’s responsibility and not yours. 

Diapers are often paired with supportive clothing such as plastic pants and onesies to provide structure and insulation. Please consult the Flowly™ catalogue for a full range of products available to support life with incontinence. Flowly™ security products such as tamper evident tape, locking covers, and anti-strip clothing may also assist in cases of reluctance towards diapering. For patients with penises, usage of a chastity cage can ensure optimal guidance of the urethra downwards towards the area of thickest padding, preventing the penis from slipping towards a thinner part of the diaper’s absorbent surface, as well as controlling unwanted touching.

Your mobility may change.

Due to the mass between the legs, the gait of a diaper wearer becomes noticeably wider, sometimes referred to as a “waddle”. This can be difficult to adjust to at first, but becomes normal to the patient over the course of about a month. Likewise, outings in public with your caregiver will often require access to adult changing spaces. Although the number and normalcy of adult changing spaces has increased significantly over the last ten years, there may be situations where such spaces are not available. It is the responsibility of the caregiver to plan outings with access to changing spaces, or to diaper the patient with a longer period of usage in mind.

Your bedding may change.

Although diapers can be trusted to absorb large amounts of urine, It will still be necessary to protect your bedding against leakages that may occur when a diaper is saturated overnight, squeezed by body weight, or rendered ineffective by sleeping posture. This may mean the usage of waterproof sheets, absorbent pads, or a combination thereof. For those without prior bedwetting experience, it may be difficult to fall asleep during the adjustment period to incontinence. Sedatives may be used to assist in falling and staying asleep, and humane restraints may be used to maintain optimal belly-up sleeping posture for absorbance efficiency.

Your bowel continence may be affected.

As the patient will be wearing high absorbency diapers at all times of the day, access to toilets for the purpose of bowel movements may be rarer or disallowed. The process of removing the diaper in order to sit on a toilet may also be a long and difficult process, especially for patients with diminished fine motor control. Likewise, reduced muscle tone of the pelvic floor will naturally affect a patient’s ability to support their bowels. Whether they have been conditioned to mess their diapers or not, patients may find themselves in situations where urgency requires them to make an immediate bowel movement in their diaper. This is known as functional bowel incontinence, and it is important for caregivers to be cognisant and prepared for unplanned stools alongside typical wetting.

Over time, a patient may become accustomed to and accepting of using the diaper for bowel movements instead of a typical bathroom. Caregivers may choose to encourage or adapt to this change, or to enforce scheduled bathroom sessions to discourage the necessity of bowel movements while diapered. Usage of laxatives can encourage regularity of bowel movements on a predictable schedule, and usage of internal deodorants can reduce unpleasant odours.

See the “Other treatments” section of this guide for discussion of Flowly™ products designed to enforce bowel incontinence.

Your image to yourself and others may change.

As you adjust to life as diaper dependant, you may experience feelings of embarrassment or shame. Remember that your caregiver knows what is right for you, and that SecuStent™ implantation has been decided as the best course of action. Remember that diapers are a medical tool designed to improve your life and reduce the stresses of toileting and leaking, and that you can trust their absorbency to be adequate for your needs. Although you may feel self-conscious about wearing diapers, most SecuStent™ recipients adjust to and accept their incontinent status within 12 to 18 months.

Status as a person with incontinence often increases feelings of dependance on caregivers and others, as well as reinforcing Psychoregressive conditioning, discouraging adult self-image and enforcing an irreversible physical change to the patient’s body. Likewise, knowledge that a patient requires diapers results in a 40 to 70% increase in adjusted social image and treatment by family, acquaintances and strangers alike.

You will still live a happy and healthy life.

The prospect of becoming permanently incontinent can be scary or intimidating, but know that with proper management, usage of diapers can become as secondary and normalised as usage of traditional bathrooms and underwear. Remember that varying levels of urinary incontinence are experienced by about 20% of adults worldwide, and that people with incontinence still experience a high quality of life with dignity and happiness. Social acceptance of voluntary incontinence has progressed greatly over the last ten years, being viewed as an acceptable alternative toileting method by the majority of society. Remember that after implantation, Incontinence will be inevitable, irreversible, and permanent, so the best attitude is one of adjustment and acceptance.

Can I reject the procedure? Know your rights as a PR patient.

Your caregiver was granted powers of Substituted Consent when you were registered for PR therapy, legally declaring you incapacitated and classing you as their legal dependant. When you consented to PR therapy, you waived all rights to bodily and psychological autonomy. This means that their decision is final, and rejection of the procedure is not possible. Resistance to the procedure will be met with medical sedation and physical restraint. Further Psychoregressive therapies or interventions may be necessary to improve acceptance of the treatment.

If you wish to separate from your legal caregiver, you can choose to be transferred to a PR institution, possessing the same rights to act as care provider. You can speak to any of your PR therapists about separating from your caregiver, but your status as a registered PR patient is permanent and irreversible. 

Other treatments

Flowly™ also provides SecuStent™ CR, a colorectal stent designed for the enforcement of bowel incontinence. Working in a similar way to the standard SecuStent™, the SecuStent™ CR holds the internal rectal sphincter open to allow stool to pass into the colon, forcing the wearer to eliminate the stool immediately. Your caregiver may have elected for the installation of a SecuStent™ CR during the same operation as the standard SecuStent™ installation. If this is the case, you will next be provided with a leaflet explaining details of the procedure and device. Your caregiver has already been provided with information related to the SecuStent™ CR, and you may be fitted with one in the future according to incontinence adjustment goals.

What happens next?

Once you have asked any questions you have to the practitioner responsible for the operation, you will be transferred to the operation room and the procedure will take place. Comfort objects such as blankets or stuffed animals are allowed in the operation room, and you can request general anaesthetic if you prefer to sleep through the procedure. Following the procedure, you will be transferred to a recovery room where correct bedding-in of the device will be confirmed. Patients remain at the facility overnight for physical and psychological observation before being released to their caregiver.

Say hello to your new life of diaper dependance. 

SecuStent™