Large and bariatric sizes from 2XL to 5XL

Where the usual size chart stops

Most size charts are built around the middle of the range, and they work well up to XL. Above 2XL the questions change: the measurement is harder to take, the fit depends on shape as much as on circumference, and the capacity of the product weighs more heavily in the choice. Those questions are rarely answered anywhere, which is why this page exists.

A very large waist is not a mid-range waist with a bigger number printed on the bag. The body is shaped differently, the product has further to travel to meet itself, and a change often calls for more time and more help. Each of those facts changes what a good fit looks like.

This guide is written for everyone involved in that choice. The person concerned, a partner or an adult child handling the changes, a home carer, a ward nurse, a buyer comparing offers: each of you needs the same two things, a measurement you can trust and a figure you can read.

We will not tell you what the care itself should look like, because that conversation belongs with the person concerned and their care team. What we can do is be precise about measurement, about numbers, and about what we manufacture.

Two habits make the rest of this guide easier. Write the measurements down with the date beside them, and keep the test method in mind whenever you read an absorption figure. Both take a minute and save a great deal of guesswork.

Everything below comes from our own technical sheets and laboratory measurements. Where a figure is not yet published, we say so plainly rather than fill the gap.

Measuring a waist and hips properly

A size chart is only as good as the measurement you feed it. Two people measuring the same waist can easily land on two different sizes, simply because they did not measure in the same place or with the same tension. The method matters more than the tape.

Measure at the widest point, not at the belt line. On a fuller abdomen the widest circumference often sits well below the natural waist, and that is the number the chart needs. Run the tape all the way round and check that it is level at the front and at the back.

Keep the tape flat against the skin, or over a thin garment, and do not pull. A tape drawn tight gives a number that no product will match, and the fit will come out too small. You should be able to slide a finger underneath it without effort.

For someone who stays seated, measure in the position they actually spend the day in. Sitting pushes the abdomen forward and up, so a figure taken standing can read lower than the one that matters. Pass the tape behind the back at the level of the widest part, bring it round, and read it without asking the person to hold their breath or shift their weight.

For someone in bed, two pairs of hands are easier than one. Roll the person gently towards you, lay the tape flat underneath, roll them back onto it, then bring both ends together over the abdomen and read the number without lifting. Hips are measured the same way, at the fullest point over the buttocks.

Record both numbers, in centimetres or in inches as you prefer, with the date. Our size charts are published in both units, so there is nothing to convert. Measure again after any noticeable change in weight or posture, because a size that fitted last season may no longer be the right one.

Why bigger must also mean more

The instinct is to picture a large size as the same product, only wider. It is not, and it should not be. A larger body presents more surface to protect, liquid has further to spread, and in practice a change takes more time and often more than one pair of hands to carry out.

If capacity does not rise with the size, the core saturates in one place while the rest of the pad stays dry. That is one of the ways a night-time leak happens, and it is why size and absorption are one decision here rather than two.

Which brings us to the figure on the pack. What Nateen publishes is total absorption capacity, measured by the Rothwell method in a 0.9% NaCl saline solution, under ISO 11948-1. The test liquid is part of the standard, and it is not a detail: a salt solution and plain water do not load an absorbent core in the same way.

A figure obtained in water and a figure obtained in saline are not comparable, in either direction. For the same product the saline figure comes out at roughly 22% of the water figure, so a pack advertising a very large number measured in water may hold far less in use than a smaller figure stated in saline. When you compare two products, your first question should be the test liquid, not the size of the number.

Where a laboratory measurement exists, we publish it in place of the calculated value, even though it lands 3% to 5% below that calculation. A measured number that is slightly lower is worth more to you than a theoretical one that flatters us.

Two further figures are often asked about. The speed at which a product takes liquid in, and the amount that returns to the skin afterwards, are not yet published by Nateen. When they are, they will appear with their method stated beside them, exactly as the capacity figures do.

Drop ratings deserve a word of caution. Those scales are internal to each brand and do not transfer from one to another, so fewer drops on one pack can mean more millilitres than more drops on another. A number such as twelve printed on a pack may even refer to hours rather than drops, which is why a millilitre value with a stated method is the only thing worth comparing.

What changes beyond 2XL

Above 2XL several parts of an all-in-one brief have to change at once, and they change for mechanical reasons. The tabs have to be longer, so that they land on the front panel with something in reserve rather than at full stretch. A tab closed at the very end of its travel pulls on the waist, and it is the fastening most likely to let go overnight.

The leg gathers sit further out. On a wider product the inner cuffs need to follow the line where the thigh actually meets the body, not the line they would follow on a medium, or they fold inwards and channel liquid towards the edge instead of away from it.

The crotch has to be wider, and the absorbent core wider with it, so that the load spreads across the pad instead of concentrating in a single spot. It also means positioning matters more: a wide crotch pushed too far forward or too far back will bunch between the thighs.

Width brings its own compromise at the groin. A product that is too wide or too stiff for the person can rub in the fold of the groin, especially after long periods seated. If you notice rubbing or marking along that line, the fit is the first thing to look at, and it is worth mentioning to the care team.

A size that is too large leaks just as readily as one that is too small, for the opposite reason. Too small, the product cannot close, the gathers are stretched flat and the core is overloaded in one place. Too large, there is a gap: the cuffs stand away from the skin, the waist gapes, and liquid runs along the surface and out at the leg or the back before the core ever takes it.

The signs are different enough to tell apart. Leaks at the back while the person is lying down usually mean the product sits too low or too loose; leaks at the thigh while seated usually mean the cuffs are not meeting the skin. Sagging between the legs, tabs crossing far across the front panel, and a waistband you can lift away from the body all point to a size down.

When a measurement falls between two sizes, remember that our published ranges overlap: a waist between 185 and 205 cm sits inside both the 2XL and the 3XL range. Rather than guessing, judge the trial itself: the size is right when the tabs land comfortably on the front panel, the cuffs follow the groin without digging in, and nothing has to be pulled to close.

What Nateen makes in these sizes

Our range rests on three families. All-in-one briefs with tabs, the Combi range; absorbent underwear pulled on like a pair of pants, the Flexi range; and bed pads for the mattress. Anatomical shaped pads sit alongside them.

The size spans differ between families, and that difference matters above 2XL. All-in-one briefs run from XS to 5XL. Absorbent underwear runs from S to 3XL, so beyond 3XL the choice moves to a taped brief, which closes around the person and can therefore be put on without standing up.

For the largest sizes we make the Combi X-Ultra Bariatric, in 2XL, 3XL and a combined 4XL/5XL. The published capacities are laboratory measurements rather than calculations: 4300 ml at 2XL, 4486 ml at 3XL and 4500 ml at 4XL/5XL, each by the Rothwell method in 0.9% saline.

The indicative waist ranges are 170 to 205 cm at 2XL and 185 to 230 cm at 3XL. They are indicative because two bodies of the same circumference are not shaped alike; your own measurement, taken as described above, is the better guide. Every size is published in centimetres and in inches.

The range also extends in the other direction, which is worth knowing if you are buying for a household or a ward. There are intermediate sizes for young people living with a disability, who have outgrown a child's size without being shaped like an adult, and premature sizes at the smallest end of the baby range.

Packs generally hold ten pieces. In the bariatric sizes that keeps a bag manageable to carry and to store, which counts for something when the products themselves are large.

One thing we would rather say plainly: the range you can order is not identical in every market. The product page for your country shows the sizes offered there, and that page is the one to trust. If the size you need is not listed, write to us rather than ordering the nearest thing.