I bought these for my sister who has incontinence issues after a major stroke. She should have worn a medium, but I got her a large instead. They're still too small. Should have gotten an XL. The waist bands are starting to rip after only one use. On one pair, the leg elastic became loose. Unfortunately, they're used, so I can't return them. On the plus size, they are super absorbant, especially using the super soaker. And they do keep her skin dry. They're definitely better than disposables. They hold the urine well, which saves me money on bed underpads. I only wish I went up a size. Insert instructions could be a little more clearer. For example, what side is up? Smooth side or nappy side? And if you're using a super soaker, does it go before or after the insert? The more inserts you use, the bulkier and tighter the pull ups get. Maybe that's why they seem so tight. My advice, just try one to check for size and quality. If it suits you well, then order more. $300+ dollars is a lot for someone on SSI.