I wear medium size plastic pants in every brand except for Suprima, which run large, so a size small suffices (can't find those anymore however). In order to fit over my ConfiDry 24/7 diapers and booster pads the plastic pants need to be roomy, so there is some extra bulk and noise. Given the benefits of the plastic pants it's a reasonable trade-off. There is some variation in sizing, but it is generally negligible, with the exception of the enclosed elastic style which run snug in the leg openings for me. Tight but still wearable.
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