I know someone who has a medical shaila about a person who wears diaper r”l because they don’t have any feeling when they have to use the bathroom (gedolim).
How should the choleh be noheg when it comes to making brachos?
The choleh only realizes in the bathroom that he is dirty because it doesn’t smell but assumes he is always dirty bec. it keeps on coming out.
You are right it sounds like a very difficult situation.
If it is indeed all the time then it is problematic, since he always has ztoah b’pi hatabas. He might consider having a ileostomy or colostomy inserted, which would permitted him to say brachos and daven.
However, if the situation is not that it is always leaking, (and most probably that is the case even though he is nervous about it) but it leaks from time to time and he doesn’t feel it, then the situation regarding this is easier. He should change his diaper right before davening etc. and then we can assume that he will still be clean for davening, etc. Since it is will then only be a safek, we can rely that tzoah bpi hataba’as that doesn’t smell is only d’rabonon, and it is a safek d’rabonon and we can be lenient. He should however check himself from time to time.
Nishmas Avrohom 1 siman 76- 9 (1,3), Shevet Hakehosi 5-27 (1), Piskei Teshuvos 76-9.